Get Dss-1688 Designation Of Authorized Representative - Info Dhhs State Nc
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How to fill out the DSS-1688 Designation Of Authorized Representative - Info Dhhs State Nc online
The DSS-1688 Designation of Authorized Representative form is essential for individuals seeking to authorize someone else to act on their behalf in obtaining food and nutrition services. This guide provides a clear and supportive approach to filling out the form online, ensuring that all required information is accurately submitted.
Follow the steps to complete the form successfully.
- Click ‘Get Form’ button to obtain the form and open it in your editor.
- Begin by filling out the Applicant Consent section if you are the applicant. Check all applicable boxes and provide your name and signature, along with the date, to indicate your permissions regarding the authorized representative.
- Next, move to the Authorized Representative Information and Consent section if you are the authorized representative. Check all applicable boxes that reflect your relationship to the applicant and your responsibilities.
- Fill in your full name, date of birth, social security number, race, sex, ethnicity, and address. Ensure that your phone number is accurate so that you can be contacted if needed.
- If applicable, provide the name of the Alcohol/Drug Treatment Center. Note that this is not necessary for SNAP applicants.
- Sign the form to certify that the information you provided is true and complete. Include the date of your signature.
- Review all sections for accuracy before moving forward. You can then save changes, download the filled form, print it out, or share it as necessary.
Complete your documents online for efficient processing.
Someone who you choose to act on your behalf with the Marketplace, like a family member or other trusted person. Some authorized representatives may have legal authority to act on your behalf.
Fill DSS-1688 Designation Of Authorized Representative - Info Dhhs State Nc
Contact Information. NC Department of Health and Human Services 2001 Mail Service Center Raleigh, NC 27699-2000. B. Authorized Representative Information and Consent: Please complete this section if you are the Authorized Representative. Check all boxes that apply. Designation of Authorized Representative. The purpose of Form DSS-1688 is to designate someone to act as an authorized representative on behalf of an individual or household. This Consolidated Agreement is made between the North Carolina Department of Health and Human.
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