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(1) AGENCY CASE NO. NORTH CAROLINA DIVISION OF SOCIAL SERVICES FOSTER CARE FACILITY LICENSE ACTION REQUEST (4) NAME OF SUPERVISING AGENCY (2) CO. NO. NEW LICENSE CHANGE RELICENSE TERMINATE /REVOKE.

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How to fill out the Dss 5015 online

The Dss 5015 form is essential for initiating and managing licensing actions for foster care facilities in North Carolina. This guide will provide you with a clear, step-by-step approach to filling out the form online, ensuring that you can complete it accurately and efficiently.

Follow the steps to correctly complete the Dss 5015 online.

  1. Begin by clicking the ‘Get Form’ button to access the Dss 5015 form online.
  2. In the first section, provide the agency case number as indicated. This is crucial for tracking your application.
  3. Select the type of license action by indicating whether you are requesting a new license, change, relicense, terminate/revoke, or waiver. Choose the appropriate option that applies to your situation.
  4. Fill in the county number and name of the supervising agency, specifying whether it is a public or private agency.
  5. For the facility address, enter the complete address, including the city, state, and zip code, ensuring all details are accurate to avoid delays.
  6. Enter the social security number only if required, along with the racial and sexual demographics of the individuals associated with the facility or foster care.
  7. Indicate the training type and hours completed, specifying orientation, skills development, or specific child training as applicable.
  8. Under capacity, fill out the number of individuals you intend to care for, specifying the type of care you will provide: family foster home, group home, institution, etc.
  9. Complete sections regarding other household members over 18 and their relevant information, including their education and social security numbers, if necessary.
  10. Review the entire form for completeness and accuracy. Ensure that all fields are filled out as required for submission.
  11. Finally, save your changes, and you have the option to download, print, or share the completed Dss 5015 form.

Begin filling out the Dss 5015 online today to efficiently manage your foster care facility licensing action.

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