Get Dss-5104d. 5104/5104a Modification/deletion Request Form - Info Dhhs State Nc

This guide provides comprehensive, user-friendly instructions on how to complete the DSS-5104d. 5104/5104a Modification/Deletion Request Form online. Whether you are modifying or deleting a request, the process is straightforward with the right guidance.

Follow the steps to accurately complete the form.

1. Press the ‘Get Form’ button to access and open the form in your preferred editor.
2. Fill in the county field with the appropriate county name involved in the request.
3. Enter the date of the request in the designated field using the format MM/DD/YYYY.
4. Provide your name and title in the 'Name & Title of Person Submitting Request' section.
5. Complete the supervisor's name and phone number accurately to ensure proper contact.
6. Obtain the supervisor's signature to validate the request before submission.
7. Input the email address where confirmation of deletion or modification should be sent.
8. Indicate whether the deletion request applies to a 5104 or associated 5104a forms by filling out the relevant sections.
9. Select the reason for deletion from the options provided, ensuring you choose the most applicable choice.
10. For modifications, provide the form number, specify the field number that requires modification, and input both the data entered and the correct data.
11. Conclude the form by indicating the division staff performing the deletion or modification and entering the date of the modification.
12. Once all fields are completed, you can save changes, download, print, or share the form as needed.

Complete your DSS-5104d form online today for a seamless experience.