Get Dss 5027

The Dss 5027 form is essential for clients seeking social services in North Carolina. This guide provides clear instructions to help you fill out the form online efficiently and accurately.

Follow the steps to successfully complete the Dss 5027 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. In the Client Identifying Information section, enter your client ID, last name, first name, date of birth, and social security number. Ensure that all personal information is accurate.
3. Specify your county and county case number in the respective fields. Add any other relevant identifiers if applicable.
4. Move to the Service Plan section and indicate the services requested and decision made for each. Fill in the service code, requested date, and reason for termination if the service has ended.
5. In the Notice of Action Taken section, provide details about the services you are eligible to receive along with any fees associated with the services.
6. Complete the Purchase of Service section by defining the starting dates for service authorization and indicating the provider details.
7. In the Income Information section, input the types and amounts of income. Fill out the relevant details about the responsible provider.
8. In the Declaration section, read through and ensure you understand your rights regarding any discrepancies in the action taken. Add your signature along with the date.
9. Complete the Client Information section by entering details about the case manager, including their name and number. Additionally, fill in any required demographic information.
10. Review all sections for accuracy and completeness, then save your changes. Finally, download, print, or share the form as needed.

Complete your Dss 5027 form online to ensure you receive the services you need.