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Client s Signature 10 Witness 11 Caseworker s Date 14 DSS-8650 Rev. 02/11 Economic and Family Services Telephone Number 15 INSTRUCTIONS FOR COMPLETION OF THE DSS-8650 Use this form to request verification of information at the time of application recertification or reported change. FOOD AND NUTRITION SERVICES FNS NOTICE OF INFORMATION NEEDED Name County FSIS Case ID No* FNS Worker The items listed on this form are needed to complete your Application Recertification If we don t receive this information by denied reduced or terminated* Proof of Residency Where you Live Change 5 your FNS benefits may be delayed Identity Social Security numbers or proof of application for. Citizenship Alien Status for Authorized Representative form signed by Wages Pay stubs or wage letter for for the months of Proof of Self-Employment/Farm Income and itemized receipts of expenses for the months of or Tax Form Year Odd jobs Record showing date worked who paid you date paid amount paid and work related expen....

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How to fill out the NC DSS-8650 online

The NC DSS-8650 is a vital form used for verifying information required for applications, recertifications, and reported changes for Food and Nutrition Services. This guide will provide you with clear, step-by-step instructions to effectively complete this form online.

Follow the steps to complete the NC DSS-8650 form accurately.

  1. Use the ‘Get Form’ button to access the NC DSS-8650 and open it in your online editor.
  2. Begin by entering the client name in the designated field. This ensures that the form is associated with the correct individual.
  3. Next, input the county name where the services will be utilized, followed by the county FNS case number in the specified sections to identify the application.
  4. Provide the name of the FNS worker who will oversee the case. This assists in streamlining communication.
  5. Indicate whether this request pertains to an application, recertification, or change by selecting the appropriate option.
  6. Specify the deadline for returning the required verification, allowing at least 10 calendar days for the FNS unit to respond.
  7. Check the boxes for the types of information needed. If there are specific requirements not listed, select ‘other’ and detail what is necessary.
  8. Repeat the process in step 7 for any additional information or deductions that may apply to the application.
  9. If present at the time of completing the form, the client should sign in the designated section. This confirms their acknowledgment of the request.
  10. Provide space for a witness signature if required and ensure it is dated when completed.
  11. The caseworker’s signature should be added along with the date, confirming their participation in processing the request.
  12. Lastly, provide the caseworker's telephone number to facilitate any necessary communication.
  13. Once completed, you can save your changes, download a copy, print it, or share the form as needed.

Complete your NC DSS-8650 online to ensure a smooth application process for food and nutrition services.

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