Get Nc Dss5027 2021-2025

The NC DSS5027 form is essential for clients seeking services through the North Carolina Division of Social Services. This guide provides a clear and comprehensive approach to completing the form online, ensuring that all necessary information is accurately captured.

Follow the steps to fill out the NC DSS5027 online efficiently.

1. Click the ‘Get Form’ button to obtain the document and open it in the online editor.
2. In Section A, begin by entering the client identifying information. Fill in the client ID, name (last, first, MI), date of birth, social security number, county, and county case number. Make sure to double-check the accuracy of this information, as it is vital for identification purposes.
3. Proceed to Section B, the service plan. Here, specify the services requested by checking the appropriate boxes. Note down any decisions made and enter the service code, requested date, termination date, and reason for any changes made to the service plan.
4. In Section C, the notice of action taken, indicate whether the services requested have been approved or denied. Provide dates for when the service will begin or any fees applicable to the services. This section also allows you to acknowledge any contributions to the cost of services.
5. Enter information in Section D regarding the purchase of service. Include the provider details, authorization status, provider ID, and funding sources. Ensure all relevant client address and phone information is clear and correct.
6. Section E focuses on income information. Record the income type and amount as accurately as possible. This section may also require details on consumer contributions and their frequency.
7. In Section F, confirm with the required signatures, including the social worker's signature. Review the declaration method and verification method to ensure compliance.
8. Finally, in Section H, provide the case manager's name, number, and any relevant special areas or legal statuses. Capture all necessary demographic information regarding race and education in their respective fields.
9. After completing the form, review all fields for accuracy. Save any changes made, and you can choose to download, print, or share the form as needed.

Complete your NC DSS5027 form online today for a seamless application experience.