N THIS FORM MUST BE TYPED. THE APPLICANT S IDENTIFYING INFORMATION MUST BE VERIFIED. G.S. 7B-311 authorizes the NC Department of Health and Human Services to provide information from the Responsible Individuals List (RIL) to child caring institutions, child placing agencies, group home facilities, and other providers of foster care, child care, or adoption services that need to determine the fitness of individuals to care for or adopt children. This does not include teachers or employees ot.
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How to fill out the NC DSS-5268 online
The NC DSS-5268 form is essential for requesting information from the Responsible Individuals List, which helps agencies determine the fitness of individuals for child care and adoption services. This guide provides step-by-step instructions on how to fill out the form accurately and efficiently online.
Follow the steps to complete the NC DSS-5268 online.
- Click the ‘Get Form’ button to access the NC DSS-5268 online document, allowing you to proceed with filling out the required information.
- In the applicant information section, type the applicant's first name, middle initial, and last name as they appear on official documents. Ensure that all names are verified for accuracy.
- Proceed to enter the applicant's date of birth in the format MM/DD/YYYY. Verify that the information is correct and complete.
- Input the applicant's full Social Security number in the specified format: XXX-XX-XXXX. Check that this information matches the applicant's identification.
- Select the applicant's gender from the options provided: Male, Female, or Other. Choose the option that best represents the applicant.
- If applicable, list any other names the applicant has used, such as maiden names or nicknames. This helps create a thorough identification profile.
- Fill in the requesting agency information by entering the agency's name, including the address, city, state, and zip code.
- The applicant must acknowledge the disclosure policy by providing their signature, date, and phone number. Make sure that this section is clearly filled out.
- Select the type of agency by checking the appropriate box—Child Placing Agency (Foster or Adopt), Group Home Facility, or County Child Welfare Agency.
- The agency must certify the request by typing and signing the name and title of the representative making the request. Ensure that the applicant’s details have been verified.
- Lastly, review all sections of the form for completeness and accuracy. Save the changes, and download or print the form for submission as needed.
Complete your NC DSS-5268 online today to efficiently manage your document needs.
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