NC DSS-5240 2015-2026 free printable template

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North Carolina Department of Health and Human Services Division of Social Services County # Case # Date / / NORTH CAROLINA OUTCOME FAMILY SERVICES AGREEMENT I. Identifying Information Child Mother

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How to fill out NC DSS-5240

01

Obtain the NC DSS-5240 form from the North Carolina Department of Social Services website or your local DSS office.

02

Read the instructions carefully to ensure you understand what information is required.

03

Fill out the personal information section, including your name, address, and contact details.

04

Provide details related to your household members, including their names and relationships to you.

05

Fill in information regarding your income, including any wages, Social Security, or other sources of income.

06

List your household expenses, including rent/mortgage, utilities, and other necessary costs.

07

Sign and date the form at the bottom to confirm that the information provided is accurate.

08

Submit the completed form to your local DSS office, either in person or via mail.

Who needs NC DSS-5240?

01

Individuals or families in North Carolina who are seeking financial assistance, food assistance, or other support services offered by the Department of Social Services.

02

People who need to report changes in their household situation or income to maintain eligibility for assistance programs.

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What is NC DSS-5240?

NC DSS-5240 is a form used by the North Carolina Department of Health and Human Services to collect information related to financial assistance programs.

Who is required to file NC DSS-5240?

Individuals applying for or receiving benefits under various state assistance programs are required to file NC DSS-5240.

How to fill out NC DSS-5240?

To fill out NC DSS-5240, individuals must provide personal information, financial details, and information regarding household composition as per the instructions provided with the form.

What is the purpose of NC DSS-5240?

The purpose of NC DSS-5240 is to gather necessary information to determine eligibility for various financial assistance programs within North Carolina.

What information must be reported on NC DSS-5240?

The information that must be reported on NC DSS-5240 includes personal identification, household income, expense details, and any additional information relevant to the benefits applied for.

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