NC DSS-5191 2014-2026 free printable template

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STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION BEFORE THE CLERK COUNTY SP AFFIDAVIT (Full name of petitioning parent 1) DISCLOSURE OF FEES & EXPENSES (Full name of

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How to fill out NC DSS-5191

01

Obtain the NC DSS-5191 form from the official website or your local DSS office.

02

Fill out the applicant's personal information including name, address, and contact information.

03

Indicate the type of assistance being requested in the appropriate section.

04

Provide information about household members, including their names, ages, and relationship to the applicant.

05

Complete the income section by detailing all sources of income for the household.

06

Fill out the expense section, listing all household expenses such as rent, utilities, and medical costs.

07

Review all information for accuracy and completeness.

08

Sign and date the form at the designated area.

09

Submit the completed NC DSS-5191 to your local DSS office either in person or by mail.

Who needs NC DSS-5191?

01

Individuals and families seeking financial assistance or support services from the North Carolina Department of Social Services.

02

Those who are applying for programs such as Food and Nutrition Services, Medicaid, or Temporary Assistance.

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What is NC DSS-5191?

NC DSS-5191 is a form used in North Carolina for reporting certain financial information to the Department of Social Services.

Who is required to file NC DSS-5191?

Individuals applying for or receiving public assistance benefits in North Carolina are required to file NC DSS-5191.

How to fill out NC DSS-5191?

To fill out NC DSS-5191, individuals should provide accurate personal information, income details, assets, and any other required financial information as indicated on the form.

What is the purpose of NC DSS-5191?

The purpose of NC DSS-5191 is to collect financial information that helps determine eligibility for public assistance programs administered by the North Carolina Department of Social Services.

What information must be reported on NC DSS-5191?

The information that must be reported on NC DSS-5191 includes personal identification details, income sources and amounts, and information about assets such as properties and bank accounts.

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