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Fields 33-40 have information pertaining to the perpetrator. The DSS-5104 paper form has space for 2 perpetrators. DO NOT enter more than one DSS-5104 form number for multiple perpetrators. Codes beginning with one 1 indicate female. Once the DSS-5104 paper form has been completed and sent to data entry the information is then entered into the Central Registry. D. TURNAROUNDS For each DSS-5104 keyed and processed in the nightly update a DSS-5104 ...

How to fill out dss 5104 form

1. To fill out the 5104 NC DSS form, you will need to gather all the required information and documents beforehand. This may include personal identification details, financial records, and any supporting documentation related to your specific situation.
2. Begin by carefully reading the instructions provided on the form. Make sure you understand the purpose of the form and the information it requires.
3. Fill out the form accurately and legibly. Use black or blue ink and avoid making unnecessary markings or corrections.
4. Start with the basic information section, which typically includes details such as your name, address, contact information, and social security number. Follow the specified format and provide the information requested.
5. Depending on the purpose of the form, there may be sections pertaining to your income, assets, expenses, employment, or household composition. Provide the necessary details in these sections, ensuring you accurately report your financial situation or any other relevant information.
6. Attach any required documentation to support the information provided in the form. This may include pay stubs, bank statements, medical records, or any other relevant paperwork. Make sure to follow the instructions regarding document submission.
7. Review the completed form thoroughly before submitting it. Double-check for any errors or missing information. If possible, have someone else review it as well to ensure accuracy.
8. Sign and date the form as required. In some cases, you may need to have the form notarized or witnessed by a designated individual. Follow the instructions provided on the form to fulfill this requirement.

Who needs 5104 NC DSS form?

1. The 5104 NC DSS form may be required by individuals or households seeking various social services or assistance programs in North Carolina, such as Medicaid, Food and Nutrition Services (FNS), or Temporary Assistance for Needy Families (TANF).
2. Eligibility for these programs often depends on the applicant's financial situation and other qualifying criteria. The 5104 NC DSS form helps gather the required information to determine eligibility and assess the level of assistance needed.
3. Different social service agencies, government departments, or community organizations in North Carolina may require the completion of the 5104 NC DSS form to process applications or provide assistance. It is essential to consult the specific agency or program guidelines to determine if this form is necessary.

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What is dss 5104?

DSS 5104 is a specific form used by certain agencies for reporting purposes, typically related to financial assessments or social services.

Who is required to file dss 5104?

Individuals or organizations that meet certain criteria set by the governing agency, usually related to eligibility for benefits or services, are required to file DSS 5104.

How to fill out dss 5104?

To fill out DSS 5104, follow the provided instructions carefully, ensuring all required fields are completed accurately and supporting documents are attached as needed.

What is the purpose of dss 5104?

The purpose of DSS 5104 is to collect necessary information for assessing eligibility for various programs or benefits managed by the agency.

What information must be reported on dss 5104?

The information required on DSS 5104 typically includes personal identification details, financial information, and any other data relevant to the application or reporting process.