NC DSS-1464A 2014-2025 free printable template
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(County) (Type of Facility) STATEMENT OF ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 FOR OTHER AGENCIES, INSTITUTIONS, ORGANIZATIONS OR FACILITIES The hereby agrees (Name
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How to fill out NC DSS-1464A
01
Obtain the NC DSS-1464A form from the North Carolina Department of Social Services website or local office.
02
Fill in the personal identification information at the top, including the applicant's name, address, and contact details.
03
Provide details about the household members, including their names, ages, and relationships to the applicant.
04
Specify the type of assistance being requested and the reason for the application.
05
List any income and assets, including employment details and financial resources.
06
Sign and date the form to certify that the information provided is true and accurate.
07
Submit the completed form either online, via mail, or in person at a local DSS office.
Who needs NC DSS-1464A?
01
Individuals or families seeking assistance from North Carolina's Department of Social Services may need to fill out NC DSS-1464A.
02
It is typically required for those applying for help with specific programs or benefits, including food assistance or financial aid.
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What is NC DSS-1464A?
NC DSS-1464A is a form used by the North Carolina Department of Social Services to report information related to income and resources for individuals seeking assistance.
Who is required to file NC DSS-1464A?
Individuals or households applying for or receiving public assistance benefits in North Carolina, including Medicaid and Food Assistance, are required to file NC DSS-1464A.
How to fill out NC DSS-1464A?
To fill out NC DSS-1464A, complete all sections of the form with accurate personal information, financial data, and relevant details regarding household composition and resources.
What is the purpose of NC DSS-1464A?
The purpose of NC DSS-1464A is to gather necessary information for determining eligibility for public assistance programs and to ensure compliance with federal and state regulations.
What information must be reported on NC DSS-1464A?
The information that must be reported on NC DSS-1464A includes personal identification details, income sources, asset information, household size, and any other relevant financial information.
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