NC DHHS DSS-1402 2019 free printable template
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North Carolina Department of Health and Human Services Division of Social Services Child Protective Services Structured Intake Form Section I Demographics Date Time Received by Name County Screening Decision Referred Due to Residency Assigned to County/Worker Name Referred to County Name Date/Time Confirmed with Was Safety Assessed Yes No Type of Report By Reason Abuse Neglect Dependency If referring to another county for assessment do not complete the information below Family Assessment...
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How to fill out NC DHHS DSS-1402
How to fill out NC DHHS DSS-1402
01
Gather all required personal information such as your name, address, and contact details.
02
Provide information regarding your household members, including their names and relationship to you.
03
Detail your income sources and amounts, including employment, benefits, and other financial contributions.
04
List any expenses related to housing, utilities, childcare, and other necessary costs.
05
Sign and date the form to certify that all information provided is true and accurate.
Who needs NC DHHS DSS-1402?
01
Individuals or families applying for food assistance, medical assistance, or other social services in North Carolina.
02
People who need to report changes in their financial situation or household composition.
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People Also Ask about
What is the NC definition of a caretaker?
- The following definitions apply in this section: (1) Caretaker. - A person who has the responsibility for the care of a disabled or elder adult as a result of family relationship or who has assumed the responsibility for the care of a disabled or elder adult voluntarily or by contract.
What is CPS called in North Carolina?
Child Protective Services | NCDHHS.
What is a caretaker in NC DSS?
"A person responsible for a juvenile's health and welfare" includes "a stepparent, foster parent, an adult member of the juvenile's household, an adult relative entrusted with the juvenile's care, [and] a potential adoptive parent during a visit or trial placement with a juvenile in the custody of a department .
How does CPS work in NC?
Each county's CPS receives and screens reports of suspected child abuse and neglect and seeks court action to protect children when necessary. CPS provides in-home, foster care, and adoption services as needed.
What is the difference between a caregiver and a caretaker?
A caregiver focuses on providing care and support to those in need, whether as a family member or as a certified nurse aide working with a medical team in a skilled nursing facility. Caretakers focus on maintenance, upkeep, and daily tasks.
How to fight DSS in North Carolina?
How do I file a complaint against a DSS in NC? Contact Us Toll-free within North Carolina: 1-877-5-NO-SCAM. From outside North Carolina: (919) 716-6000. En Espanol: (919) 716-0058.
How much do family members get paid for caregiving in NC?
Veteran Directed Home & Community Based Care in NC The caregiving family member will be paid the hourly rate determined by the VA, typically $8-$21 per hour.
What does being a caretaker mean?
: one that gives physical or emotional care and support. served as caretaker to the younger children. : one that takes care of the house or land of an owner who may be absent.
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What is NC DHHS DSS-1402?
NC DHHS DSS-1402 is a form used by the North Carolina Department of Health and Human Services to report certain financial and demographic information related to public assistance programs.
Who is required to file NC DHHS DSS-1402?
Individuals who are applying for or receiving benefits from public assistance programs in North Carolina are required to file the NC DHHS DSS-1402 form.
How to fill out NC DHHS DSS-1402?
To fill out the NC DHHS DSS-1402, individuals must provide personal information such as their name, address, income details, and any other required information related to their household circumstances.
What is the purpose of NC DHHS DSS-1402?
The purpose of NC DHHS DSS-1402 is to collect necessary information to determine eligibility for public assistance programs and to ensure accurate and efficient processing of applications.
What information must be reported on NC DHHS DSS-1402?
The NC DHHS DSS-1402 requires reporting of personal identification information, household income, expenses, family size, and any other relevant financial information.
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