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North Carolina Department of Health and Human Services Division of Social Services Consent/Authorization Form for a Clinical Assessment of Protective Parenting (CAMP) I hereby authorize___ to perform

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Obtain a copy of the dss-5401 consent form

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Read the instructions carefully to understand the information required

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Fill out the personal details such as name, date of birth, address, and contact information

04

Provide details of the purpose of the consent and the individuals or entities authorized to receive the information

05

Sign and date the form to confirm your consent

Who needs dss-5401 consent form for?

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Individuals who need to authorize the release of their personal information to specific individuals or entities

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What is dss-5401 consent form for?

The dss-5401 consent form is used to obtain consent from individuals for the collection and use of their personal information.

Who is required to file dss-5401 consent form for?

Any organization or individual that collects and uses personal information must file the dss-5401 consent form.

How to fill out dss-5401 consent form for?

The dss-5401 consent form can be filled out by providing the required information about the purpose of data collection, the type of data being collected, and obtaining the individual's consent.

What is the purpose of dss-5401 consent form for?

The purpose of the dss-5401 consent form is to ensure that individuals are aware of and agree to the collection and use of their personal information.

What information must be reported on dss-5401 consent form for?

The dss-5401 consent form must include details such as the purpose of data collection, the types of data being collected, and the consent of the individual.

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