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Adoption RSS Feed

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Adoption request[2]

switch 12/8/2007 | 0 (0) | 86 | 1 | 0 | English

ADOPT-200 Adoption Request If you are adopting more than one child, fill out an adoption request for each child. Your name(s) (adopting parent(s)): a. b. Relationship to child: Your address: Street: State: City: Zip: Your phone #:( ) I Type of adoption: (Check one) Agency (name): Independent International (name of agency): Stepparent/Domestic Partn  ... more>>

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Contact after adoption agreement[1]

switch 12/8/2007 | 0 (0) | 76 | 3 | 0 | English

Contact After Adoption Agreement Original Change ADOPT-310 Your name(s) (adopting parent(s)): a. b. Relationship to child: Your address (skip this if you have a lawyer): Street: City: State: Zip: Your phone #: ( ) Your lawyer (if you have one): (Name, address, phone #, and State Bar #): 123 Information about the child: a. Child's name (after adopti  ... more>>

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UTAH INTERSTATE COMPACT REPORT ON CHILD PLACEMENT STATUS

balazon 1/10/2008 | 0 (0) | 127 | 1 | 0 | English

DISTRIBUTION (Complete four (4) copies of this form): . Sending Agency retains a (1) copy and forwards completed original plus three (3) copies to: . Sending Compact Administrator, DCA, or alternate retains one (1) copy and forwards two (2) copies to: . Receiving Agency Compact Administrator, DCA, or alternate retains one (1) copy and fo  ... more>>

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Foster Home Inspection Safety Report

emartin74 3/21/2008 | 0 (0) | 93 | 3 | 0 | English

FOSTER HOME FIRE INSPECTION SAFETY REPORT NAME OF FOSTER HOME _________________________________ PERSON IN CHARGE _______________________________ STREET ADDRESS _______________________________________________________Phone # ____________________________ CHECK YES or NO AS TO THE CONDITIONS IN THE HOME RELATING TO THE INSPECTION 1. Does the occupant  ... more>>

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DSS Legal Pleading Form for Energy Assistance or Work Assistance

emartin74 3/21/2008 | 0 (0) | 69 | 1 | 0 | English

NORTH CAROLINA ________________COUNTY IN THE MATTER OF IN THE _______________________ COURT BEFORE THE _________________________ : : : : APPLICATION FOR APPOINTMENT OF PERSONAL REPRESENTATIVE , Director of Social Services of the County of unto the court: 1. That of and Petitioner herein, respectfully shows __________________________, North Car  ... more>>

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State of North Carolina Department of Human Resources Report of Medical Examination Requested by ...... County Department of Social Services

emartin74 3/21/2008 | 0 (0) | 91 | 1 | 0 | English

DMA -5006 (Rev. 10/91) STATE OF NORTH CAROLINA (DSS - 1653) DEPARTMENT OF HUMAN RESOURCES REPORT OF MEDICAL EXAMINATION REQUESTED BY ________________________ COUNTY DEPARTMENT OF SOCIAL SERVICES Part I. (To be filled in by county DSS) Case No. ________________________________________ Name of patient ________________________________________ Dist No  ... more>>

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Eligibility Information System, Low Income Energy System and Child Placement Information Tracking System Refund Receipt

emartin74 3/21/2008 | 0 (0) | 88 | 3 | 0 | English

FORM I.D. RECEIPT NO. p ELIGIBILITY INFORMATION SYSTEM, LOW INCOME ENERGY SYSTEM AND CHILD PLACEMENT INFORMATION TRACKING SYSTEM N.C. DEPARTMENT OF HUMAN RESOURCES - DIV. OF SOCIAL SERVICES COUNTY DEPARTMENT OF SOCIAL SERVICES CO. CASE NO. REFUND RECEIPT CO. NO. CASE I.D./LIEAP I.D. CD CASEHEAD/PAYEE NAME FIRST MI LAST JR/SR/ETC. SIS I.D. (CPfT  ... more>>

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Verification of Change in Situation

emartin74 3/21/2008 | 0 (0) | 92 | 1 | 0 | English

Verification of Change In Situation Casehead Case ID Date: County Case # Worker # Use of this form: Use this form to record changes in situation between reviews or to record changes reported on the Work First Family Assistance report. Phone In Person Mail Work First Family Assistance Report Earned Unearned Unchanged Method Of Report: Date Chang  ... more>>

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Verification of Change in Situation Spanish Form

emartin74 3/21/2008 | 0 (0) | 106 | 1 | 0 | English

Verificación de cambio en situación Fecha: Casehead (Apellido de persona registrada en el caso) ID del Caso N . caso condado o o N . trabajador Uso de este formulario: Use este formulario para registrar cambios en la situación entre revisiones o para registrar cambios comunicados en el informe de Asistencia Familiar Work First. G En persona G Co  ... more>>

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North Carolina Department of Correction Work Release Program Report on Aid Needed by Inmate's Dependent

emartin74 3/21/2008 | 0 (0) | 205 | 1 | 0 | English

DSS-1664 (11-87) Public Assistance (DSS-DC-1) N. C. DEPARTMENT OF CORRECTION Work Release Program Report on Aid Needed by Inmate's Dependent To: Administrative Officer Work Release Accounting N.C. Department of Correction 831 West Morgan Street Raleigh, North Carolina 27603 The following information is submitted in response to your request: 1. Inma  ... more>>

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Work First Family Assistance Protectnive Payee Agreement

emartin74 3/21/2008 | 0 (0) | 101 | 1 | 0 | English

Work First Family Assistance Protective Payee Agreement Date: I, agree to be a protective payee of the Work First Family Assistance payment for: Name of Casehead /Minor Parent Effective Date of Protective Payments Case ID Number County Case As protective payee for the family, I also agree to help with the following: 1. Assuring that the monthly  ... more>>

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North Carolina Department of Health and Human Services Division of Social Services Replacement Affidavit

emartin74 3/21/2008 | 0 (0) | 95 | 1 | 0 | English

NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Social Services REPLACEMENT AFFIDAVIT County: F.S. Case No.: Date of Report: Issuance Month/Year: Head of Household: Address: Reason for Report and Replacement Action: I hereby certify under penalty of perjury and/or fraud that food purchased with my food stamp benefits has been de  ... more>>

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Report of Erroneous Issuance

emartin74 3/21/2008 | 0 (0) | 103 | 1 | 0 | English

NORTH CAROLINA DIVISION OF SOCIAL SERVICES Report of Erroneous Issuance 1. NAME ADDRESS Source Code Date of Discovery County Case No. FSIS ID No. Social Security # EPICS Referral ID # Food Stamp Status ___Active ___ Inactive 2. PURPOSE a. Reason: Recipient Claim . . . . . . . . . . . .o b. Restoration of Lost Benefits . . . . . . . . . .o 3. CATEG  ... more>>

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Designation of Authorized Representative

emartin74 3/21/2008 | 0 (0) | 104 | 1 | 0 | English

North Carolina Department of Health and Human Services Division of Social Services Designation of Authorized Representative A. Applicant Consent: Please complete this section if you are the applicant. Check all boxes that apply. □ □ B. I give permission for my Authorized Representative to apply for benefits on my behalf. This person knows my circ  ... more>>

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Designation of Authorized Representative Spanish Form

emartin74 3/21/2008 | 0 (0) | 108 | 1 | 0 | English

Departamento de Salud y Servicios Humanos de Carolina del Norte División de Servicios Sociales Designación de Representante autorizado DE: DIRECCIÓN: CIUDAD: FECHA: CONDADO: CÓDIGO POSTAL: _________ A: Director, Departamento de Servicios Sociales del Condado [Atención: Programa de Estampillas para Alimentos (Food Stamp Program)] Por favor marque  ... more>>

   
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