DSS Forms

DSS Form Downloads:

Work First Program Substance Use Information DFF form 8215

https://policies.ncdhhs.gov/divisional/social-services/forms/dss-8215-substance-use-information/@@display-file/form_file/dss-8215.pdf

Work First and Food and Nutrition Services Program Referral to Qualified Professional in Substance Use DSS form 8224 

https://policies.ncdhhs.gov/wp-content/uploads/DSS-8224-ia.pdf

Work First Program Substance Use Behavioral Indicator Check List II DSS form 5325

https://policies.ncdhhs.gov/divisional/social-services/forms/dss-5325-substance-use-behavioral-indicator-checklist-ii/@@display-file/form_file/dss-5325-ia.pdf

Consent for Release of Confidential Information DSS form 8219

https://policies.ncdhhs.gov/divisional/social-services/forms/dss-8219-consent-for-release-of-confidential-information/@@display-file/form_file/dss-8219-ia.pdf