Work First Family Assistance Forms

Internet Links to Most Forms Used in the Work First Family Assistance Program: (If available the Spanish version of the form is listed)

Programs Fact Sheet

http://info.dhhs.state.nc.us/olm/forms/dss/dss-6964.pdf

Privacy Practices

English: http://info.dhhs.state.nc.us/olm/forms/dma/dma-2188.pdf
Spanish: http://info.dhhs.state.nc.us/olm/forms/dma/dma-2188sp.pdf

Right to Apply for Benefits

English: http://info.dhhs.state.nc.us/olm/forms/dma/dma-5094.pdf
Spanish: http://info.dhhs.state.nc.us/olm/forms/dma/dma-5094sp.pdf

Immigrant Access Notice

Spanish: http://info.dhhs.state.nc.us/olm/forms/dss/dss-8227s.pdf

Notice about Social Security Numbers

English: http://info.dhhs.state.nc.us/olm/forms/dma/dma-5001.pdf
Spanish: http://info.dhhs.state.nc.us/olm/forms/dma/dma-5001sp.pdf

WFFA Application Booklet

English: http://info.dhhs.state.nc.us/olm/forms/dss/dss-8228.pdf

Child Special Needs Questionnaire

English: http://info.dhhs.state.nc.us/olm/forms/dma/dma-5069.pdf
Spanish: http://info.dhhs.state.nc.us/olm/forms/dma/dma-5069sp.pdf

Mutual Responsibility Agreement Forms

http://info.dhhs.state.nc.us/olm/forms/dss/dss-6963a-ia.pdf
http://info.dhhs.state.nc.us/olm/forms/dss/dss-6963b-ia.pdf

Screening for Domestic Violence

http://info.dhhs.state.nc.us/olm/forms/dss/dss-6968.pdf

Medical Transportation Notice of Rights

http://info.dhhs.state.nc.us/olm/forms/dma/dma-5046.pdf

Wage Verification Form

English: http://info.dhhs.state.nc.us/olm/forms/dss/dss-8113.pdf
Spanish: http://info.dhhs.state.nc.us/olm/forms/dss/dss-8113sp-ia.pdf

Contribution Form

http://info.dhhs.state.nc.us/olm/forms/dss/dss-8176-ia.pdf

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