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
