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Dss 5204-2026
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- Click ‘Get Form’ to open the dss 5204 in the editor.
- Begin by entering the Child’s Case Number at the top of the form. This is essential for tracking and reference.
- Fill in the Case Name, County Case #, and Date fields accurately to ensure proper documentation.
- In the Caregiver’s Name section, provide both names clearly. This identifies who is responsible for the child.
- For each requirement listed, indicate 'Y' for Yes or 'N' for No based on your assessment of the caregiver's capabilities and environment.
- Use the Comments/Service Delivery sections to elaborate on any specific observations or needs related to each requirement.
- Ensure that both caregivers sign and date where indicated, confirming their agreement and understanding of their responsibilities.
- Finally, have a social worker review and sign off on the document before submission to ensure compliance with agency standards.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 1998 | 4.8 Satisfied (143 Votes) |
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