Dss 5272-2026

The document is an application form from the North Carolina Department of Health and Human Services for obtaining or renewing a Facility ID Number for mental health residential treatment facilities for children and adolescents. It outlines the necessary information required from the facility, including contact details, capacity, licensing dates, and compliance with safety regulations. Additionally, it specifies requirements for Title IV-E reimbursement eligibility and includes a section for the Executive Director to confirm compliance with personnel requirements.

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Click ‘Get Form’ to open the dss 5272 in the editor.
Begin by filling in the 'Supervising Agency or Owner' section. Enter the name, address, city, state, zip code, executive director's name and phone number, contact person's details, and ensure you provide an email address for correspondence.
Next, complete the 'Facility' section. Input the facility name, address, city, state, zip code, county, phone number, Medicaid provider number (if applicable), capacity, gender level of facility (M/F/Both), age range, and license dates.
In the 'Request' section, indicate whether you are applying for a new ID number or renewing/changing an existing one.
Answer the compliance question regarding continuous adherence to personnel requirements and criminal history checks. Ensure that all necessary documentation is attached.
Finally, have the Executive Director or designee sign and date the form before submitting it to the specified address.

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What does DSS case mean?

The Department of Social Services (DSS) is required to investigate if they receive a report that a child has been mistreated. More particularly, DSS is looking for evidence of abuse, neglect, or dependency.

What not to say in child custody court?

Disrespectful Language : Avoid using any form of disrespect, such as insults, sarcasm, or derogatory remarks about the judge, the opposing party, or even the legal system. Negative Comments About the Other Parent : Speaking poorly about the other parent can reflect badly on you. Emotional Outbursts

How do I report a DSS worker in NC?

Customers or clients may file a complaint using the NC DSS Civil Rights Complaint Form. Please fill out the form and provide a copy to the local county DSS Title VI Compliance Officer.

What is DSS custody?

When the Department of Social Services (DSS) receives a report of suspected neglect or abuse, they are required to investigate. If they determine that the child is not safe in the home, they can either take custody of the child at that time or they can create a Temporary Parental Safety Agreement with the parents.

What does DSS stand for in North Carolina?

The Department of Social Services, or DSS, is an agency in each North Carolina county that provides programs and social services including Medicaid, food and housing assistance, child care subsidies, services for seniors and disabled adults, and job search assistance.