Dss 8655 of-2025

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The document is a medical examination report requested by the County Department of Social Services to assess an individual's health status and functional limitations for work or training. It includes sections for personal information, authorization for medical information release, and detailed medical evaluations by a physician regarding the individual's conditions, work capacity, and potential need for vocational rehabilitation.

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Click ‘Get Form’ to open the dss 8655 in the editor.
Begin with Part I, filling in the Dist. No., Case No., DOB, Patient Name, SSN, Address, and Date. Ensure all personal information is accurate.
In Part II, authorize the release of medical information by signing and dating where indicated. This section is crucial for allowing your physician to share necessary health details.
Proceed to Part III for the Medical Report. The physician will need to answer questions regarding any medical or psychological conditions affecting work capacity. Ensure they check 'YES' or 'NO' as applicable.
The physician should provide detailed responses for sections A through H, including diagnosis, prognosis, current medications, and any work restrictions.
Finally, ensure that the reporting physician completes their name, address, specialty, signature, and date at the end of the report.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (133 Votes)
2005	4.3 Satisfied (117 Votes)

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What is form 8655 used for?

Form 8655 can be used to authorize Reporting Agents to file certain tax returns on paper for existing clients who have already authorized the filing of magnetic/electronic Forms 941 and/or Forms 940 by the Reporting Agent.

What does the NC Department of Health and Human Services do?

The North Carolina Department of Health and Human Services manages the delivery of health and human-related services for all North Carolinians, especially our most vulnerable people children, elderly, disabled and low-income families.

What is the purpose of Form 8655?

Use this form to authorize a reporting agent to: Sign and file certain returns; Make deposits and payments for certain returns; Receive duplicate copies of tax information, notices, and other written and/or electronic communication regarding any authority granted; and.

How long are 8655 forms good for?

Once Form 8655 is signed, any authority granted is effective beginning with the period indicated on lines 15, 16, 18a, 18b, and/or 18c and continues indefinitely unless terminated or revoked by the taxpayer or reporting agent.

Can form 8655 be signed electronically?

The Reporting Agent may secure and record an electronic signature by capturing the signature of a taxpayer or authorized representative for the purpose of signing Form 8655 on an electronic stylus device in a Point of Sale (POS) environment (only).

How to check the status of form 8655?

Call the IRS at (801) 620-3852 to check the status of Form 8655 applications and for any other questions regarding the Reporting Agent application process. In approximately two weeks, reporting agents receive a mailed notification of accep- tance from the IRS and, in a separate mailing, a five-digit signature PIN.

Dss 8655 of-2025

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Dss 8655 of-2025

Here's how it works

How to use or fill out dss 8655 of with our platform

See more dss 8655 of versions

Complete this form in 5 minutes or less

Got questions?

How can I create an electronic signature in my dss8227 on Android?

What internet browser do I need to edit dss 8553 online?

What is form 8655 used for?

What does the NC Department of Health and Human Services do?

What is the purpose of Form 8655?

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People also ask

How long are 8655 forms good for?

Can form 8655 be signed electronically?

How to check the status of form 8655?

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