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How to use or fill out DSS Form 2454 (NOV 09) qxd with our platform
- Click ‘Get Form’ to open the DSS Form 2454 in the editor.
- Begin by entering the Applicant/Recipient’s Name, Case No., and Case Name in Section I. This information is crucial for identifying the case.
- Next, provide the Fax Number and the Economic Services Worker’s Name to ensure proper communication with the county DSS.
- In Section II, select whether you are a Roomer or Boarder by checking the appropriate box. This helps clarify your relationship with the applicant/recipient.
- Fill in your payment details, including how much you pay and how often (Weekly, Biweekly, Monthly). Specify how many meals you eat per day with this household.
- Complete your Printed Name, Signature, Telephone No., and Date at the bottom of the form to validate your submission.
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