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DSS Referral Form for Early Intervention Services (CDSA - info dhhs state nc 2026
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- Click ‘Get Form’ to open the DSS Referral Form in the editor.
- Begin by entering the 'Date of DSS Referral' and the 'Date of DSS Finding of Substantiation or In Need of Services'. This information is crucial for timely processing.
- Fill in the child's details, including 'Child’s Name', 'Date of Birth', and select their gender. Ensure accuracy as this information is vital for identification.
- Provide demographic details such as 'Race/Ethnicity' and 'Language', if other than English, to help tailor services appropriately.
- Complete the contact information fields, including address and telephone number, for both the child and parent/caretaker. If applicable, include legal guardian details.
- Answer questions regarding any known health problems or involvement with other agencies. This helps assess the child's needs comprehensively.
- Indicate whether the child has Medicaid/HealthChoice or other insurance options. This information is essential for service eligibility.
- Finally, provide any additional information that may assist the Child Developmental Service Agency (CDSA) in understanding your family's situation.
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Related links
Go to North Carolina Early Intervention website Call the number for your local CDSA or LEA and ask to make a referral. Make sure you know the full name,
(Referral must be completed and sent to Early Intervention Services within 72 hours of Substantiation or In Need of Services Finding)