Dss 5268-2026

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Definition and Purpose of DSS-5268

The DSS-5268 form, also known as the North Carolina Responsible Individuals List form, plays a crucial role in the assessment of individuals for positions related to child care, adoption, or foster care. This document is utilized to request information from the Responsible Individuals List (RIL) to determine an individual's suitability for roles that demand careful evaluation of character and background. The form supports agencies in ensuring the welfare and protection of children by certifying that requests for information are legitimate and in line with state laws.

How to Use the DSS-5268 Form

When using the DSS-5268 form, first ensure you have gathered essential information about the individual in question. This may include their full name, social security number, and details about the agency requesting the information. Once the form is filled out, it should be submitted to the North Carolina Department of Health and Human Services. It is important to certify that the request's purpose aligns with state regulations and that all sections of the form are accurately completed. Consider securing assistance from legal consultants if necessary, to navigate any complexities.

Obtaining the DSS-5268 Form

To obtain the DSS-5268, you should contact the North Carolina Department of Health and Human Services or visit their official website to download the form directly. Some local government offices and child welfare agencies might also provide physical copies. Make sure to access the latest version of the form to comply with any updates or changes in legislation. Additionally, check for any specific requirements or accompanying documents needed when submitting the form.

Steps to Complete the DSS-5268 Form

  1. Understand the Purpose: Clarify the reason behind submitting the form – whether for employment, volunteer positions, or other child-related services.

  2. Fill Out Personal Information: Accurately enter the details of the individual being assessed, including their full name, social security number, and date of birth.

  3. Agency Details: Provide information about the agency requesting the information, including contact details and any relevant identifiers.

  4. Certify the Request: Ensure that you complete the certification portion to declare the legitimate purpose of the request, as required by law.

  5. Review: Double-check all entries for accuracy to prevent processing delays.

  6. Submit the Form: Follow the submission guidelines, whether through mail, online submission, or in-person delivery, as specified by the state's guidelines.

Why Use the DSS-5268 Form?

The DSS-5268 form is pivotal for maintaining the safety and integrity of programs involving child care, adoption, or foster care. By vetting individuals through this form, agencies can uphold their duty of care in selecting appropriate personnel. Using this form helps ensure compliance with legal standards and enhances the trust within the community by demonstrating a commitment to thorough background checks.

Who Typically Uses the DSS-5268 Form?

Government agencies, child welfare organizations, adoption agencies, and foster care services are among the principal users of the DSS-5268 form. These entities utilize the form as part of their due diligence process in assessing potential employees or volunteers who will be in contact with children. Schools and child-related community programs may also use the form when evaluating candidates for roles that involve direct interaction with minors.

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Key Elements of the DSS-5268 Form

Several crucial components define the DSS-5268 form:

  • Individual Information: Contains fields for personal identification details.
  • Agency Information: Specifies the requesting agency and contact details.
  • Certification Section: Requires affirmation of the legal intent behind the request.
  • Submission Method: Outlines options for how the completed form can be sent and processed.

Each of these elements must be carefully considered and completed to meet the form’s objectives effectively.

Legal Use of the DSS-5268 Form

The DSS-5268 form must be used in strict adherence to North Carolina state laws. This requires agencies to ensure that requests for information aim to protect children within their care and are not used for unauthorized purposes. Legal compliance involves obtaining consent where necessary and maintaining confidentiality with the information received. Incorrect use of the form can lead to significant legal consequences and undermines the trust established between agencies and the individuals they evaluate.

State-Specific Rules for the DSS-5268 Form

North Carolina has distinct rules governing the use of the DSS-5268 form. These include specific criteria for eligibility and use, as well as unique submission protocols. Agencies must stay informed about any legislative updates or changes to ensure ongoing compliance. Familiarity with these state-specific guidelines is essential for the accurate and lawful processing of requests.

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Debbie Mauney - DSS Director - State of North Carolina | LinkedIn.
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.
Emailing us is an efficient and easy way to get the information you need promptly. If you have a request for information or would like to send general comments, please send us an email at dssweb@dhhs.nc.gov. It is our division policy to respond to all emails within five business days.
Get Help with Your Benefits For other questions, you can call the NC EBT Call Center at 1-866-719-0141 or use our contact form here. The Call Center is open from 7:30 am to 5:30 pm Monday through Friday. It is not open on weekends or holidays.
Contact Us Location. NCDHHS - Division of Social Services. Dorothea Dix Campus, McBryde Building. Mailing Address. NC Division of Social Services. 2401 Mail Service Center. Main Numbers. Phone: 919-527-6335. Fax: 919-334-1018. Child Support. 919-855-4755. Child Welfare Service Constituent Concerns Office. 919-527-6340.

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People also ask

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.
DSS Customer Connection Child Protective Services 980-31-HELPS (43577) Adult Protective Services 704-336-CARE (2273)

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