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  1. DSS-1402: CPS Intake Report. Open Preview. File Type: pdf File Size: 428 KB Categories: Social Services Tags: ... NC Department of Health and Human Services 2001 Mail Service Center Raleigh, NC 27699-2000. Customer Service Center: 1-800-662-7030 Visit RelayNC for information about TTY services. Division of Budget and Analysis.

  2. Please refer to the Child Protective Services Structured Intake Form Instructions (DSS -1402ins) for guidance and additional information on conducting a thorough intake interview and filling out this form.

  3. pdf DSS-2435I_VI: Mẫu Tái Xác Nhận và Thông Báo Hết Hạn và Phỏng Vấn Dịch Vụ Dinh Dưỡng và Thực Phẩm (Food and Nutrition Services hay FNS) Form

  4. The Structured Intake Form is organized in such a way that the Who, What, When, Where, and How questions are answered along with eliciting information from the reporter regarding family strengths and safety factors.

  5. form pdf DSS-1464a: Statement of Assurance of Compliance with Title VI of the Civil Rights Act of 1964 for Other Agencies, Institutions, Organizations or Facilities

  6. 1. Complete a new CPS Intake in NC FAST or the Structured Intake Report tool, using a strengths-based approach with the reporter. 2. Consult the Maltreatment Screening Tool(s) that correspond to the allegations. 3. Determine the county responsible for completing the CPS Assessment. 4. Consult the Response Priority Decision Tree. 5.

  7. Reporter Information on the DSS 1402, Structured Intake Report. 3. How is the form provided to the county? The form is available on-line with other DSS forms. 4. Where does a supervisor sign? A supervisor signature is required for a screened-out report. Refer to Intake Report #22.

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