2004-2025 Form

What is the DSS Referral Form for Early Intervention Services

The DSS Referral Form for Early Intervention Services is a crucial document used within the North Carolina Department of Health and Human Services (DHHS) framework. This form facilitates the referral process for children who may need early intervention services due to developmental delays or disabilities. It serves as a formal request for evaluation and assistance, ensuring that eligible children receive the necessary support at an early age, which is vital for their development and well-being.

How to Use the DSS Referral Form for Early Intervention Services

Using the DSS Referral Form for Early Intervention Services involves several steps to ensure that the referral is processed effectively. First, individuals must gather relevant information about the child, including personal details and any observed developmental concerns. Next, the form should be filled out completely, providing accurate information to facilitate timely evaluations. Once completed, the form can be submitted to the appropriate agency, which will initiate the evaluation process. It is important to keep a copy of the submitted form for personal records.

Steps to Complete the DSS Referral Form for Early Intervention Services

Completing the DSS Referral Form for Early Intervention Services requires careful attention to detail. Follow these steps:

• Begin by entering the child's full name and date of birth.
• Provide contact information for the parent or guardian.
• Detail any specific concerns regarding the child’s development, including areas such as speech, motor skills, or social interactions.
• Include any relevant medical history or previous evaluations that may assist in the assessment process.
• Sign and date the form to validate the information provided.

Key Elements of the DSS Referral Form for Early Intervention Services

Several key elements must be included in the DSS Referral Form for Early Intervention Services to ensure it meets the necessary requirements:

• Child's personal information, including name, date of birth, and address.
• Parent or guardian's contact details.
• A description of developmental concerns that prompted the referral.
• Any previous assessments or interventions the child has received.
• Signature of the parent or guardian to authorize the referral.

Eligibility Criteria for Early Intervention Services

Eligibility for early intervention services in North Carolina typically includes children from birth to age three who demonstrate developmental delays in one or more areas. These areas may include cognitive, physical, communication, social-emotional, or adaptive development. The referral process, initiated through the DSS Referral Form, is essential for determining eligibility and accessing the appropriate services. Families are encouraged to seek assistance if they have concerns about their child's development.

Form Submission Methods

The DSS Referral Form for Early Intervention Services can be submitted through various methods to accommodate different preferences:

• Online submission through designated state portals, if available.
• Mailing the completed form to the local Department of Social Services office.
• In-person delivery at the local office to ensure immediate processing.