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A. County Information at the top of the Form (fields 1 through 4)
B. SIS Information (fields #5 through #14)
(The DSS-5095 form is separated into multiple sections)
Complete Fields #1 through #4 for every DSS-5095 submitted.
This section contains information needed to open a SIS case via the DSS-5095 form. Complete Fields #7 through #13 for an adoption assistance child who is being assigned a new SIS ID number and a DSS-5027 form has not been submitted.
To save time, the new Form DSS-5095 can be used to open both the service case in SIS and the Adoption Assistance case in CPPS.
a) When this method is selected, Adoption Assistance Services for Children (service code 010) will automatically be opened in the Service Plan portion of the SIS. A begin date for this service must be entered by the data entry staff on the DSS-5027.
b) When this method is used, it is imperative that the correct SIS Client ID is used. A name search must be conducted to determine if the child has an existing Client ID or active record (DSS-5027) in the Services Information System (SIS) before assigning a Client ID. Only after a thorough search has been conducted, and all possible matches have been ruled out, should a new Client ID be assigned using this method. Failure to conduct a name search prior to assigning a Client ID can result in multiple IDs being created for a single client.
c) A turnaround DSS-5027 will also be created to enable the worker to make SIS updates.
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office.
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