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NCDHHS Policies and Manuals
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Divisional N-Z
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Services for the Blind
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SB Forms
SB Forms
Title
Categories
Type
Format
Size
Link
DSB Forms Guide (October 2019)
Services for the Blind
Form
xlsx
24 KB
Open
Preview
Criminal Record Check Consent Form (DHR-ESB-3004)
Services for the Blind
Form
pdf
83 KB
Open
Preview
Criminal Record Check Transmittal Form (DHR-ESB-3001)
Services for the Blind
Form
pdf
94 KB
Open
Preview
Employee Incident Report
Services for the Blind
Form
pdf
89 KB
Open
Preview
Supervisor Incident Report
Services for the Blind
Form
pdf
197 KB
Open
Preview
Witness Incident Report
Services for the Blind
Form
pdf
55 KB
Open
Preview
dsb-4046-instructions: DSB/DSB Outreach Report Instructions
Services for the Blind
Form
pdf
110 KB
Open
Preview
dsb-4046-ia: DSB/DSB Outreach Report
Services for the Blind
Form
pdf
1 MB
Open
Preview
dhhs-1000-DSB-instructions: DSB/Authorization to Disclose Health Information Instructions
Services for the Blind
Form
pdf
148 KB
Open
Preview
dhhs-1000-ia: DSB Authorization to Disclose Health Information
Services for the Blind
Form
pdf
382 KB
Open
Preview
dhhs-1000-sp-ia: DSB/Authorization to Disclose Health Information-Spanish
Services for the Blind
Form
pdf
392 KB
Open
Preview
dhhs-3531 dsb-0910-ia: Conference Authorization
Services for the Blind
Form
pdf
556 KB
Open
Preview
dsb-0197-ILR-ia: ILR Request for Residence Modification
Services for the Blind
Form
pdf
345 KB
Open
Preview
dsb-0197-ILR-instructions: ILR/Request for Residence Modification Instructions
Services for the Blind
Form
pdf
136 KB
Open
Preview
dsb-0311: DSB/Employee Administration Request Form
Services for the Blind
Form
pdf
75 KB
Open
Preview
dsb-0502-ia: DSB/Travel Authorization and Training Registration
Services for the Blind
Form
pdf
579 KB
Open
Preview
dsb-0502-instructions: DSB/Travel Authorization and Training Registration Instructions
Services for the Blind
Form
pdf
156 KB
Open
Preview
dsb-0503-ia: DSB/Driver Service Billing Form
Services for the Blind
Form
pdf
353 KB
Open
Preview
dsb-0511: DSB/Pharmacy Claim Form
Services for the Blind
Form
pdf
571 KB
Open
Preview
dsb-0511-instructions: DSB/Pharmacy Claim Form Instructions
Services for the Blind
Form
pdf
135 KB
Open
Preview
dsb-0525-DSB-instructions: DSB/DSB Accounts Receivable/Refund Instructions
Services for the Blind
Form
pdf
133 KB
Open
Preview
dsb-0525-ia: DSB/DSB Accounts Receivable/Refund
Services for the Blind
Form
pdf
301 KB
Open
Preview
dsb-0612-ia: DSB/Staff Approved to Authorize Services, Approve Authorizations, and/or Approved Invoices
Services for the Blind
Form
pdf
509 KB
Open
Preview
dsb-0613-VR-ia: VR/Assignment of Reimbursement
Services for the Blind
Form
pdf
319 KB
Open
Preview
dsb-0613-VR-instructions: VR/Assignment of Reimbursement Instructions
Services for the Blind
Form
pdf
155 KB
Open
Preview
dsb-0950-ia: DSB/Verification of Items Received
Services for the Blind
Form
pdf
322 KB
Open
Preview
dsb-0950-ia-instructions: DSB/Verification of Items Received Instructions
Services for the Blind
Form
pdf
122 KB
Open
Preview
dsb-1010-ia: Blind Registry/Registrant Data Form
Services for the Blind
Form
pdf
1,005 KB
Open
Preview
dsb-2001-ia: MED.EYE/Application for Eye Care Certification
Services for the Blind
Form
pdf
766 KB
Open
Preview
dsb-2001-instructions: MED.EYE/Application for Eye Care Certification Instructions
Services for the Blind
Form
pdf
113 KB
Open
Preview
dsb-2007-ia: DSB/Evaluation with Video Magnification (Closed Circuit Television)
Services for the Blind
Form
pdf
376 KB
Open
Preview
dsb-2007-instructions DSB/Evaluation with Video Magnification (Closed Circuit Television) Instructions
Services for the Blind
Form
pdf
146 KB
Open
Preview
dsb-2031-ia: MED.EYE/Letter to Accompany Mailed Application
Services for the Blind
Form
pdf
323 KB
Open
Preview
dsb-2032-ia: MED.EYE/Notification of Need for Additional Information
Services for the Blind
Form
pdf
322 KB
Open
Preview
dsb-2032-instructions: MED.EYE/Notification of Need for Additional Information Instructions
Services for the Blind
Form
pdf
112 KB
Open
Preview
dsb-2033-ia: MED.EYE/Notification of Eligibility Status
Services for the Blind
Form
pdf
338 KB
Open
Preview
DSB/Report of Eye Examination Instructions
Services for the Blind
Form
pdf
132 KB
Open
Preview
dsb-2033-instructions: MED.EYE/Notification of Eligibility Status Instructions
Services for the Blind
Form
pdf
129 KB
Open
Preview
dsb-2202-ia: DSB/Report of Eye Examination
Services for the Blind
Form
pdf
542 KB
Open
Preview
dsb-2205-A-ia: DSB/Referral for Low Vision Evaluation
Services for the Blind
Form
pdf
339 KB
Open
Preview
dsb-2205-A-instructions: DSB/Referral for Low Vision Evaluation Instructions
Services for the Blind
Form
pdf
150 KB
Open
Preview
dsb-2205-B-ia: DSB/Report on Low Vision Evaluation
Services for the Blind
Form
pdf
305 KB
Open
Preview
dsb-2207-ia; MED.EYE/Vision Screening List
Services for the Blind
Form
pdf
385 KB
Open
Preview
dsb-2207-instructions: MED.EYE/Vision Screening List Instructions
Services for the Blind
Form
pdf
112 KB
Open
Preview
dsb-2218-ia: MED.EYE/Permission Form for Vision Screening at Day Care
Services for the Blind
Form
pdf
312 KB
Open
Preview
dsb-2218-instructions: MED.EYE/Permission Form for Vision Screening at Day Care Instructions
Services for the Blind
Form
pdf
109 KB
Open
Preview
dsb-2220-ia: MED.EYE/Report to Parents of Child Screened at Day Care
Services for the Blind
Form
pdf
317 KB
Open
Preview
dsb-2220-instructions: MED.EYE/Report to Parents of Child Screened at Day Care Instructions
Services for the Blind
Form
pdf
116 KB
Open
Preview
dsb-4002-AT-ILR-ia: ILR/Referral for Assistive Technology Services
Services for the Blind
Form
pdf
397 KB
Open
Preview
dsb-4002-AT-ILR-instructions: ILR/Referral for Assistive Technology Services Instructions
Services for the Blind
Form
pdf
124 KB
Open
Preview
dsb-4002at-VR-ia: VR/Referral for Assistive Technology Services
Services for the Blind
Form
pdf
408 KB
Open
Preview
dsb-4002at-VR-instructions: VR/Referral for Assistive Technology Services Instructions
Services for the Blind
Form
pdf
132 KB
Open
Preview
dsb-4002-ILR-ia: ILR/Referral Form
Services for the Blind
Form
pdf
325 KB
Open
Preview
dsb-4002-ILR-instructions ILR/Referral Form Instructions
Services for the Blind
Form
pdf
130 KB
Open
Preview
dsb-4002-VR-ia VR Referral Form
Services for the Blind
Form
pdf
330 KB
Open
Preview
dsb-4004b-ILR-ia: ILR/Independent Living Rehabilitation Agreement of Understanding with Applicant for Services
Services for the Blind
Form
pdf
330 KB
Open
Preview
dsb-4004b-ILR-instructions: ILR/Independent Living Rehabilitation Agreement of Understanding with Applicant for Services Instructions
Services for the Blind
Form
pdf
105 KB
Open
Preview
dsb-4004-ILR-ia: ILR/Independent Living Rehabilitation Application
Services for the Blind
Form
pdf
634 KB
Open
Preview
dsb-4004-ILR-instructions: ILR/Independent Living Rehabilitation Application Instructions
Services for the Blind
Form
pdf
157 KB
Open
Preview
dsb-4004-VR-ia: VR/Rehabilitation Application
Services for the Blind
Form
pdf
493 KB
Open
Preview
dsb-4004-VR-instructions: VR/Rehabilitation Application Instructions
Services for the Blind
Form
pdf
211 KB
Open
Preview
dsb-4005a-handbook-VR: VR/Vocational Rehabilitation Handbook
Services for the Blind
Form
pdf
81 KB
Open
Preview
dsb-4005a-ILR: ILR/Independent Living Plan
Services for the Blind
Form
pdf
111 KB
Open
Preview
dsb-4005a-VR-ia: VR/Agreement of Understanding with Applicant for Services
Services for the Blind
Form
pdf
323 KB
Open
Preview
dsb-4005a-VR-instructions: VR/Agreement of Understanding with Applicant for Services Instructions
Services for the Blind
Form
pdf
119 KB
Open
Preview
dsb-4005b-cont-VR-ia: VR/Individualized Plan for Employment (Continuation Page-Services)
Services for the Blind
Form
pdf
333 KB
Open
Preview
dsb-4005b-cont-VR-instruction: VR/Individualized Plan for Employment (Continuation Page-Services) Instructions
Services for the Blind
Form
pdf
125 KB
Open
Preview
dsb-4005b-ILR-ia: ILR/Independent Living Plan
Services for the Blind
Form
pdf
335 KB
Open
Preview
dsb-4005b-ILR-instructions: ILR/Independent Living Plan Instructions
Services for the Blind
Form
pdf
120 KB
Open
Preview
dsb-4005b-VR-ia: VR/Individualized Plan for Employment
Services for the Blind
Form
pdf
353 KB
Open
Preview
dsb-4005b-VR-instructions: VR/Individualized Plan for Employment Instructions
Services for the Blind
Form
pdf
165 KB
Open
Preview
dsb-4005c-ILR-ia: ILR/Independent Living Plan Continuation Page
Services for the Blind
Form
pdf
319 KB
Open
Preview
dsb-4005c-ILR-instructions: ILR/Independent Living Plan Continuation Page Instructions
Services for the Blind
Form
pdf
112 KB
Open
Preview
dsb-4005c-VR-ia: VR/Individualized Plan for Employment Closure Amendment
Services for the Blind
Form
pdf
336 KB
Open
Preview
dsb-4005c-VR-instructions: VR/Individualized Plan for Employment Closure Amendment Instructions
Services for the Blind
Form
pdf
166 KB
Open
Preview
dsb-4005d-ILR-ia: ILR/Independent Living Plan Amendment
Services for the Blind
Form
pdf
326 KB
Open
Preview
dsb-4005d-ILR-instructions: ILR/Independent Living Plan Amendment Instructions
Services for the Blind
Form
pdf
150 KB
Open
Preview
dsb-4005d-VR-ia: VR/Individualized Plan for Employment Amendment
Services for the Blind
Form
pdf
340 KB
Open
Preview
dsb-4005d-VR-instructions: VR/Individualized Plan for Employment Amendment Instructions
Services for the Blind
Form
pdf
162 KB
Open
Preview
dsb-4005e: DSB/Code of Conduct
Services for the Blind
Form
pdf
217 KB
Open
Preview
dsb-4005-ILR-ia: ILR/Independent Living Closure Amendment
Services for the Blind
Form
pdf
331 KB
Open
Preview
dsb-4005-ILR-instructions: ILR/Independent Living Closure Amendment Instructions
Services for the Blind
Form
pdf
121 KB
Open
Preview
dsb-4008sub-VR-AW: VR/Waiver for Documenting Refusal of Services Required of Section 511 (25+ Years Old)
Services for the Blind
Form
docx
109 KB
Open
Preview
dsb-4008sub-VR-C: VR/Certificate of Completion
Services for the Blind
Form
docx
108 KB
Open
Preview
dsb-4008sub-VR-DOC: VR/Record of Transition & PETS Services Received
Services for the Blind
Form
docx
113 KB
Open
Preview
dsb-4008sub-VR-IR: VR/Information and Referral Services Report
Services for the Blind
Form
docx
107 KB
Open
Preview
dsb-4008sub-VR-YW: VR/Waiver for Documenting Refusal of Services Required of Section 511 (Youth Age 14-24)
Services for the Blind
Form
docx
109 KB
Open
Preview
dsb-4009ojt-m-VR-ia: VR/Modified On-The-Job Training Agreement
Services for the Blind
Form
pdf
333 KB
Open
Preview
dsb-4009ojt-m-VR-instructions: VR/Modified On-The-Job Training Agreement Instructions
Services for the Blind
Form
pdf
161 KB
Open
Preview
dsb-4009ojt-VR-ia: VR/On-The-Job Training Agreement Instructions
Services for the Blind
Form
pdf
160 KB
Open
Preview
dsb-4009ojt-pr-VR-ia: VR/On-The-Job Training (OJT) Progress Report
Services for the Blind
Form
pdf
333 KB
Open
Preview
dsb-4009ojt-pr-VR-instructions VR/On-The-Job Training (OJT) Progress Report Instructions
Services for the Blind
Form
pdf
128 KB
Open
Preview
dsb-4009ojt-VR-ia: VR/On-The-Job Training Agreement
Services for the Blind
Form
pdf
333 KB
Open
Preview
dsb-4009ojt-wrap-VR-ia: VR/On-The-Job Training Agreement Wage Reimbursement for Advanced Placement
Services for the Blind
Form
pdf
332 KB
Open
Preview
dsb-4009ojt-wrap-VR-instructions: VR/On-The-Job Training Agreement Wage Reimbursement for Advanced Placement Instructions
Services for the Blind
Form
pdf
163 KB
Open
Preview
dsb-4009wcc-a-VR-ia: VR/Request for Workers’ Compensation Coverage
Services for the Blind
Form
pdf
323 KB
Open
Preview
dsb-4009wcc-a-VR-instructions: VR/Request for Workers’ Compensation Coverage Instructions
Services for the Blind
Form
pdf
126 KB
Open
Preview
dsb-4009wcc-b-VR-ia: VR/Rehabilitation Individual Report of Injury
Services for the Blind
Form
pdf
318 KB
Open
Preview
dsb-4009wcc-b-VR-instructions: VR/Rehabilitation Individual Report of Injury Instructions
Services for the Blind
Form
pdf
125 KB
Open
Preview
dsb-4009wcc-c-VR-ia: VR/Rehabilitation Individual Incident Investigation Report
Services for the Blind
Form
pdf
331 KB
Open
Preview
dsb-4009wcc-c-VR-instructions: VR/Rehabilitation Individual Incident Investigation Report Instructions
Services for the Blind
Form
pdf
134 KB
Open
Preview
dsb-4009wcc-d-VR-ia: VR/Rehabilitation Individual Workers’ Compensation Medical Authorization
Services for the Blind
Form
pdf
355 KB
Open
Preview
dsb-4009wcc-d-VR-instructions: VR/Rehabilitation Individual Workers’ Compensation Medical Authorization Instructions
Services for the Blind
Form
pdf
99 KB
Open
Preview
dsb-4009wop-VR-ia: VR/Agreement for Work Experience without Pay
Services for the Blind
Form
pdf
355 KB
Open
Preview
dsb-4009wop-VR-instructions: VR/Agreement for Work Experience without Pay Instructions
Services for the Blind
Form
pdf
154 KB
Open
Preview
dsb-4011-ILR-ia: ILR/Case Progress Notes
Services for the Blind
Form
pdf
300 KB
Open
Preview
dsb-4011-ILR-instructions: ILR/Case Progress Notes Instructions
Services for the Blind
Form
pdf
121 KB
Open
Preview
dsb-4011-VR-ia: VR/Case Progress Notes
Services for the Blind
Form
pdf
300 KB
Open
Preview
dsb-4011-VR-instructions: VR/Case Progress Notes Instructions
Services for the Blind
Form
pdf
124 KB
Open
Preview
dsb-4016a-ILR-ia: ILR/Equipment and Computer Use Agreement
Services for the Blind
Form
pdf
344 KB
Open
Preview
dsb-4016a-ILR-instructions: ILR/Equipment and Computer Use Agreement Instructions
Services for the Blind
Form
pdf
141 KB
Open
Preview
dsb-4016-ia: DSB/Equipment and Computer Use Agreement
Services for the Blind
Form
pdf
353 KB
Open
Preview
dsb-4016-instructions: DSB/Equipment and Computer Use Agreement Instructions
Services for the Blind
Form
pdf
155 KB
Open
Preview
dsb-4017-ILR-ia: ILR/Authorization to Disclose Independent Living Rehabilitation Information
Services for the Blind
Form
pdf
552 KB
Open
Preview
dsb-4017-ILR-instructions: ILR/Authorization to Disclose Independent Living Rehabilitation Information Instructions
Services for the Blind
Form
pdf
123 KB
Open
Preview
dsb-4017-VR-ia: VR/Authorization to Disclose Vocational Rehabilitation Information
Services for the Blind
Form
pdf
355 KB
Open
Preview
dsb-4017-VR-instructions: VR/Authorization to Disclose Vocational Rehabilitation Information Instructions
Services for the Blind
Form
pdf
124 KB
Open
Preview
dsb-4020-ia: DSB/Pharmacy Agreement
Services for the Blind
Form
pdf
336 KB
Open
Preview
dsb-4033a-ILR-ia: ILR/ILOB Travel Reimbursement for Mini Center Instructors
Services for the Blind
Form
pdf
960 KB
Open
Preview
dsb-4033a-ILR-instructions: ILR/ILOB Travel Reimbursement for Mini Center Instructors Instructions
Services for the Blind
Form
pdf
921 KB
Open
Preview
dsb-4033b-ILR-ia: ILR/Billing for Mini Center Instructors
Services for the Blind
Form
pdf
985 KB
Open
Preview
dsb-4033b-ILR-instructions: ILR/Billing For Mini Center Instructors Instructions
Services for the Blind
Form
pdf
115 KB
Open
Preview
dsb-4033-VR-ia: VR/Billing for Reader Service
Services for the Blind
Form
pdf
543 KB
Open
Preview
dsb-4033-VR-instructions: VR/Billing for Reader Service Instructions
Services for the Blind
Form
pdf
128 KB
Open
Preview
dsb-4040-ia: VR/ILR Financial Needs Survey
Services for the Blind
Form
pdf
600 KB
Open
Preview
dsb-4040-instructions: VR/ILR Financial Needs Survey Instructions
Services for the Blind
Form
pdf
183 KB
Open
Preview
dsb-4041-VR-ia: VR/Extension of Time to Determine Eligibility
Services for the Blind
Form
pdf
316 KB
Open
Preview
dsb-4041-VR-instructions: VR/Extension of Time to Determine Eligibility Instructions
Services for the Blind
Form
pdf
126 KB
Open
Preview
dsb-4042-ILR-ia: ILR/Authorization to Photograph/Use Photograph/Interview
Services for the Blind
Form
pdf
333 KB
Open
Preview
dsb-4042-ILR-instructions: ILR/Authorization to Photograph/Use Photograph/Interview Instructions
Services for the Blind
Form
pdf
153 KB
Open
Preview
dsb-4042-VR-ia: VR/Authorization to Photograph/Use Photograph/Interview
Services for the Blind
Form
pdf
343 KB
Open
Preview
dsb-4042-VR-instructions: VR/Authorization to Photograph/Use Photograph/Interview Instructions
Services for the Blind
Form
pdf
119 KB
Open
Preview
dsb-4043-ia: ILS/Mini-Center Mobility Report
Services for the Blind
Form
pdf
351 KB
Open
Preview
dsb-4044-VR-ia: VR/Deaf Blind Assessment
Services for the Blind
Form
pdf
873 KB
Open
Preview
dsb-4044-VR-instructions: VR/Deaf Blind Assessment Instructions
Services for the Blind
Form
pdf
156 KB
Open
Preview
dsb-4045-ILR-ia: ILR/Health Check List
Services for the Blind
Form
pdf
449 KB
Open
Preview
dsb-4045-ILR-instructions: ILR/Health Check List Instructions
Services for the Blind
Form
pdf
138 KB
Open
Preview
dsb-4045-VR-ia: VR/Health Check List
Services for the Blind
Form
pdf
452 KB
Open
Preview
dsb-4045-VR-instructions: VR/Health Check List Instructions
Services for the Blind
Form
pdf
141 KB
Open
Preview
dsb-4047a-VR-ia: VR/Low Vision Eye Doctor Evaluation Report Addendum
Services for the Blind
Form
pdf
294 KB
Open
Preview
dsb-4047-VR-ia: VR/Low Vision Eye Doctor Evaluation Report
Services for the Blind
Form
pdf
410 KB
Open
Preview
dsb-4048b-ia: DSB/Agreement to Purchase Bioptics for Non-Driving Purposes
Services for the Blind
Form
pdf
515 KB
Open
Preview
dsb-4048-ia: DSB/Hearing Aid Agreement
Services for the Blind
Form
pdf
362 KB
Open
Preview
dsb-4048-instructions: DSB/Hearing Aid Agreement Instructions
Services for the Blind
Form
pdf
336 KB
Open
Preview
dsb-4049-ILR-ia: ILR/Independent Living Rehabilitation Counselor II Evaluation
Services for the Blind
Form
pdf
654 KB
Open
Preview
dsb-4049-VR-ia: VR/Vocational Rehabilitation Counselor II Evaluation
Services for the Blind
Form
pdf
654 KB
Open
Preview
dsb-4050-ILR-ia: ILR/Mini Center Narrative
Services for the Blind
Form
pdf
323 KB
Open
Preview
dsb-4050-ILR-instructions: ILR/Mini Center Narrative Instructions
Services for the Blind
Form
pdf
111 KB
Open
Preview
dsb-4051-ILR-ia: ILR/Independent Living Mini Center Survey
Services for the Blind
Form
pdf
335 KB
Open
Preview
dsb-4051-ILR-instructions: ILR/Independent Living Mini Center Survey Instructions
Services for the Blind
Form
pdf
111 KB
Open
Preview
dsb-4052-ILR-ia: ILR/Mini Center Instructor Evaluation Form
Services for the Blind
Form
pdf
383 KB
Open
Preview
dsb-4052-ILR-instructions: ILR/Mini Center Instructor Evaluation Form Instructions
Services for the Blind
Form
pdf
113 KB
Open
Preview
dsb-4054-ILR-ia: ILR/ILR Administrative P-Card Purchase Justification
Services for the Blind
Form
pdf
329 KB
Open
Preview
dsb-4054-ILR-instructions: ILR/ILR Administrative P-Card Purchase Justification Instructions
Services for the Blind
Form
pdf
110 KB
Open
Preview
dsb-4056-VR-ia: VR/Transition Technology Loan Agreement
Services for the Blind
Form
pdf
328 KB
Open
Preview
dsb-4056-VR-instructions: VR/Transition Technology Loan Agreement Instructions
Services for the Blind
Form
pdf
165 KB
Open
Preview
dsb-4057-ILR-ia: ILR/Mini Center Instructor Application
Services for the Blind
Form
pdf
94 KB
Open
Preview
dsb-4058-VR-ia: VR/Transportation Services
Services for the Blind
Form
pdf
360 KB
Open
Preview
dsb-4058-VR-instructions: VR/Transportation Services Instructions
Services for the Blind
Form
pdf
131 KB
Open
Preview
dsb-5056-BE-ia: BE/Training Evaluation
Services for the Blind
Form
pdf
203 KB
Open
Preview
dsb-5056-BE-instructions: BE/Training Evaluation Instructions
Services for the Blind
Form
pdf
98 KB
Open
Preview
dsb-5057-BE-ia: BE/On-The-Job Training Checklist for Levels I & II
Services for the Blind
Form
pdf
408 KB
Open
Preview
dsb-5057-BE-instructions: BE/On-The-Job Training Checklist for Levels I & II Instructions
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pdf
118 KB
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dsb-5058-BE: BE/On-The-Job Training Guide For Levels I & II
Services for the Blind
Form
pdf
130 KB
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dsb-5064-BE-ia: BE/On-The-Job Training Agreement
Services for the Blind
Form
pdf
326 KB
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dsb-5064-BE-instructions: BE/On-The-Job Training Agreement Instructions
Services for the Blind
Form
pdf
97 KB
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dsb-5065-BE-ia: BE/On-The-Job Trainer Invoice
Services for the Blind
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pdf
160 KB
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dsb-5065-BE-instructions: BE/On-The-Job Trainer Invoice Instructions
Services for the Blind
Form
pdf
99 KB
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dsb-7001-ia: ILS/Independent Living Services Program Application
Services for the Blind
Form
pdf
389 KB
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dsb-7080-ia: ILS/Cane Request Form
Services for the Blind
Form
pdf
362 KB
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dsb-7103-B-ia: ILS/Orientation and Mobility Service Plan
Services for the Blind
Form
pdf
560 KB
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dsb-7103-ia: ILS/Independent Living Services Program Assessment and Plan
Services for the Blind
Form
pdf
435 KB
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dsb-7103-instructions: ILS/Independent Living Services Program Assessment and Plan Instructions
Services for the Blind
Form
pdf
139 KB
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dsb-7108-ia: ILS/Agreement for In-Home Aide Services: Level I- Home Management
Services for the Blind
Form
pdf
354 KB
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dsb-7219-ia: ILS & MED.EYE/Application for Conference
Services for the Blind
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pdf
307 KB
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dsb-7219-instructions: ILS & MED.EYE/Application for Conference Instructions
Services for the Blind
Form
pdf
115 KB
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dsb-7222: SAB/dsb-7222
Services for the Blind
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pdf
38 KB
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dsb-7223: SAB/dsb-7223
Services for the Blind
Form
pdf
39 KB
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dsb-7224: SAB/dsb-7224
Services for the Blind
Form
pdf
39 KB
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dsb-7225: SAB/dsb-7225
Services for the Blind
Form
pdf
34 KB
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dsb-7309-ia: ILS/Time Log for In-Home Service (Level I-Home Management)
Services for the Blind
Form
pdf
379 KB
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dsb-7311-ia: ILS/Training Record for In-Home Aide (Level I-Home Management)
Services for the Blind
Form
pdf
332 KB
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dsb-7399-ia: ILS/Forms Request
Services for the Blind
Form
pdf
330 KB
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dsb-7401-ILR-ia: ILR/Independent Living Eligibility Certification
Services for the Blind
Form
pdf
331 KB
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dsb-7401-ILR-instructions: ILR/Independent Living Eligibility Certification Instructions
Services for the Blind
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pdf
119 KB
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dsb-7402-ILR-ia: ILR/Independent Living Plan Waiver
Services for the Blind
Form
pdf
306 KB
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dsb-7402-ILR-instructions: ILR/Independent Living Plan Waiver Instructions
Services for the Blind
Form
pdf
114 KB
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dsb-7403-VR-ia: VR/Internship/Traineeship Agreement
Services for the Blind
Form
pdf
340 KB
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dsb-7403-VR-instructions: VR/Internship/Traineeship Agreement Instructions
Services for the Blind
Form
pdf
168 KB
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dsb-7404-ia: ILS/Notice: White Support Cane
Services for the Blind
Form
pdf
106 KB
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dsb-7405-ia: DSB/Confidentiality Statement for Drivers
Services for the Blind
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pdf
301 KB
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dsb-7406-ia: DSB/Code of Conduct Violation Incident Report
Services for the Blind
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pdf
299 KB
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dsb-7407-ia: DSB/Code of Conduct Violation Investigation Report
Services for the Blind
Form
pdf
319 KB
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dsb-DrivingRecordStatus-ia: DSB/Driving Record Status Form
Services for the Blind
Form
pdf
316 KB
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FNS_ILS_2-2016: DSB ILS Financial Needs Survey
Services for the Blind
Form
pdf
566 KB
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FNS_MEC_2-2016: DSB MEC Financial Needs Survey
Services for the Blind
Form
pdf
560 KB
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HCFA-1500: MED.EYE/Health Insurance Claim Form
Services for the Blind
Form
pdf
92 KB
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HCFA-1500-instructions: MED.EYE/Health Insurance Claim Form Instructions
Services for the Blind
Form
pdf
1 MB
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IRS-2678-DSB-Instructions: DSB/Employer Appointment of Agent Instructions
Services for the Blind
Form
pdf
137 KB
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IRS-2678-ia: Employer/Payer Appointment of Agent
Services for the Blind
Form
pdf
81 KB
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IRS-I-9-DSB-Instructions: Employment Eligibility Verification Instructions
Services for the Blind
Form
pdf
112 KB
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IRS-I-9-ia Form I-9 Employment Eligibility Verification
Services for the Blind
Form
pdf
372 KB
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IRS-W-9-DSB-Instructions: Request for Taxpayer Identification Number and Certification Instructions
Services for the Blind
Form
pdf
139 KB
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irs-w-9-ia: DSB/Request for Taxpayer Identification Number and Certification
Services for the Blind
Form
pdf
250 KB
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DSB/North Carolina Voter Registration Application
Services for the Blind
Form
pdf
853 KB
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DSB/NC Voter Registration Agency Transmittal Form
Services for the Blind
Form
pdf
47 KB
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DSB/NC Voter Registration Preference Form- Spanish
Services for the Blind
Form
pdf
200 KB
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DSB/NC Voter Registration Supplies Order Form
Services for the Blind
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pdf
95 KB
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DSB/Payment Verification Form
Services for the Blind
Form
pdf
266 KB
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PD-136-DSB-instructions: DSB/Application for Academic Assistance Instructions
Services for the Blind
Form
pdf
144 KB
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PD-136-ia: DSB/Application for Academic Assistance
Services for the Blind
Form
pdf
79 KB
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DSB/Request Prior Approval Claim Form for Eyeglasses
Services for the Blind
Form
pdf
168 KB
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New Hanover County Special Needs Registration Form
Services for the Blind
Form
pdf
360 KB
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NC DHHS Teacher Evaluation Process Pre-Observation
Services for the Blind
Form
pdf
32 KB
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NC DHHS Teacher Evaluation Process Timeline
Services for the Blind
Form
pdf
35 KB
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NC DHHS Teacher Individual Growth Plan
Services for the Blind
Form
pdf
49 KB
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NC DHHS Teacher Summary Rating Form
Services for the Blind
Form
pdf
65 KB
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NC Teacher Evaluation Process for DHHS
Services for the Blind
Form
pdf
103 KB
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Teacher Certification Rubric for Evaluating DHHS Teachers
Services for the Blind
Form
pdf
430 KB
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Teacher Certification Rubric for Evaluating NC Teachers
Services for the Blind
Form
pdf
220 KB
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Teacher Certification Teacher Observation Form
Services for the Blind
Form
pdf
48 KB
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Teacher Certification Post-Observation Conference Documentation
Services for the Blind
Form
pdf
25 KB
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Use of Leave Options Form
Services for the Blind
Form
pdf
39 KB
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