Form Dss-8218b - Work First Program Testing Notice - North Carolina Economic And Family Services Section
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2Work First Program Testing Notice
(Provide this notice to each individual that is referred for testing)
County Name: ____________________ Product Delivery Case Number: __________________________
Applicant/Recipient Name: _______________________________________________________________
Per North Carolina State law, § 108A-29.1, a test for controlled substances is required when there is reasonable
suspicion that an individual is engaged in the illegal use of controlled substances. The test is a condition of eligibility
to receive Work First cash assistance.
Reasonable suspicion was determined because of:
____ a criminal conviction involving controlled substances within three (3) years and/or
____ your score on the DAST-10 (substance use screening tool).
Your Rights
You have the right to refuse to take or complete the test, however, you will be determined ineligible to receive
cash assistance.
You have the right to have the test performed by a laboratory approved by the Department of Health and Human
Services (DHHS).
You have the right to privacy and dignity during the testing process.
You have the right to confidentiality of information regarding your test results, your medical history or any
medications you are taking.
You have the right to have a positive initial test confirmed by a more sophisticated procedure before any action is
taken on your case due to the test result.
In the event you have a confirmed positive test, you must be contacted within five (5) business days of the
county Department of Social Services learning of the test result.
You have the right to a hearing if you disagree with the results of the test.
You may request a retest of the same sample by any laboratory approved by DHHS (at your expense).
You have the right for the eligible household members to receive cash assistance if you are disqualified or
sanctioned, due to a confirmed test or failure to be screened or tested.
You have the right to request a hearing if you disagree with the actions taken on your case.
Your Responsibilities
You must inform testing/collection site personnel of any medical conditions or lawful medications you are taking
that might affect your test results.
If you want to have a retest of a confirmed positive result, you must notify, in writing, the county Department of
Social Services within 60 days of the confirmed positive test.
You are responsible for all costs related to a retest.
Hearing Rights
You must ask for the hearing within 60 calendar days (or 90 if you have a good reason for delay). The 60
day is
th
___________________________________.
You can request a hearing in person, by telephone or in writing. Contact your caseworker to ask for a hearing.
When required by policy a local hearing will be held within five (5) calendar days of your request unless you ask
for it to be postponed. The hearing can be postponed, with good reason, for as much as 10 calendar days.
You (or the person speaking for you) can view your record at any time, except for third-party information. If you
ask, you may also see additional information that will be used at the hearing. Free copies of this information are
available.
DSS-8218B (rev.08-2015)
Economic and Family Services Section
The North Carolina Division of Social Services does not discriminate against any person on the basis of race, color, national origin, disability,
sex, or age in the admission, treatment, or participation in is programs, services and activities, or in employment.
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