DSS Form 1301 "Certification of Homework Hours" - South Carolina

What Is DSS Form 1301?

This is a legal form that was released by the South Carolina Department of Social Services - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2009;
  • The latest edition provided by the South Carolina Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DSS Form 1301 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Social Services.

ADVERTISEMENT
ADVERTISEMENT

Download DSS Form 1301 "Certification of Homework Hours" - South Carolina

Download PDF

Fill PDF online

Rate (4.7 / 5) 59 votes
Reset
South Carolina Department of Social Services
Family Independence
CERTIFICATION OF HOMEWORK HOURS
Name of Student:
Case Number:
Name of School:
Address of School:
Quarter/Semester:
Begin Date of Class:
End Date of Class:
Number of
Number of
Is Homework
Recommended/
Class Name
Scheduled
Recommended/
Required
Class Hours
Required?
Homework Hours
I certify that these hours are actual and true.
Instructor or School Designee’s Signature
Return completed form to: Case Manager:
Address:
Telephone No.:
Fax No.:
DSS Form 1301 (OCT 09)
Reset
South Carolina Department of Social Services
Family Independence
CERTIFICATION OF HOMEWORK HOURS
Name of Student:
Case Number:
Name of School:
Address of School:
Quarter/Semester:
Begin Date of Class:
End Date of Class:
Number of
Number of
Is Homework
Recommended/
Class Name
Scheduled
Recommended/
Required
Class Hours
Required?
Homework Hours
I certify that these hours are actual and true.
Instructor or School Designee’s Signature
Return completed form to: Case Manager:
Address:
Telephone No.:
Fax No.:
DSS Form 1301 (OCT 09)
INSTRUCTIONS FOR DSS FORM 1301
This form has been developed by the South Carolina Department of Social Services to be used to certify homework
hours for students. The instructor or school designee should complete and sign the form and the client is responsible for
returning it to his/her case manager.
TANF allows us to count 1 hour of homework per class hour.
Student Name: The complete name of the student.
Case Number: The student’s case number.
Name of School: The complete name of the school student attends.
Address of School: The complete address of the school student attends.
Quarter/Semester: Indicate the quarter/semester for which the student is enrolled.
Begin Date of Class: Indicate start date of the student’s class.
End Date of Class: Indicate the end date of the student’s class.
Class Name: Indicate the name of the class for which the student is currently enrolled.
Number of Scheduled Class Hours: Number of scheduled hours of the class for which the student is enrolled.
Homework Recommended/Required: Indicate if homework is recommended or required in the class for which the
student is enrolled.
Number of Recommended/Required Homework Hours: Indicate number of recommended/required homework hours
in the class for which student is enrolled.
Instructor’s Signature or School Designee/Date: Signature of instructor or school designee and the date that the form
is completed.
Case Manager’s Name: The complete name of case manager making request.
Case Manager’s Address: The complete address of the case manager making request for homework hours.
Case Manager’s Telephone Number/Fax Number: Self-Explanatory
DSS Form 1301 (OCT 09)
PAGE 2
Page of 2