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SECTION 300: DSB-1010: REGISTRANT DATA FORM AND INSTRUCTIONS

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REVISED: 01/25/10

DSB-1010 REGISTRANT DATA FORM AND INSTRUCTIONS

DSB-1010: Registrant Data Form may be prepared by any referral source from information on the DSB-2202: Report of Eye Examination. This form is also used by Social Workers for the Blind to notify the Register Clerk of changes in registrants’ situations such as name changes, address changes, county transfers and deletions.

The form is now available on line and information should be entered and then forwarded electronically to the Register Clerk (see Email option in lower right hand corner). The only exception to this is when a person is being added to the Register and then the form should be printed after information has been entered (see print option in lower right corner of form) and medical information should be attached. The DSB-1010 and the medical information should then be mailed to the Register Clerk at Division of Services for the Blind, 2601 MSC, Fisher Building, Raleigh, NC 27699-2601.

Enter the date the form is being prepared and the name of the person submitting the data. Enter in the appropriate block to indicate if the registrant is new, a change of information on an existing registrant, a removal of a registrant or a transfer from one county to another.

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