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MUTUAL RESPONSIBILITY AGREEMENT <br /> PLAN OF ACTION REQUIREMENTS <br /> <br />Participant's Name: County Case Number. <br /> <br />North Carolina's Work First Program is based on the philosophy that all people have the responsibility to their families and <br />community to work and provide for their children. The family and Social Services develop this Mutual Responsibility <br />Agreement, Plan of Action. It qutlines the steps to be taken to become self-sufficient. It will be'reviewed and may be <br />changed as needed. <br /> <br />Employment Goal: <br /> <br />Other Goals: <br /> <br />Number of months remaining on 24~month time clock <br /> <br />· and 60~month time clock <br /> <br />ACTIVITY/ <br /> SERVICE <br /> <br />EXPECTATIONS <br /> <br />Comments: <br /> <br />Our signatures indicate that we have jointly developed this Plan of Action and agree to the responsibilities and conditions <br />outlined. The policy regarding time-limited benefits, sanctions, hearings, and extensions have been explained. <br /> <br />Work First Participant's Signature: <br /> <br />Work First Worker's Signature: <br /> <br />DSS-6963B (Rev. 5/99) <br />Economic Independence <br /> <br />Date: Telephone: <br />Date: Telephone: <br /> <br /> <br />