North Carolina Department of Health and Human Services Forms

This document is for vendors in North Carolina who are applying to become a part of the Community Rehabilitation Program.

This document is a monthly report for the Telecommunications Relay Service Surcharge in North Carolina. It provides an overview of the funds collected and their usage for supporting telecommunications services for individuals with hearing or speech disabilities.

This form is used for registering a service animal for people with disabilities in North Carolina.

This form is used for applying for Supplemental Security Income (SSI) and food stamps (SNAP) in North Carolina.

This Form is used for applying for health coverage and financial assistance in North Carolina.

This Form is used for applying for health coverage and financial assistance in North Carolina.

This form is used for parents in North Carolina to apply for financial assistance for emergency child care due to the impact of Covid-19.

This document is a Covid-19 financial assistance application for emergency child care for parents in North Carolina.

This amendment form is used for requesting contract renewal and making changes to requirements in North Carolina.

This form is used for applying to obtain a copy of a North Carolina birth certificate.

This document is a tool used in North Carolina for individuals transitioning to community living. It helps with planning and support for individuals with intellectual or developmental disabilities.

This document provides guidance on transitioning individuals with disabilities from a state hospital to community living in North Carolina.

This document is a diversion tool used in the state of North Carolina. It provides options for individuals who have committed minor offenses to avoid traditional criminal justice procedures.

This document is for individuals in North Carolina who are participating in the Transitions to Community Living Initiative. It provides an informed decision-making tool to assist individuals in making decisions about their long-term care options.

This form is used to request the Woman's Right to Know Patient Education Handbook in North Carolina. It provides information and resources related to women's reproductive health and rights.

This document contains the application content for the Project for Assistance in Transition from Homelessness (PATH) RFA in North Carolina.

This document provides a narrative description of the path match for personnel in North Carolina. It explains how personnel in the state are matched to their assigned paths.

This document provides a detailed explanation of the budget for a specific path project in North Carolina. It outlines the expenses and funding sources for the project.

This document contains the match narrative for Attachment I in North Carolina.

This document provides a narrative explanation of the path match for fringe benefits in the state of North Carolina. It outlines the guidelines and requirements for determining eligibility and calculating fringe benefits for employees.

This form is used for applying to become a new vendor for the Community Rehabilitation Program in North Carolina.

This Form is used for renewing the vendor application for the Community Rehabilitation Program in North Carolina.

This Form is used for notifying EMS in North Carolina about the placement of an AED (Automated External Defibrillator).

This Form is used for third-party attestation of Item P14 in North Carolina.

This document is used for providing instructions on how to complete the Form DSS-6844S Purchase Contract Budget in North Carolina when entering into a purchase contract.

This form is used for obtaining oral consent from residents in North Carolina.

This form is used for applying for registration as an analytical laboratory in North Carolina.

This Form is used for nursing homes in North Carolina to renew their application with the DHHS.

This document is the Appendix D Model Provider Assurance Form used in North Carolina. It outlines the assurance requirements for healthcare providers.

This document is a report of an internal inspection conducted on the National Directory of New Hire in North Carolina. It provides information about the findings and recommendations resulting from the inspection.

This form is used for teaching institutions in North Carolina to apply for renewal.

This form is used for healthcare clinics in North Carolina to apply for registration with the Department of Health and Human Services.

This Form is used for renewing a clinic application in North Carolina.

This document is an ophthalmological application specific to North Carolina. It is used for applying for services related to eye care in the state.

This Form is used for requesting replacement of Food and Nutrition Services EBT cards that were lost or damaged due to a disaster in North Carolina.

This form is used for the North Carolina Homeless Management Information System (HMIS) Rapid Re-housing (RRH) and Prevention Intake.

This form is used for conducting a functional assessment of adult services in North Carolina. It helps evaluate the individual's needs and determine the appropriate level of support and services required.

This form is used for the first examination to determine whether involuntary commitment is necessary in the state of North Carolina.