North Carolina Department of Health and Human Services Forms

This form is used for self-attestation of wages in North Carolina.

This document is for assessing the readiness of a trip to North Carolina. It helps evaluate various factors to ensure a smooth and safe travel experience.

This document is an annual report that monitors safety measures in North Carolina. It provides information and updates on various safety initiatives and highlights any improvements or areas of concern.

This form is used for attesting third-party information regarding homelessness in North Carolina

This document describes a physical examination offer available in North Carolina. It provides information on the details and benefits of the physical examination.

This document is used for third-party attestation of limited English proficiency (LEP) in North Carolina for Item P22.

This Form is used for researchers in North Carolina to apply for the renewal of their research application.

This Form is used for pre-screening individuals before entering a home in North Carolina.

This document supplements the Programatic Risk Evaluation Matrix for Housing and Home Improvement in North Carolina. It provides additional information about the risk evaluation process for housing and home improvement projects in the state.

This Form is used for giving consent to use and disclose health information for treatment, payment, and healthcare operation purposes in North Carolina.

This document provides guidance on choosing a place to live in North Carolina. It includes important factors to consider when making this decision.

This document is a certification for independent accountants in North Carolina who are not certified public accountants (CPAs). It verifies their qualifications and credentials in providing accounting services.

This form is used for renewing the Dog Handler Application in North Carolina.

This form is used for applying for the Adoption Promotion Fund in North Carolina.

This form is used for renewing a distributor application in North Carolina. It is required for distributors of certain products, such as tobacco and alcoholic beverages, to renew their licenses.

This form is used for insurance verification and billing at the Walter B. Jones Center in North Carolina. It ensures that patients' insurance information is accurately recorded and that billing is properly processed.

This form is used for food stamp investigations and reporting disqualifications in North Carolina.

This form is used for applying to become an optometrist in the state of North Carolina.

This notice explains how Murdoch Developmental Center in North Carolina protects your privacy and the confidentiality of your information. It outlines your rights regarding your personal health information and how it may be used and disclosed.

This type of document is used for third-party attestation in North Carolina when the reason for leaving a program is not unsubsidized employment.

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

This form is used for collecting feedback for the Public Review of LIHEAP Weatherization Waiver in North Carolina.

This document provides information about a psychological application specific to North Carolina. It may involve various mental health services or resources available in the state.

This Form is used for renewing an Analytical Laboratory Application in North Carolina.

This form is used for self-attestation of total includable family income in North Carolina.

This document is for individuals who have completed competency testing for in-home aide services in North Carolina. It certifies their skills in level 3 home management.

This Form is used for providing third-party attestation for the number of family members as requested in Item P11 for residents of North Carolina.

This form is used to record the activities of committee members in North Carolina. It helps in tracking and documenting the contributions and involvement of committee members.

This document is a referral for services provided by the North Carolina Assistive Technology Program in North Carolina. It is used to connect individuals with disabilities to resources and support for assistive technology.

This document is a checklist used in North Carolina for reviewing second party employment services in the Work First program.

This document is for self-attesting that you were employed prior to participating in a program or activity in North Carolina.

This document is used to register families for the NC Kids program in North Carolina.

This type of document is used for making payments in North Carolina. Payment coupons typically include information about the payment amount, due date, and payment instructions. They are commonly used for paying bills, taxes, or other financial obligations in the state.

This type of document is used for attestation and documentation of public participation in the Low-Income Home Energy Assistance Program (LIHEAP) in North Carolina.

This Form is used for reporting adoption expenditures in North Carolina. It is an affidavit that verifies the expenses incurred during the adoption process.

This form is used to provide agency information for the Department of Administration and Security Services (DAAS) in North Carolina.

This form is used to declare your family's total income for recertification purposes in North Carolina. It applies to a 12-month or 6-month annualized period.

This Form is used for third-party attestation of exclusion discovered after exiting a North Carolina property.