North Carolina Department of Health and Human Services Forms

This document is a checklist used in North Carolina to remind individuals about the recertification process. It outlines the necessary steps and requirements for recertification.

This document is a compliance monitoring tool used in North Carolina for Medicaid Administrative Claiming (MAC) for both adults and children. It provides instructions on how to ensure compliance with Medicaid regulations and guidelines.

This Form is used for reviewing audits and reports in North Carolina.

This document is used to authorize access to funds for the Links Program in North Carolina.

This document is a Request for Applications for the Food and Nutrition Services Employment and Training Program in North Carolina. This program aims to provide employment and training opportunities in the field of food and nutrition services.

This document is used to formalize the agreement between parties in North Carolina regarding the sharing and use of data.

This document is a form specifically for North Carolina residents who need to report the destruction of their Food and Nutrition Services Disaster Electronic Benefit Transfer Card.

This form is used for individuals who want to volunteer for site visits in North Carolina.

This document is an application form for individuals or businesses seeking to become a host agency in the state of North Carolina.

This document is for volunteers in North Carolina who are interested in participating in the NC Fast Case Management Implementation Pilot County program. It provides information and guidelines for volunteering in the program.

This Form is used for obtaining authorization from residents in North Carolina.

This form is used for third-party attestation for low literacy skills in North Carolina. It's a document required to provide evidence or verification of an individual's literacy level from a trusted source other than the individual themselves.

This document is used for monitoring Home and Community-Based Services (HCBS) in North Carolina. It helps ensure that proper care is being provided to individuals receiving HCBS.

This Form is used for self-attesting low employment prospects for Item P30 in North Carolina.

This document is used for registering clients in North Carolina. It is a shortened version of Form DAAS-101.

This Form is used for authorizing direct deposit in North Carolina.

This document is a contact checklist for the Local Contact Agency (LCA) in North Carolina. It provides information on how to reach out to the LCA for assistance or any inquiries you may have.

This form is used for vendors participating in the Low Income Household Water Assistance Program (LIHWAP) in North Carolina. It is an agreement for water and wastewater services provided to low-income households.

This type of document is used for applying for psychiatric services in the state of North Carolina.

This document is used for obtaining consent from a local contact agency in North Carolina to release confidential information.

This document is a Transfer of Learning Tool (TOL) designed to help individuals in North Carolina who are transitioning into a supervisory role. It provides guidance and resources to enhance their understanding and skills in supervision.

This type of document is a general medical application specific to North Carolina. It is used to apply for medical services or assistance within the state.

This Form is used for reporting monthly consumer contributions and program income in the state of North Carolina.

This form is used for conducting a needs assessment in North Carolina. It helps identify the support needs of individuals and communities in the state.

This document is used when a participant in a program in North Carolina has been approved to take a break in their participation.

This document is a checklist used to review work first services in North Carolina. It helps ensure that the services provided meet the necessary standards and requirements.

This document is a checklist used by Child and Family Services to ensure quality assurance during the review of completed onsite review instruments in North Carolina. It provides guidance and criteria for reviewing the instruments to ensure accuracy and completeness.

This type of document is used for providing clinical screening information in North Carolina.

This type of document is a checklist used in North Carolina for reviewing cash assistance applications. It ensures that the necessary requirements are met for individuals to receive work first cash assistance.

This form is used for applying for registration as a distributor in North Carolina.

This form is used for inquiring about a child placing agency that provides foster care in North Carolina.

This document outlines the minimum habitability standards for rapid rehousing in North Carolina. It provides a checklist to ensure that housing meets these standards.

This form is used for creating a plan to smoothly transition a child or adolescent from a healthcare facility or program back into their home or community in North Carolina. It includes important information and instructions for the child/adolescent's caregivers and healthcare providers to ensure a successful transition.

This form is used for third-party attestation of the number of family members at recertification in North Carolina.

This form is used for residents in North Carolina to authorize certain actions or give permission in specific situations.

This form is used for teaching institutions in North Carolina to apply for registration with the DHHS.

This document is for enrolling participants in the Senior Community Service Employment Program in North Carolina. It outlines the agreement between the participant and the program and includes important information regarding eligibility, services, and participant expectations.

This document is for identifying and addressing housing barriers in North Carolina and creating a stabilization plan.