North Carolina Department of Health and Human Services Forms

This Form is used for self-attestation as a veteran or spouse of a veteran in North Carolina.

This type of document refers to a neurological application specific to North Carolina. It may be used for medical purposes related to the diagnosis, treatment, or studies of neurological conditions in North Carolina.

This type of document is a checklist for orientation or re-orientation training for the Senior Community Service Employment Program in North Carolina. It outlines the necessary steps or activities that participants must complete during the training process.

This document is used for confirming compliance with fire safety regulations in North Carolina. It attests that the necessary fire safety measures have been implemented and maintained in a particular setting. This helps ensure the safety of individuals and property in case of a fire emergency.

This form is used for authorizing a complainant in North Carolina to disclose personal information related to a complaint.

This checklist is used when reviewing Work First Services provided by second parties in North Carolina.

This form is used for renewing an animal shelter application in North Carolina.

This document is an Internal Control Questionnaire specific to the state of North Carolina. It helps organizations evaluate and assess their internal control systems and identify areas for improvement.

This form is used for applying for Refugee Medical Assistance (RMA) in North Carolina. It is designed for refugees seeking medical assistance.

This Form is used for the annual reporting of the North Carolina Safer Syringe Initiative in the state of North Carolina.

This document is used for tracking the monthly hours worked by individuals in the Senior Community Service Employment Program in North Carolina.

This Form is used for applying to the Low Income Energy Assistance Program in North Carolina for assistance with energy costs. (Spanish)

This Form is used for individuals in North Carolina to apply for registration as a dog handler.

This form is used for applying for the Low Income Home Energy Assistance Program (Liheap) in North Carolina.

This form is used for tracking and monitoring the health of pregnant women in North Carolina. It provides a comprehensive overview of the maternal health status and allows healthcare providers to ensure proper care and support throughout pregnancy.

This form is used by the staff in North Carolina to record and report their medical information. It provides a detailed look at the health status, medical history, and any ongoing treatment of employees, ensuring a safe and healthy work environment.