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PLEASE DO NOT STAPLE File Number: (office use only) NORTH CAROLINA DEPARTMENT OF INSURANCE CONSUMER SERVICES DIVISION 8554081212 PLEASE PRINT REQUEST FOR ASSISTANCE An online version of this form
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How to fill out the North Carolina Department of Health and Human Services forms:
01
Start by obtaining the necessary forms from the North Carolina Department of Health and Human Services website or by visiting their office in person.
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Carefully read the instructions provided on each form to understand the specific requirements and information needed.
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Begin filling out the form by providing your personal information, such as your full name, address, date of birth, and contact details. Make sure to write legibly and use black ink.
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Review any additional instructions or requirements for submitting the form. This may include signing and dating the form or attaching any necessary supporting documents.
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Make copies of the completed form and any supporting documentation for your records before submitting it to the North Carolina Department of Health and Human Services.

Who needs the North Carolina Department of Health and Human Services:

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Individuals in North Carolina who require assistance with healthcare-related services such as Medicaid, medical assistance programs, or other health and human services programs.
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Families and individuals in need of nutritional support through programs like the Supplemental Nutrition Assistance Program (SNAP) or Women, Infants, and Children (WIC).
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Low-income individuals and families seeking assistance with child care, refugee support, or services for individuals with disabilities.
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The North Carolina Department of Revenue is responsible for overseeing tax laws and regulations in the state.
Individuals and businesses that earn income or operate in North Carolina are required to file with the Department of Revenue.
To fill out the North Carolina Department of Revenue forms, individuals can visit the department's website or seek assistance from tax professionals.
The purpose of the North Carolina Department of Revenue is to collect taxes and ensure compliance with state tax laws.
Income, deductions, and credits must be reported on the North Carolina Department of Revenue forms.
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