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North Carolina Office of Administrative Hearings - Forms

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Hearings Forms

Word H-06
General Petition Form

For filing most contested cases.

NOTE: for Personnel, Child Support, Special Education, or Contested Tax cases, use the appropriate form H-06A to H-06F; for Medicaid cases, use the hearing request form supplied by DHHS.

Word H-06A
Personnel Petition Form

For filing an appeal of a personnel decision if you are a State employee, local government employee, applicant for employment or former employee covered under Chapter 126 - Personnel Act. (added line for petitioner email address Oct 31, 2013).

Word H-06B
Child Support-Tax Intercept Petition Form

For filing a contested case if you have received a Notice of Intent to Intercept your taxes for child support from the North Carolina Department of Health and Human Services and the notice sets out your appeal rights specifically to the Office of Administrative Hearings. (changed DHHS service agent July 18, 2013)

Word H-06C
Child Support-Distribution Petition Form

For filing a contest case if you are a custodial parent who has received a Notice of Overpayment stating that you were overpaid child support and sets out your appeal rights specifically to the Office of Administrative Hearings. (changed DHHS service agent July 18, 2013)

Word H-06D
Child Support-Credit Report Petition Form

For filing a contested case if you have received a Child Support Consumer Credit Report Notice that your support obligation information will be forwarded to a credit reporting agency and sets out your appeal rights specifically to the Office of Administrative Hearings. (changed DHHS service agent July 18, 2013)

Word H-06E
Special Education Petition Form

For filing a contested case (due process) hearing on a special education case. (except for Manifestation Determination, see form H-06E-A)

Word H-06E-A
Special Education - Manifestation Determination Petition Form

For filing a contested case (due process) hearing on a special education case regarding a manifestation determination review decision.

Word H-06F
Contested Tax Petition Form

For filing a contested case if you have received a Notice of Final Determination from the NC Department of Revenue.
Note: this form should not be used for tax intercept issues.

Word H-OI
Indigent Status Petition Form

For requesting a waiver of the contested case filing fee due to financial hardship.
Note: not all cases require a filing fee - see OAH Case Filing Fee List for a representative list of filing fees.

PDF H-05
Subpoena Forms

Subpoena forms with instructions.

PDF H-08
Designation Of Mediator

 

PDF H-08A
Report Of Mediator

 Mediator's report form.

PDF H-14 Form
Motion By Out-of-State Attorney to Practice Before OAH
PDF H-14 Statute
Motion By Out-of-State Attorney to Practice Before OAH

 

Word H-25B
Hearing Tapes/CD Request Form

 

Word H-25C
Transcript Request Form

Transcript request form.

PDF H-25D
Special Education
Transcript Request Form

 

PDF H-70
Secure Leave Form

Secure Leave form for Attorneys

Service Survey Form

Confidential Survey.


Medicaid Mediation & Hearing Forms

Medicaid Mediation Forms:
Word Med-01
Medicaid Mediation - General Information

Information about the mediation process for Medicaid appeals.

Word Med-02
Agreement to Mediate Form

Agreement of both parties to use the mediation process.

Word Med-04
Report Of Mediation Conference and Memorandum of Agreement

 

Word Med-05
Report Of Mediator

 

Word Med-06
Recipient Mediation Questionnaire

 

Word Med-07
Respondent Mediation Questionnaire

 

Word Med-08
Mediation Information Transmittal Cover Sheet

 

Medicaid Hearings Forms:
Word Medicaid Hearing Request Form

Contact DHHS if you do not have a hearing request form (do not use an OAH request form).

Word Med-09
Language Interpreter or Communication Accessibility Request Form

Request for foreign language interpreter, American sign language interpreter or assistive hearing device.

Word H-25B
Hearing Tapes/CD Request Form

 

Word H-25C
Transcript Request Form

 


Rules Forms

Word OAH 0300
Notice of Text

PDF OAH 0300
Notice of Text

Notice of Text (changed substantial economic impact level to $1,000,000, Aug. 2013; removed procedure to object to the Agency on a proposed rule, June 2013)

Word OAH 0400
Submission for
Permanent Rule

PDF OAH 0400
Submission for
Permanent Rule

Submission for Permanent Rule (changed substantial economic impact level to $1,000,000, Aug. 2013)

Word OAH 0500
Temporary Rule
Findings of Need

PDF OAH 0500
Temporary Rule
Findings of Need

Temporary Rule Findings of Need

Word OAH 0600
Emergency Rule

PDF OAH 0600
Emergency Rule

 Emergency Rule Findings of Need

Word OAH 0700
Publication on
the OAH Website

PDF OAH 0700
Publication on
the OAH Website

 Publication on OAH Website

Fiscal Note

 


Civil Rights Forms

Word Abbreviated Intake Form
PDF Abbreviated Intake Form

This form will provide preliminary information to the Charge Intake Coordinator in order to assist in the interview and charge filing process.