North Carolina Office of Administrative Hearings - Forms

Some forms are in PDF format.
You will need Acrobat Reader to view them.

Hearings Forms

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. (OAH address and Fax updated Aug. 27, 2008)

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). (OAH address and Fax updated Aug. 27, 2008)

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. (OAH address and Fax updated Aug. 27, 2008)

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. (OAH address and Fax updated Aug. 27, 2008)

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. (OAH address and Fax updated Aug. 27, 2008)

H-06E
Special Education Petition Form

For filing a contested case (due process) hearing on a special education case. (OAH address and Fax updated Aug. 27, 2008)

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. (OAH address and Fax updated Aug. 27, 2008)

H-05
Subpoena Forms

Subpoena forms with instructions

H-08
Designation Of Mediator

H-08A
Report Of Mediator

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

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

H-25B
Hearing Tapes Request Form

(OAH address and Fax updated Aug. 27, 2008)

H-25C
Transcript Request Form

H-25D
Special Education
Transcript Request Form

H-70
Secure Leave Form

Secure Leave form for Attorneys

Service Survey Form

Confidential Survey.

Medicaid Appeal Forms

Med-01
General Information Form

Information about the mediation process for Medicaid appeals.

Med-02
Agreement to Mediate

Agreement of both parties to use the mediation process.

Med-03
Designation Of Mediator

Med-04
Report Of Mediation Conference and Memorandum of Agreement

Med-05
Report Of Mediator

Med-06
Recipient Mediation Questionnaire

Med-07
Respondent Mediation Questionnaire

Med-08
Mediation Information Transmittal Cover Sheet

Rules Forms

OAH 0300 Notice of Text OAH 0300 Notice of Text	Notice of Text (updated Feb. 1, 2008)
OAH 0400 Submission for Permanent Rule OAH 0400 Submission for Permanent Rule	Submission for Permanent Rule (updated Feb. 1, 2008)
OAH 0500 Temporary Rule Findings of Need OAH 0500 Temporary Rule Findings of Need	Temporary Rule Findings of Need (updated Feb. 1, 2008)
OAH 0600 Emergency Rule OAH 0600 Emergency Rule	Emergency Rule Findings of Need (updated Feb. 1, 2008)
OAH 0700 Publication on the OAH Website OAH 0700 Publication on the OAH Website	Publication on OAH Website (updated Feb. 1, 2008)
Fiscal Note

Civil Rights Forms

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.