Hearing Forms Below are forms you may wish to use for your contested case at the Office of Administrative Hearings. Some forms are in PDF format--you will need Adobe Acrobat Reader to view them. Petition Forms General Petition Form (Form H-06) 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 Recipient Appeals, use the Hearing Request Form supplied by DHHS or your MCO. Personnel Petition Form (Form H-06A) 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. Child Support Tax Intercept Petition Form (Form H-06B) 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. Child Support Distribution Petition Form (Form H-06C) For filing a contested case if you are a custodial parent who has received a Notice of Overpayment stating that you were overpaid child support and the Notice sets out your appeal rights specifically to the Office of Administrative Hearings. Child Support Credit Report Petition Form (Form H-06D) 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 the Notice sets out your appeal rights specifically to the Office of Administrative Hearings. Special Education Petition Form (Form H-06E) For filing a due process contested case in a special education case. (This form should not be used to appeal a Manifestation Determination review decision. See Form H-06E-A below.) Special Education Manifestation Determination Petition Form (Form H-06E-A) For filing a due process contested case in a special education case regarding a Manifestation Determination review decision. (Consultant for Dispute Resolution updated Sept. 1, 2017) Child/Adult Care Food (CACFP) (Form H-06G-CACFP) For a filing a contested case petition if you have received a Notice of Proposed Termination and Disqualification from the Child/Adult Care Food Program. Contested Tax Petition Form (Form H-06F) For filing a contested case if you have received a Notice of Final Determination from the NC Department of Revenue. (This form should not be used for tax intercept issues. See Form H-06B above.) Request to Proceed in Forma Pauperis (Previously Indigent Status Petition Form (Form H-0I)) For requesting a waiver of the contested case filing fee due to financial hardship. (Not all cases require a filing fee. See Contested Case Filing Fees for a representative list of filing fees.) Mediation Forms Designation of Mediator Form (Form H-08) For designating the mediator to conduct the mediated settlement conference (mediation) in a contested case. Report of Mediator Form (Form H-08A) For reporting the results of the mediated settlement conference (mediation). Subpoena Form Subpoena Form with Instructions (Form H-05) For compelling the production of documents or testimony. Non-Attorney Representation Form Notice of Non-Attorney Representation Form (Form H-0R) For providing notice that a business entity will use a non-attorney representative in its contested case. Out-of-State Attorney (Pro Hac Vice) Form and Statute Motion by Out-of-State Attorney to Practice Before OAH (Pro Hac Vice) Form (Form H-14) For out-of-state attorneys requesting to appear before NC OAH. NCGS 84-4.1 Limited Practice of Out-of-State Attorneys Statutory authority for out-of-state attorneys appearing before NC OAH. Hearing Recording Request Form and Transcript Request Forms Hearing Recording Request Form (Form H-25B) For requesting a copy of the audio recording of your hearing. Special Education Hearing Transcript Request Form (Form H-25D) For requesting a copy of the transcript of your Special Education hearing. Transcript Request Contract Form For requesting a copy of the transcript of your contested case hearing. Attorney Secure Leave Form and Rule Attorney Secure Leave Form (Form H-70) For attorneys notifying NC OAH of his/her secure leave pursuant to 26 NCAC 03 .0119. 26 NCAC 03 .0119 Secure Leave Periods for Attorneys Rule governing secure leave periods for attorneys appearing before NC OAH.
Hearing Forms Below are forms you may wish to use for your contested case at the Office of Administrative Hearings. Some forms are in PDF format--you will need Adobe Acrobat Reader to view them. Petition Forms General Petition Form (Form H-06) 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 Recipient Appeals, use the Hearing Request Form supplied by DHHS or your MCO. Personnel Petition Form (Form H-06A) 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. Child Support Tax Intercept Petition Form (Form H-06B) 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. Child Support Distribution Petition Form (Form H-06C) For filing a contested case if you are a custodial parent who has received a Notice of Overpayment stating that you were overpaid child support and the Notice sets out your appeal rights specifically to the Office of Administrative Hearings. Child Support Credit Report Petition Form (Form H-06D) 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 the Notice sets out your appeal rights specifically to the Office of Administrative Hearings. Special Education Petition Form (Form H-06E) For filing a due process contested case in a special education case. (This form should not be used to appeal a Manifestation Determination review decision. See Form H-06E-A below.) Special Education Manifestation Determination Petition Form (Form H-06E-A) For filing a due process contested case in a special education case regarding a Manifestation Determination review decision. (Consultant for Dispute Resolution updated Sept. 1, 2017) Child/Adult Care Food (CACFP) (Form H-06G-CACFP) For a filing a contested case petition if you have received a Notice of Proposed Termination and Disqualification from the Child/Adult Care Food Program. Contested Tax Petition Form (Form H-06F) For filing a contested case if you have received a Notice of Final Determination from the NC Department of Revenue. (This form should not be used for tax intercept issues. See Form H-06B above.) Request to Proceed in Forma Pauperis (Previously Indigent Status Petition Form (Form H-0I)) For requesting a waiver of the contested case filing fee due to financial hardship. (Not all cases require a filing fee. See Contested Case Filing Fees for a representative list of filing fees.) Mediation Forms Designation of Mediator Form (Form H-08) For designating the mediator to conduct the mediated settlement conference (mediation) in a contested case. Report of Mediator Form (Form H-08A) For reporting the results of the mediated settlement conference (mediation). Subpoena Form Subpoena Form with Instructions (Form H-05) For compelling the production of documents or testimony. Non-Attorney Representation Form Notice of Non-Attorney Representation Form (Form H-0R) For providing notice that a business entity will use a non-attorney representative in its contested case. Out-of-State Attorney (Pro Hac Vice) Form and Statute Motion by Out-of-State Attorney to Practice Before OAH (Pro Hac Vice) Form (Form H-14) For out-of-state attorneys requesting to appear before NC OAH. NCGS 84-4.1 Limited Practice of Out-of-State Attorneys Statutory authority for out-of-state attorneys appearing before NC OAH. Hearing Recording Request Form and Transcript Request Forms Hearing Recording Request Form (Form H-25B) For requesting a copy of the audio recording of your hearing. Special Education Hearing Transcript Request Form (Form H-25D) For requesting a copy of the transcript of your Special Education hearing. Transcript Request Contract Form For requesting a copy of the transcript of your contested case hearing. Attorney Secure Leave Form and Rule Attorney Secure Leave Form (Form H-70) For attorneys notifying NC OAH of his/her secure leave pursuant to 26 NCAC 03 .0119. 26 NCAC 03 .0119 Secure Leave Periods for Attorneys Rule governing secure leave periods for attorneys appearing before NC OAH.
