| A | B |
|---|
| Notice fo Benefits Change | DSS-8110 |
| Immigrant Access Notice | DSS-8227 |
| Adult Mail-In Application | DMA-5000 |
| NC Health Choice/Medicaid Mail-In Application Log | DMA-5066 |
| Social History Summary for the Disabled | DMA-5009 |
| Medicaid Application Pending for Deductible | DMA-5099 |
| Daily Reception Log | DMA-5093 |
| Request for Information | DMA-5097 |
| Health Check/NC Health Choice Application | DMA-5063 |
| Adult Mail-In Application Log | DMA-5105 |
| Authorization to Disclose Information | DMA-5028 |
| Medicaid Application Pending (other) | DMA-5098 |
| Notice of Your Right to Apply | DMA-5094 |
| Medicaid/Work First Notice of Inquiry | DMA-5095 |
| Notice of the use of Social Security Number | DMA-5001 |
| Disability Dtermination Transmittal | DMA-4037 |
| Your Application for Benefits is Being Denied/Withdrawn | DSS-8109 |
