DHHS ITD: Aid to County (ATC) Request Form Submitted by dlfaison on Wed, 05/19/2021 - 16:57 Indicates required field Support Type - Select -State UserCounty UserITD Application Support State User State User Role Request - None -Budget AdminBudget Admin 2Budget SuperBusiness DirectorcontractsPrinterProgram AdminProgram UserDevelopersState AdminState Read OnlyState Super State Office Division - None -Division for Child & Family Welfare (DCFW) Division of Public Health (DPH)Division of Information Technology (ITD/DIRM) County User County User Role Request - None -County AdminCounty User ITD Application Support ITD Application Support Role Request - None -Budget AdminBudget Admin 2Budget SuperBusiness DirectorContractsPrinterProgram AdminProgram UserCounty AdminCounty UserDevelopersState AdminState Read OnlyState Super User Request - Select -Add New UserChange UserInactivate User NCID Username Name First Middle Initial Last Suffix Title Division - Select -Office of the Controller (OOC)Office of the Secretary (OOS)Privacy and Security Office (PSO)Property and ConstructionDivision for Child & Family Welfare (DCFW)Public Health (DPH)Services for the Blind (DSB)Services for the Deaf and Hard of Hearing (DSDHH)Social Services (DSS)State Operated Healthcare Facilities (DSOHF)Vocational Rehabilitation Services (DVRS) Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code County - Select -AlamanceAlbermarle RegionalAlexanderAnsonAppalachianBeaufortBertieBladenBrunswickBuncombeBurkeCabarrusCaldwellCarteretCaswellCatawbaChathamCherokeeChowanClayClevelandColumbusCravenCumberlandDareDavidsonDavieDuplinDurhamEdgecombeFoothillsForsythFranklinGastonGrahamGranville-VanceGreeneGuilfordHalifaxHarnettHaywoodHendersonHertfordHokeHydeIredellJacksonJohnstonJonesLeeLenoirLincolnMaconMadisonMartin-Tyrrell-WashingtonMecklenburgMontgomeryMooreNashNew HanoverNorthamptonOnslowOrangePamlicoPenderPersonPittPolkRandolphRichmondRobesonRockinghamRowanSampsonScotlandStanlyStokesSurrySwainToe RiverTransylvaniaUnionWakeWarrenWayneWilkesWilsonYadkinYancey Phone Number Email County 2 - None -AlamanceAlbermarle RegionalAlexanderAnsonAppalachianBeaufortBertieBladenBrunswickBuncombeBurkeCabarrusCaldwellCarteretCaswellCatawbaChathamCherokeeChowanClayClevelandColumbusCravenCumberlandDareDavidsonDavieDuplinDurhamEdgecombeFoothillsForsythFranklinGastonGrahamGranville-VanceGreeneGuilfordHalifaxHarnettHaywoodHendersonHertfordHokeHydeIredellJacksonJohnstonJonesLeeLenoirLincolnMaconMadisonMartin-Tyrrell-WashingtonMecklenburgMontgomeryMooreNashNew HanoverNorthamptonOnslowOrangePamlicoPenderPersonPittPolkRandolphRichmondRobesonRockinghamRowanSampsonScotlandStanlyStokesSurrySwainToe RiverTransylvaniaUnionWakeWarrenWayneWilkesWilsonYadkinYancey Are you a member of the Native American Tribe? Yes No
