Forms
participation form
This important document lists important information such as your contact information that is used for our Interactive Voice Response (IVR) system that informs debtors who to contact at your site for information regarding debts you are submitting to the Clearinghouse.
This form is required to begin participating and each year after. The form covers the period of September through the following December. The next year's participation form becomes available just prior to the annual training workshops which occur in September. This allows for the submission of debts at the end of a calendar year and continue for the entire next year. Note: if a local government does not submit this form by December 20, their debts will not be sent to the Department of Revenue and Education Lottery until the form is submitted.
For the September 2008 through December 2009 form: 2009 Participation Form
After submitting, if there are any changes to contacts, emails or phone numbers: 2009 Participation Form Changes
initial sign-up forms
All of these forms need to be sent to North Carolina League of Municipalities (cities and towns) or North Carolina Association of County Commissioners (counties and all others).
- Memorandum_of_Understanding.pdf
- Local_Agency_Certification.pdf
- Multiple Unit Collection Rider.pdf - for those other than counties and municipalities
- Inter Transfer Fund.pdf - Capital Management Trust of the Carolinas account set-up
other forms and documents
- Sample Resolution for Board Adoption.pdf - suggested that your Board is aware of your participation in the program
- Sample Notification - Appeals - Tracking.pdf - notification (due process) and appeals requirements, sample notification and appeals letters, hearing/appeals documents
- Business Associate Rider.pdf - required for all participants submitting or plan to submit EMS and/or Health debts - send to Kathy DeMay - 215 N. Dawson St, Raleigh 27603
Sample Notification Letters to Debtors
- Notification Letter-Basic 1.doc (Microsoft Word) Notification Letter-Basic 1.pdf
- Notification Letter-Basic 2.doc (Microsoft Word) Notification Letter-Basic 2.pdf
- Notification Letter-Detailed.doc (Microsoft Word) Notification Letter-Detailed.pdf
- Mail Merge Instructions - MSWord.pdf - detailed step-by-step instructions with screen captures for a mail merge using our client software and Microsoft Word 2003) to generate the notification letters
- Mail Merge Instructions Labels - MSWord.pdf - detailed step-by-step instructions with screen captures for a mail merge using our client software and Microsoft Word 2003) to generate envelope labels for the notification letters
Data Submission Options
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Spreadsheet - such as Microsoft Excel - Excel Sample.xls
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ASCII (standard for exchanging data among different computer systems) - from external billing/accounting systems or third-party vendors - ASCII Layout
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Hardcopy forms - for those who have a small number of debts with none or limited staff resources (free data entry for 50 debtors or less, call us to discuss) - Hardcopy Debt Submission.pdf
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Client software - provides the functions of entering debtors and debts. Integrated file transfers will send to computer system and also download once debtors are setoff by the Department of Revenue and/or the Education Lottery.