Follow the steps to complete the NC DHB-5097 online.

1. Click the ‘Get Form’ button to obtain the NC DHB-5097 form and open it in the editing interface.
2. Begin by entering the recipient's information in the 'To' section, including the county case number and district number.
3. Fill in the worker’s name and their telephone number to ensure that your information is directed to the correct caseworker.
4. Provide the full address associated with the application in the designated field.
5. Enter the date on which you are filling out the form.
6. Respond to the request for additional information by including all specified details to ensure your application is processed promptly.
7. For any required fields regarding income, make sure to accurately report your gross monthly income and any applicable deductibles for the relevant months.
8. Follow the instructions to attach necessary documentation, such as medical bills, proof of income, and other supporting documents as listed in the form.
9. Review the additional items and changes in your situation as requested, ensuring you provide accurate and truthful information.
10. Once all sections are completed and reviewed, save changes to the form and proceed to download, print, or share the completed document as needed.

Take action now and complete the NC DHB-5097 form online for your Medicaid or Special Assistance application.