Dma 5153-2026

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4.8 out of 5

142 votes

The document is a North Carolina Residency Applicant Declaration form used to verify an individual's residency for Medicaid eligibility. The applicant declares their inability to provide two residency verification documents and acknowledges the truthfulness of their statement, understanding the potential legal consequences of false declarations.

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Click ‘Get Form’ to open the dma 5153 in the editor.
Begin by entering the 'Case Name' and 'Case ID' at the top of the form. These fields are essential for identifying your application.
Next, fill in your 'Worker #' to ensure proper processing of your declaration.
In the declaration section, clearly state your name where indicated. This confirms your identity as the applicant.
Provide a brief explanation of why you cannot provide two residency verification documents in the designated area.
Sign and date the form at the bottom. Ensure that your signature is clear, as it validates your declaration.
Finally, enter your address and telephone number to complete your contact information for follow-up purposes.

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What is an NC residency declaration?

North Carolina Residency The Residency Determination Service (RDS) is the centralized system in North Carolina for determining residency for students. The state of North Carolina substantially subsidizes the cost of tuition for all students whose domicile, or permanent legal residence, is in North Carolina.

How to declare residency in NC?

To claim residency, you must submit a residency application to the North Carolina Residency Determination Service (RDS). They will provide you with a Residency Certification Number (RCN), which you can then provide as part of your application for admission.

What documents do you need for RDS?

Residency Determination Service (RDS) Drivers License or Non-Driver ID. Tax Return Information. Vehicle License Registration Information. Social Security Number. Voter Registration (if applicable) Immigration Documents (if applicable)

What is North Carolinas DMA?

The North Carolina Division of Medical Assistance (DMA) manages the Medicaid and Health Choice programs. Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors, and people with disabilities.

What is proof of residency for Medicaid in NC?

(1) A valid North Carolina drivers license or other identification card issued by the North Carolina Division of Motor Vehicles. (2) A current North Carolina rent or mortgage payment receipt, or current utility bill in the name of the applicant or the applicants legal spouse showing a North Carolina address.

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Why do you fill out the NC residency determination?

Residency determination establishes if students should have in-state or out-of-state tuition. Because North Carolina residency status is governed solely by North Carolina statute, lack of eligibility for in-state status in another state does not guarantee in-state status in North Carolina.