Dma 5152-2026

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The document is a North Carolina Residency Declaration form used to verify an individual's residency in North Carolina. It requires the applicant's name, physical address, and a declaration of their intent to reside in the state or their job commitment. The form must be signed by a declarant who attests to the accuracy of the information provided.

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Click ‘Get Form’ to open the dma 5152 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 the Worker Number, which helps link your case to a specific worker within the North Carolina Department of Social Services.
In the residency declaration section, provide the Applicant's Name and their physical address. This information confirms their residency status in North Carolina.
Indicate whether the applicant intends to reside in North Carolina or if they entered with a job commitment by checking the appropriate box.
Finally, ensure that you sign and date the form. Include your relationship to the applicant and provide a contact telephone number for any follow-up.

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What is proof of residency for Medicaid in NC?

Income Asset Limits for Eligibility April 2025 March 2026 North Carolina Medicaid Long-Term Care Eligibility for Seniors Type of MedicaidSingleMarried (both spouses applying) Regular Medicaid / Aged Blind and Disabled $1,305 / month $1,763 / month3 more rows Jul 28, 2025

What documents are needed for Medicaid in NC?

State residency for individuals who are not living in an institution and are age 21 or over is generally defined as the state in which the individual is living and intends to reside. An individual does not need to have a fixed address.