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Designed to accommodate citizens unable to travel due to medical conditions, the form captures essential personal identification information, residency details, and contact preferences. It requires applicants to confirm their homebound status, verify the availability of supporting medical documentation, and provide consent for virtual or in-person interactions with DMV representatives. The application facilitates a streamlined communication process between the applicant and the Central Issuance Unit, ensuring that those with limited mobility can access necessary DMV services through direct coordination and verification. The document also includes internal administrative sections for DMV staff to track the receipt and processing method of each request.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":57,"@type":76,"position":81},"https://docshare.wps.com/document/general/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/north-carolina-division-of-motor-vehicles-homebound-service-request-application/308560/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/north-carolina-division-of-motor-vehicles-homebound-service-request-application/308560.png","ImageObject",300,407,{"name":92,"@type":93},"\tCallum ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-20","2026-09-20",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",17,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Who should fill out this form?","Question",{"text":113,"@type":114},"This form is intended for individuals who are rendered homebound due to an illness and wish to request services from the North Carolina Division of Motor Vehicles.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What documentation is required to support this request?",{"text":118,"@type":114},"Applicants must be able to provide supporting medical documentation to verify their homebound status as a prerequisite for service consideration.",{"name":120,"@type":111,"acceptedAnswer":121},"How can the completed application be submitted?",{"text":122,"@type":114},"The application should be submitted via email to homebound@ncdot.gov or faxed to the NCDMV Central Issuance Unit at (919) 615-7289.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},308560,1790012095,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":56,"category_name":57,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":14},137451211410,"https://ap-avatar.wpscdn.com/avatar/2000bb0a9246f588df?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786362646172706240","NGSDLS-005-Application/ Customer Request Rev. 07/21/2025  \nNorth Carolina Division of Motor Vehicles  \nHomebound Service Request  \n1. Are you rendered “Homebound” due to an illness? Yes No  \n2. Can you provide supporting Medical Documentation? Yes No  \n3. Do you consent to a home or Virtual visit with a DMV representative? Yes No  \n4. Have you ever had an issuance from the North Carolina DMV? Yes No  \n5. Name:  \n6. Date of Birth:  \n7. Residence Address:  \n8. County:  \n9. Point of Contact:  \n10. Telephone Number:  \n11. Email Address:  \nPlease submit this application via email to [homebound@ncdot.gov](homebound@ncdot.gov) or fax to NCDMV– Central Issuance Unit at (919) 615-7289. Upon receipt of the completed application, the point of contact will be contacted by a customer service representative to confirm if the requirements have been  \nmet.  \n(To Be Completed By DMV)  \nRequest received via: Phone: Email:","cbCaitKvQrvlomvx","https://ap.wps.com/l/cbCaitKvQrvlomvx","pdf",224958,"English","# Homebound Service Request Form\n## Applicant Information\n## Submission and Processing Procedures","[{\"question\":\"Who should fill out this form?\",\"answer\":\"This form is intended for individuals who are rendered homebound due to an illness and wish to request services from the North Carolina Division of Motor Vehicles.\"},{\"question\":\"What documentation is required to support this request?\",\"answer\":\"Applicants must be able to provide supporting medical documentation to verify their homebound status as a prerequisite for service consideration.\"},{\"question\":\"How can the completed application be submitted?\",\"answer\":\"The application should be submitted via email to homebound@ncdot.gov or faxed to the NCDMV Central Issuance Unit at (919) 615-7289.\"}]","North Carolina Division of Motor Vehicles - Homebound Service Request Application | PDF",1789869625]