Administrative Hearing Request Packet - North Carolina

NORTH CAROLINA ADMINISTRATIVE HEARING REQUEST PACKET

Office of Administrative Hearings (OAH) Contested Case Proceedings

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PART ONE: PRELIMINARY INFORMATION AND CHECKLIST

Section 1.1: Case Intake Information

Petitioner Information:

Full Legal Name: [________________________________]

Street Address: [________________________________]

City: [________________________________] State: NC ZIP: [__________]

Mailing Address (if different): [________________________________]

Telephone: [________________________________]

Email Address: [________________________________]

Business Entity Information (if applicable):

☐ Individual / Natural Person
☐ Corporation
☐ Limited Liability Company (LLC)
☐ Partnership
☐ Sole Proprietorship
☐ Other: [________________________________]

State of Formation: [________________________________]

NC Registration/ID Number: [________________________________]

Respondent Agency Information:

Agency Name: [________________________________]

Agency Address: [________________________________]

Contact Person (if known): [________________________________]

Agency Telephone: [________________________________]

Agency Case/Reference Number: [________________________________]

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Section 1.2: Agency Decision Being Contested

Nature of Agency Action:

☐ License denial
☐ License revocation
☐ License suspension
☐ Permit denial or revocation
☐ Civil penalty assessment
☐ Fine imposition
☐ Benefits denial or termination
☐ Adverse employment action
☐ Medicaid provider action
☐ Environmental enforcement action
☐ Other agency action: [________________________________]

Date of Agency Decision: [__/__/____]

Date Written Notice Received: [__/__/____]

Method of Notice Receipt:

☐ Personal delivery
☐ United States mail
☐ Certified mail
☐ Email
☐ Other: [________________________________]

60-Day Filing Deadline: [__/__/____]

Alternative Statutory Deadline (if applicable): [__/__/____]

Statutory Basis for Alternative Deadline: [________________________________]

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Section 1.3: Article 3 vs. Article 3A Determination

CRITICAL DETERMINATION: The applicable article governs all procedural requirements.

Article 3 (N.C.G.S. § 150B-22 through 150B-37) applies to:

• Most state administrative agencies
• Cases heard by Administrative Law Judges (ALJs) at OAH
• ALJ issues final decision (for cases filed on or after January 1, 2012)

Article 3A (N.C.G.S. § 150B-38 through 150B-42) applies to:

• Occupational licensing boards (as defined by N.C.G.S. § 93B-1)
• Department of Insurance / Commissioner of Insurance
• State Banking Commission / Commissioner of Banks
• Credit Union Division of the Department of Commerce
• State Chief Information Officer (Article 15 of Chapter 143B matters)
• NC State Building Code Council and Residential Code Council
• Office of the State Fire Marshal

This case is governed by:

☐ Article 3 - Hearing before OAH Administrative Law Judge
☐ Article 3A - Hearing before the agency/board that issued the decision

Key Procedural Differences:

Procedure	Article 3	Article 3A
Hearing Officer	OAH Administrative Law Judge	Agency/Board Members
Final Decision Maker	ALJ (cases filed 1/1/2012+)	Agency/Board
Procedural Rules	Detailed in statute	Less detailed; agency rules apply
Discovery	Full NC Rules of Civil Procedure	As permitted by agency
Subpoena Authority	ALJ issues subpoenas	Agency issues subpoenas

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Section 1.4: Pre-Filing Checklist

Before Filing the Petition:

☐ Confirmed filing deadline (60 days from notice or alternative statutory period)
☐ Determined whether Article 3 or Article 3A applies
☐ Reviewed agency notice for specific appeal instructions
☐ Attempted informal settlement with agency (N.C.G.S. § 150B-22)
☐ Gathered all documentation of agency decision
☐ Prepared filing fee ($125.00) or completed Indigent Status Petition Form
☐ Identified all parties to be served
☐ Determined representation status (attorney or authorized non-attorney)

Documents to Compile:

☐ Original agency decision/notice
☐ All correspondence with agency
☐ Documents submitted to agency during initial proceeding
☐ Evidence supporting challenge to agency action
☐ Any previous administrative hearing records
☐ Witness contact information
☐ Timeline of relevant events

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PART TWO: PETITION FOR CONTESTED CASE HEARING

Form OAH-P: Petition for Contested Case Hearing

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STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,
	PETITION FOR
v.	CONTESTED CASE HEARING
[________________________________],
Respondent Agency.

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I. PARTIES

1. Petitioner [________________________________] is a [individual/corporation/LLC/other: ________________] with a principal address at [________________________________], City of [________________________________], County of [________________________________], North Carolina [__________].

2. Respondent [________________________________] is a North Carolina state agency with offices located at [________________________________].

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II. JURISDICTION AND VENUE

3. This contested case is brought pursuant to Article [____] of Chapter 150B of the North Carolina General Statutes.

4. The Office of Administrative Hearings has jurisdiction over this matter pursuant to N.C.G.S. § 150B-23.

5. Petitioner has standing to bring this contested case as a person aggrieved by the agency action described herein.

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III. TIMELINESS

6. On [__/__/____], Respondent issued [a decision/notice/order] regarding [________________________________].

7. Petitioner received written notice of Respondent's decision on [__/__/____].

8. This Petition is filed within [60 days / the time period specified by [statutory citation]: ____________________] of Petitioner's receipt of notice, as required by N.C.G.S. § 150B-23(f).

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IV. FACTUAL BACKGROUND

9. [State facts establishing the nature of the dispute and Petitioner's interest]:

[________________________________]

[________________________________]

[________________________________]

10. On or about [__/__/____], Petitioner [applied for / held / was subject to]: [________________________________].

11. On [__/__/____], Respondent [denied / revoked / suspended / assessed / imposed]: [________________________________].

12. The basis stated by Respondent for its action was: [________________________________]

[________________________________]

13. Additional relevant facts include:

a. [________________________________]

b. [________________________________]

c. [________________________________]

d. [________________________________]

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V. AGENCY ACTION CAUSING SUBSTANTIAL PREJUDICE

14. Pursuant to N.C.G.S. § 150B-23(a), Petitioner alleges that Respondent has:

☐ Deprived Petitioner of property, specifically: [________________________________]

☐ Ordered Petitioner to pay a fine or civil penalty in the amount of: $[________________]

☐ Otherwise substantially prejudiced Petitioner's rights, specifically: [________________________________]

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VI. GROUNDS FOR REVERSAL

15. Pursuant to N.C.G.S. § 150B-23(a), Petitioner alleges that Respondent committed one or more of the following errors:

☐ Exceeded its authority or jurisdiction. Specifically: [________________________________]

[________________________________]

☐ Acted erroneously. Specifically: [________________________________]

[________________________________]

☐ Failed to use proper procedure. Specifically: [________________________________]

[________________________________]

☐ Acted arbitrarily or capriciously. Specifically: [________________________________]

[________________________________]

☐ Failed to act as required by law or rule. Specifically: [________________________________]

[________________________________]

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VII. STATEMENT OF ISSUES

16. The following issues are presented for determination in this contested case:

a. [________________________________]

b. [________________________________]

c. [________________________________]

d. [________________________________]

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VIII. RELIEF REQUESTED

17. WHEREFORE, Petitioner respectfully requests that the Administrative Law Judge:

☐ Reverse the decision of Respondent;

☐ Vacate the [penalty/fine/assessment] imposed by Respondent;

☐ Order Respondent to [issue/reinstate/restore] [________________________________];

☐ Order Respondent to refund $[________________] paid by Petitioner;

☐ Stay the agency action pending resolution of this contested case;

☐ Award Petitioner reasonable attorneys' fees and costs pursuant to [________________________________];

☐ Grant such other and further relief as the Administrative Law Judge deems just and proper.

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IX. MEDIATED SETTLEMENT CONFERENCE REQUEST

18. ☐ Petitioner requests that a mediated settlement conference be scheduled pursuant to N.C.G.S. § 150B-23.1.

☐ Petitioner does not request a mediated settlement conference at this time but reserves the right to request one.

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X. REPRESENTATION

If represented by attorney:

This Petition is submitted by:

Attorney Name: [________________________________]

North Carolina State Bar Number: [________________]

Firm Name: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

Facsimile: [________________________________]

Email: [________________________________]

If business entity represented by non-attorney (N.C.G.S. § 150B-23(b)):

☐ Officer of the corporation
☐ Manager or member-manager of LLC
☐ Employee with written authorization (attach authorization)
☐ Owner with 25% or greater interest with written authorization (attach authorization)

Non-Attorney Representative Name: [________________________________]

Title/Position: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

Email: [________________________________]

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XI. SIGNATURE AND VERIFICATION

I, [________________________________], [Petitioner / Attorney for Petitioner / Authorized Representative], hereby verify that the statements contained in this Petition are true and accurate to the best of my knowledge, information, and belief.

Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

NC State Bar No. (if attorney): [________________]

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XII. CERTIFICATE OF SERVICE

I hereby certify that on [__/__/____], I served a copy of this Petition for Contested Case Hearing on the following parties by the method indicated:

Respondent Agency:

Name: [________________________________]

Address: [________________________________]

☐ U.S. Mail, postage prepaid
☐ Certified Mail, Return Receipt Requested
☐ Hand Delivery
☐ Email to: [________________________________]
☐ Facsimile to: [________________________________]

Additional Parties (if applicable):

Name: [________________________________]

Address: [________________________________]

Method: ☐ U.S. Mail ☐ Certified Mail ☐ Hand Delivery ☐ Email ☐ Facsimile

Signature: [________________________________]

Date: [__/__/____]

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PART THREE: FILING FEE AND INDIGENT STATUS

Section 3.1: Filing Fee Information

Standard Filing Fee: $125.00 (N.C.G.S. § 150B-23.2)

Payment Methods:

• Check payable to "NC Office of Administrative Hearings"
• Money order
• Electronic payment through e-OAH portal

Fee Assessment: The Administrative Law Judge has authority to assess the filing fee against the losing party in the final decision.

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Section 3.2: Indigent Status Petition (OAH Form)

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

PETITION FOR INDIGENT STATUS AND WAIVER OF FILING FEE

[________________________________],
Petitioner,	Case No. [________________]
v.
[________________________________],
Respondent Agency.

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I, [________________________________], hereby petition for a determination of indigent status and waiver of the filing fee required by N.C.G.S. § 150B-23.2, and in support thereof state as follows:

A. Personal Information

Full Legal Name: [________________________________]

Current Address: [________________________________]

Telephone: [________________________________]

Date of Birth: [__/__/____]

Social Security Number (last 4 digits): XXX-XX-[____]

B. Household Information

Number of persons in household: [____]

Names and ages of dependents:

Name	Age	Relationship
[________________________________]	[____]	[________________]
[________________________________]	[____]	[________________]
[________________________________]	[____]	[________________]
[________________________________]	[____]	[________________]

C. Income Information

Monthly Gross Income (before deductions):

Source	Monthly Amount
Employment wages/salary	$[________________]
Self-employment income	$[________________]
Social Security benefits	$[________________]
Disability benefits	$[________________]
Unemployment benefits	$[________________]
Pension/retirement income	$[________________]
Public assistance (TANF, etc.)	$[________________]
Child support/alimony received	$[________________]
Other income: [________________]	$[________________]
TOTAL MONTHLY GROSS INCOME	$[________________]

D. Asset Information

Asset Type	Estimated Value
Cash on hand	$[________________]
Checking account balance	$[________________]
Savings account balance	$[________________]
Stocks, bonds, investments	$[________________]
Real estate equity (excluding primary residence)	$[________________]
Vehicle equity	$[________________]
Other assets: [________________]	$[________________]
TOTAL ASSETS	$[________________]

E. Monthly Expense Information

Expense Type	Monthly Amount
Rent or mortgage payment	$[________________]
Utilities (electric, gas, water)	$[________________]
Telephone/internet	$[________________]
Food	$[________________]
Medical expenses/insurance	$[________________]
Transportation	$[________________]
Child care	$[________________]
Child support/alimony paid	$[________________]
Other necessary expenses: [________________]	$[________________]
TOTAL MONTHLY EXPENSES	$[________________]

F. Declaration

☐ I am currently receiving public assistance through: [________________________________]

☐ I am represented by legal aid or pro bono counsel.

☐ Payment of the $125.00 filing fee would impose a financial hardship on me and my household.

I declare under penalty of perjury that the information provided above is true and correct to the best of my knowledge.

Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

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PART FOUR: NOTICE OF APPEARANCE

Form: Notice of Appearance of Counsel

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	NOTICE OF APPEARANCE
[________________________________],
Respondent Agency.

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TO THE OFFICE OF ADMINISTRATIVE HEARINGS AND ALL PARTIES:

Please take notice that the undersigned attorney hereby enters an appearance on behalf of [☐ Petitioner / ☐ Respondent] [________________________________] in the above-captioned contested case.

All pleadings, notices, and other documents in this matter should be served upon the undersigned at the address set forth below.

Attorney Information:

Name: [________________________________]

North Carolina State Bar Number: [________________]

Firm Name: [________________________________]

Street Address: [________________________________]

Mailing Address: [________________________________]

Telephone: [________________________________]

Facsimile: [________________________________]

Email: [________________________________]

☐ I consent to electronic service via the email address provided above.

☐ I am registered for electronic filing through e-OAH.

Respectfully submitted,

Signature: [________________________________]

Date: [__/__/____]

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Certificate of Service

I hereby certify that on [__/__/____], I served a copy of this Notice of Appearance on all parties by:

☐ U.S. Mail ☐ Email ☐ Facsimile ☐ Hand Delivery ☐ e-OAH filing

Signature: [________________________________]

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PART FIVE: NOTICE OF NON-ATTORNEY REPRESENTATION

Form: Notice of Non-Attorney Representation (Business Entities)

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	NOTICE OF NON-ATTORNEY
[________________________________],	REPRESENTATION
Respondent Agency.

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Pursuant to N.C.G.S. § 150B-23(b), [________________________________] (the "Business Entity") hereby provides notice that it will be represented in this contested case by a non-attorney representative as permitted by law.

A. Business Entity Information

Legal Name: [________________________________]

Entity Type: ☐ Corporation ☐ LLC ☐ Partnership ☐ Other: [________________]

State of Formation: [________________________________]

NC Secretary of State ID: [________________________________]

Principal Business Address: [________________________________]

B. Non-Attorney Representative Information

Name: [________________________________]

Title/Position: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

Email: [________________________________]

C. Basis for Representation (select one)

☐ Corporate Officer - I am an officer of the corporation.

Title: [________________________________]

☐ LLC Manager/Member-Manager - I am a manager or member-manager of the limited liability company.

☐ Authorized Employee - I am an employee who has been granted written authority by an officer, managing agent, general partner, or member-manager to represent the business entity in this matter.

(Attach written authorization)

☐ Owner with 25% or Greater Interest - I own 25% or more of the business entity and have been granted written authority by an officer, managing agent, general partner, or member-manager to represent the entity in this matter.

Ownership Percentage: [____]%

(Attach written authorization)

D. Acknowledgment

I understand that by representing this business entity, I am not engaging in the unauthorized practice of law and that my authority to represent the entity is limited to the specific contested case referenced above.

I further understand that I am responsible for complying with all rules and procedures of the Office of Administrative Hearings and that failure to do so may adversely affect the business entity's case.

Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

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PART SIX: DISCOVERY PROCEDURES

Section 6.1: Discovery Overview (26 NCAC 03 .0112)

Permissible Discovery Methods:
All discovery methods available under the North Carolina Rules of Civil Procedure (N.C.G.S. § 1A-1) are permitted, including:

☐ Interrogatories (Rule 33)
☐ Requests for Production of Documents (Rule 34)
☐ Requests for Admission (Rule 36)
☐ Depositions upon Oral Examination (Rule 30)
☐ Depositions upon Written Questions (Rule 31)
☐ Physical/Mental Examinations (Rule 35)

Discovery Timeline:

• Discovery deadline set in Scheduling Order (at least 2 weeks before hearing)
• Response to discovery requests due within 15 days
• Parties must exhaust informal discovery opportunities first

Discovery Response Options (within 15 days):

1. Provide the requested information/materials
2. Move for relief from the request
3. Offer a schedule for reasonable compliance

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Section 6.2: Interrogatories

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	PETITIONER'S FIRST SET OF
[________________________________],	INTERROGATORIES TO RESPONDENT
Respondent Agency.

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Pursuant to N.C.G.S. § 150B-27 and Rule 33 of the North Carolina Rules of Civil Procedure, [Petitioner/Respondent] [________________________________] hereby propounds the following interrogatories to [Petitioner/Respondent] [________________________________], to be answered separately and fully, in writing, under oath, within fifteen (15) days of service.

DEFINITIONS

For purposes of these Interrogatories:

1. "Document" means any writing, recording, or photograph, including electronically stored information.

2. "Communication" means any oral or written exchange of information.

3. "You" or "Your" refers to the party to whom these interrogatories are directed and includes agents and employees.

4. "Agency Decision" refers to the [decision/notice/order] dated [__/__/____] that is the subject of this contested case.

INTERROGATORIES

INTERROGATORY NO. 1: Identify all persons who participated in making the Agency Decision, including their names, titles, and roles in the decision-making process.

ANSWER:

[________________________________]

[________________________________]

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INTERROGATORY NO. 2: Describe all documents, records, and other materials reviewed or relied upon in making the Agency Decision.

ANSWER:

[________________________________]

[________________________________]

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INTERROGATORY NO. 3: State the factual basis for each ground cited in the Agency Decision for the action taken against Petitioner.

ANSWER:

[________________________________]

[________________________________]

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INTERROGATORY NO. 4: Identify all witnesses the Respondent intends to call at the contested case hearing, including their names, addresses, and a summary of their anticipated testimony.

ANSWER:

[________________________________]

[________________________________]

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INTERROGATORY NO. 5: Describe all communications between Respondent and any third parties concerning Petitioner or the subject matter of the Agency Decision.

ANSWER:

[________________________________]

[________________________________]

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INTERROGATORY NO. 6: State whether Respondent contends that Petitioner violated any statute, rule, or regulation, and if so, identify each such statute, rule, or regulation with specificity.

ANSWER:

[________________________________]

[________________________________]

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INTERROGATORY NO. 7: Describe the investigation or review process that led to the Agency Decision, including dates, methods, and persons involved.

ANSWER:

[________________________________]

[________________________________]

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INTERROGATORY NO. 8: [Additional interrogatory]: [________________________________]

ANSWER:

[________________________________]

[________________________________]

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Respectfully submitted,

Signature: [________________________________]

Printed Name: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

NC State Bar No.: [________________]

Date: [__/__/____]

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Section 6.3: Request for Production of Documents

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	PETITIONER'S FIRST REQUEST
[________________________________],	FOR PRODUCTION OF DOCUMENTS
Respondent Agency.

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Pursuant to N.C.G.S. § 150B-27 and Rule 34 of the North Carolina Rules of Civil Procedure, [Petitioner/Respondent] [________________________________] requests that [Petitioner/Respondent] [________________________________] produce the following documents for inspection and copying within fifteen (15) days of service of this request.

INSTRUCTIONS

1. Documents shall be produced as kept in the ordinary course of business.

2. If any document is withheld on the basis of privilege, provide a privilege log identifying the document, its date, author, recipients, subject matter, and the privilege claimed.

3. If any responsive document has been lost, destroyed, or is otherwise unavailable, describe the document and explain the circumstances.

REQUESTS FOR PRODUCTION

REQUEST NO. 1: All documents constituting or relating to the Agency Decision, including but not limited to internal memoranda, reports, analyses, and recommendations.

RESPONSE:

[________________________________]

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REQUEST NO. 2: The complete administrative file or record concerning Petitioner and/or the subject matter of the Agency Decision.

RESPONSE:

[________________________________]

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REQUEST NO. 3: All correspondence, emails, and other communications between Respondent and Petitioner concerning the subject matter of the Agency Decision.

RESPONSE:

[________________________________]

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REQUEST NO. 4: All documents identified in Respondent's answers to Petitioner's Interrogatories.

RESPONSE:

[________________________________]

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REQUEST NO. 5: All policies, procedures, guidelines, or manuals applicable to the type of agency action at issue in this contested case.

RESPONSE:

[________________________________]

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REQUEST NO. 6: All documents Respondent intends to introduce as exhibits at the contested case hearing.

RESPONSE:

[________________________________]

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REQUEST NO. 7: All documents relating to investigations, audits, or reviews of Petitioner conducted by Respondent.

RESPONSE:

[________________________________]

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REQUEST NO. 8: [Additional request]: [________________________________]

RESPONSE:

[________________________________]

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Respectfully submitted,

Signature: [________________________________]

Printed Name: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

NC State Bar No.: [________________]

Date: [__/__/____]

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Section 6.4: Motion to Compel Discovery

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	MOTION TO COMPEL DISCOVERY
[________________________________],
Respondent Agency.

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[Petitioner/Respondent] [________________________________], pursuant to N.C.G.S. § 150B-33 and 26 NCAC 03 .0112, respectfully moves the Administrative Law Judge to enter an Order compelling [Petitioner/Respondent] to respond to discovery, and in support states:

I. BACKGROUND

1. On [__/__/____], [Movant] served [Interrogatories / Requests for Production / Requests for Admission / Notice of Deposition] on [Opposing Party].

2. [Opposing Party's] response was due on [__/__/____].

3. As of the date of this Motion:

☐ [Opposing Party] has failed to respond to the discovery requests.

☐ [Opposing Party] has provided an incomplete response.

☐ [Opposing Party] has objected to the discovery requests without valid basis.

☐ [Opposing Party] has refused to comply with the discovery requests.

II. DISCOVERY AT ISSUE

4. The specific discovery requests at issue are:

[________________________________]

[________________________________]

5. [Opposing Party's] deficient response or objection was:

[________________________________]

[________________________________]

III. GOOD FAITH EFFORTS

6. Pursuant to 26 NCAC 03 .0112, [Movant] certifies that it has made good faith efforts to resolve this discovery dispute, including:

[________________________________]

[________________________________]

IV. GROUNDS FOR COMPELLING DISCOVERY

7. The discovery sought is:

☐ Needed for the proper presentation of [Movant's] case;
☐ Not sought for purposes of delay;
☐ Significant to the issues in controversy.

8. The specific reasons why the discovery should be compelled are:

[________________________________]

[________________________________]

V. RELIEF REQUESTED

WHEREFORE, [Movant] respectfully requests that the Administrative Law Judge:

a. Enter an Order compelling [Opposing Party] to fully respond to the discovery requests within [____] days;

b. Award [Movant] reasonable expenses, including attorneys' fees, incurred in bringing this Motion;

c. Impose such other sanctions as the ALJ deems appropriate pursuant to N.C.G.S. § 150B-33.

Respectfully submitted,

Signature: [________________________________]

Printed Name: [________________________________]

NC State Bar No.: [________________]

Date: [__/__/____]

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PART SEVEN: SUBPOENAS

Section 7.1: Subpoena Information

Authority: N.C.G.S. § 150B-25, 150B-33(b)(1); 26 NCAC 03 .0121-.0122

Types of Subpoenas:

• Subpoena for witness appearance at hearing
• Subpoena for deposition
• Subpoena duces tecum (production of documents/things)

Who May Serve:

• Sheriff or deputy sheriff
• Any person 18 years of age or older who is not a party to the case

Methods of Service:

• Personal delivery to the witness
• Leaving at witness's dwelling house or usual place of abode with person of suitable age and discretion

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Section 7.2: Subpoena Form (OAH Form H-05)

STATE OF NORTH CAROLINA
OFFICE OF ADMINISTRATIVE HEARINGS

SUBPOENA
☐ For Witness Appearance
☐ For Deposition
☐ Duces Tecum (Document Production)

Case No.: [________________]

[________________________________],
Petitioner,
v.
[________________________________],
Respondent.

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TO: [________________________________] (Name of Witness)

[________________________________] (Address)

[________________________________] (City, State, ZIP)

YOU ARE COMMANDED to appear before Administrative Law Judge [________________________________] at the Office of Administrative Hearings, [________________________________], on [__/__/____] at [____:____ ☐ AM ☐ PM], to testify in the above-entitled contested case on behalf of [☐ Petitioner / ☐ Respondent].

☐ DUCES TECUM: You are further commanded to bring with you and produce at said time and place the following documents, records, or items:

[________________________________]

[________________________________]

[________________________________]

[________________________________]

☐ FOR DEPOSITION: You are commanded to appear for a deposition at [________________________________] (location), on [__/__/____] at [____:____ ☐ AM ☐ PM].

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WITNESS FEE INFORMATION:

Pursuant to N.C.G.S. § 150B-25, a witness subpoenaed to attend a hearing is entitled to the same fees as a witness in civil actions in the superior courts.

Current witness fee: $[________________] per day
Mileage: $[________________] per mile

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FAILURE TO COMPLY:

Failure to obey this subpoena may be punishable as contempt and may subject you to penalties as provided by law.

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ISSUED BY:

Administrative Law Judge: [________________________________]

OR

Attorney for [☐ Petitioner / ☐ Respondent]: [________________________________]

NC State Bar No.: [________________]

Address: [________________________________]

Telephone: [________________________________]

Date Issued: [__/__/____]

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Section 7.3: Proof of Service of Subpoena

PROOF OF SERVICE

I, [________________________________], being at least 18 years of age and not a party to this action, certify that I served the foregoing Subpoena on [________________________________] (name of witness) on [__/__/____] by:

☐ Personal Service - delivering a copy of the Subpoena directly to the witness at [________________________________] (location).

☐ Substituted Service - leaving a copy at the witness's dwelling house or usual place of abode at [________________________________] (address) with [________________________________] (name), a person of suitable age and discretion residing therein.

☐ Witness fees in the amount of $[________________] were tendered at the time of service.

☐ Witness fees were not tendered.

Server's Signature: [________________________________]

Server's Printed Name: [________________________________]

Server's Address: [________________________________]

Date: [__/__/____]

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PART EIGHT: PREHEARING PROCEDURES

Section 8.1: Prehearing Statement

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	PREHEARING STATEMENT OF
[________________________________],	[PETITIONER/RESPONDENT]
Respondent Agency.

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Pursuant to 26 NCAC 03 .0108 and the Scheduling Order entered in this matter, [Petitioner/Respondent] [________________________________] submits the following Prehearing Statement:

I. NATURE OF PROCEEDING

1. This is a contested case arising from [________________________________].

2. The agency action being challenged is [________________________________].

3. The hearing is governed by ☐ Article 3 / ☐ Article 3A of Chapter 150B.

II. FACTUAL CONTENTIONS

4. [Petitioner/Respondent] contends that the following facts are material to this case:

a. [________________________________]

b. [________________________________]

c. [________________________________]

d. [________________________________]

e. [________________________________]

III. LEGAL ISSUES

5. The legal issues to be determined in this case include:

a. [________________________________]

b. [________________________________]

c. [________________________________]

IV. STIPULATED FACTS

6. The parties have stipulated to the following facts:

a. [________________________________]

b. [________________________________]

c. [________________________________]

☐ No stipulations have been reached.

V. WITNESS LIST

7. [Petitioner/Respondent] intends to call the following witnesses at the hearing:

Witness Name	Address/Contact	Summary of Expected Testimony
[________________________________]	[________________________________]	[________________________________]
[________________________________]	[________________________________]	[________________________________]
[________________________________]	[________________________________]	[________________________________]
[________________________________]	[________________________________]	[________________________________]
[________________________________]	[________________________________]	[________________________________]

VI. EXHIBIT LIST

8. [Petitioner/Respondent] intends to offer the following exhibits:

Exhibit No.	Description	Pages
[____]	[________________________________]	[____]
[____]	[________________________________]	[____]
[____]	[________________________________]	[____]
[____]	[________________________________]	[____]
[____]	[________________________________]	[____]
[____]	[________________________________]	[____]

VII. DISCOVERY STATUS

9. ☐ All discovery has been completed.

☐ The following discovery remains outstanding: [________________________________]

VIII. PENDING MOTIONS

10. ☐ There are no pending motions.

☐ The following motions are pending: [________________________________]

IX. ESTIMATED HEARING TIME

11. [Petitioner/Respondent] estimates that [____] hours / [____] days will be required for its presentation of evidence.

X. SETTLEMENT STATUS

12. ☐ Settlement discussions are ongoing.

☐ The case has not settled.

☐ A mediated settlement conference ☐ has been / ☐ has not been conducted.

XI. SPECIAL MATTERS

13. [Petitioner/Respondent] brings the following special matters to the ALJ's attention:

☐ Need for interpreter (language: [________________________________])
☐ Disability accommodations required: [________________________________]
☐ Sequestration of witnesses requested
☐ Expert witness(es) will testify
☐ Other: [________________________________]

XII. VENUE

14. ☐ [Petitioner/Respondent] has no objection to the hearing being held in Wake County.

☐ [Petitioner/Respondent] requests that the hearing be held in [________________________________] County for the following reasons: [________________________________]

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Respectfully submitted,

Signature: [________________________________]

Printed Name: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

NC State Bar No.: [________________]

Date: [__/__/____]

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Certificate of Service

I certify that on [__/__/____], I served a copy of this Prehearing Statement on:

[________________________________]

by: ☐ U.S. Mail ☐ Email ☐ Facsimile ☐ Hand Delivery ☐ e-OAH

Signature: [________________________________]

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Section 8.2: Final Prehearing Order (Joint Submission)

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	FINAL PREHEARING ORDER
[________________________________],
Respondent Agency.

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The parties, through counsel, submit this Final Prehearing Order pursuant to 26 NCAC 03 .0108:

A. ATTORNEYS OF RECORD

For Petitioner:

[________________________________], NC State Bar No. [________________]

[________________________________] (Firm)

[________________________________] (Address)

[________________________________] (Phone/Email)

For Respondent:

[________________________________], NC State Bar No. [________________]

[________________________________] (Agency/Firm)

[________________________________] (Address)

[________________________________] (Phone/Email)

B. STIPULATED FACTS

The parties stipulate to the following facts:

1. [________________________________]

2. [________________________________]

3. [________________________________]

C. CONTESTED ISSUES OF FACT

The following issues of fact are in dispute:

1. [________________________________]

2. [________________________________]

3. [________________________________]

D. CONTESTED ISSUES OF LAW

The following issues of law are in dispute:

1. [________________________________]

2. [________________________________]

E. PETITIONER'S WITNESSES AND EXHIBITS

Witnesses:
| Name | Expected Testimony |
|------|-------------------|
| [________________________________] | [________________________________] |
| [________________________________] | [________________________________] |

Exhibits:
| No. | Description |
|-----|-------------|
| P-[____] | [________________________________] |
| P-[____] | [________________________________] |

F. RESPONDENT'S WITNESSES AND EXHIBITS

Witnesses:
| Name | Expected Testimony |
|------|-------------------|
| [________________________________] | [________________________________] |
| [________________________________] | [________________________________] |

Exhibits:
| No. | Description |
|-----|-------------|
| R-[____] | [________________________________] |
| R-[____] | [________________________________] |

G. JOINT EXHIBITS

No.	Description
J-[____]	[________________________________]
J-[____]	[________________________________]

H. ESTIMATED HEARING TIME

Petitioner: [____] hours
Respondent: [____] hours
Total Estimated Time: [____] hours / [____] days

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FOR PETITIONER:

Signature: [________________________________]
Date: [__/__/____]

FOR RESPONDENT:

Signature: [________________________________]
Date: [__/__/____]

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IT IS SO ORDERED:

Administrative Law Judge: [________________________________]
Date: [__/__/____]

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PART NINE: SETTLEMENT CONFERENCE AND MEDIATION

Section 9.1: Mediated Settlement Conference Overview

Authority: N.C.G.S. § 150B-23.1; 26 NCAC 03 .0301-.0308

When Required: The Chief ALJ may order a mediated settlement conference within 10 days of the petition being filed.

Party Request: Either party may request a mediated settlement conference at any time.

Mediator Selection:

• Parties have 21 days to agree on a certified mediator
• If no agreement, the ALJ appoints a mediator
• Mediator must be certified by the NC Dispute Resolution Commission

Timeline: Conference held 90-120 days after mediation order

Location: Typically held at the county courthouse in the county where the hearing will be held

Required Attendance:

• Parties personally (not just through counsel)
• For corporations: officer, director, or employee with settlement authority
• For government agencies: representative with settlement authority

Costs: Parties pay the cost of mediation (mediator's fee split equally unless otherwise agreed)

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Section 9.2: Designation of Mediator Form

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	DESIGNATION OF MEDIATOR
[________________________________],
Respondent Agency.

---

Pursuant to 26 NCAC 03 .0303, the parties hereby designate the following mediator for the mediated settlement conference in this matter:

Mediator Information:

Name: [________________________________]

NC Dispute Resolution Commission Certification No.: [________________]

Address: [________________________________]

Telephone: [________________________________]

Email: [________________________________]

Mediator's Hourly Rate: $[________________]

The parties agree that the mediator's fee shall be:

☐ Split equally between the parties
☐ Allocated as follows: [________________________________]

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FOR PETITIONER:

Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

FOR RESPONDENT:

Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

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Section 9.3: Report of Mediator

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	REPORT OF MEDIATOR
[________________________________],
Respondent Agency.

---

I, [________________________________], the mediator appointed/selected in this matter, report as follows:

A. Conference Information

Date(s) of Mediated Settlement Conference: [__/__/____]

Location: [________________________________]

Duration: [____] hours

B. Attendance

For Petitioner:

☐ Petitioner attended in person
☐ Petitioner's counsel attended: [________________________________]
☐ Other attendee(s): [________________________________]

For Respondent:

☐ Respondent's representative attended: [________________________________]
☐ Respondent's counsel attended: [________________________________]
☐ Other attendee(s): [________________________________]

C. Result

☐ SETTLED - The case has been settled in its entirety.

☐ PARTIALLY SETTLED - The following issues have been resolved: [________________________________]

☐ NOT SETTLED - The case was not settled.

☐ IMPASSE - After good faith efforts, the parties reached an impasse.

☐ CONTINUED - The conference was continued to [__/__/____].

D. Compliance with Attendance Requirements

☐ All required parties attended with full settlement authority.

☐ A party failed to attend or failed to attend with settlement authority.
Explanation: [________________________________]

E. Request for Sanctions (if applicable)

☐ The mediator requests that the ALJ consider sanctions against [________________________________] for: [________________________________]

---

Mediator's Signature: [________________________________]

Mediator's Printed Name: [________________________________]

Date: [__/__/____]

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Section 9.4: Motion for Settlement Conference

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	MOTION FOR SETTLEMENT
[________________________________],	CONFERENCE
Respondent Agency.

---

[Petitioner/Respondent] [________________________________], pursuant to N.C.G.S. § 150B-23.1, respectfully moves the Administrative Law Judge to order a settlement conference in this matter, and in support states:

1. This contested case involves [________________________________].

2. A settlement conference would be beneficial because:

☐ The parties have not previously engaged in settlement discussions.

☐ Circumstances have changed since previous settlement discussions.

☐ New information suggests settlement may be possible.

☐ A neutral third party may facilitate resolution.

☐ Other: [________________________________]

3. [Petitioner/Respondent] believes settlement is possible and commits to participating in the conference in good faith.

4. ☐ [Petitioner/Respondent] requests a mediated settlement conference with a certified mediator.

☐ [Petitioner/Respondent] requests an informal settlement conference with the ALJ.

WHEREFORE, [Petitioner/Respondent] requests that the ALJ order a settlement conference at the earliest practicable date.

Respectfully submitted,

Signature: [________________________________]

Printed Name: [________________________________]

NC State Bar No.: [________________]

Date: [__/__/____]

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PART TEN: MOTIONS PRACTICE

Section 10.1: General Motion Requirements

Filing Requirements (26 NCAC 03 .0115):

• All prehearing motions must be in writing
• Served on all parties
• Filed with OAH
• Opposing party has 10 days to respond

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Section 10.2: Motion for Continuance

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	MOTION FOR CONTINUANCE
[________________________________],
Respondent Agency.

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[Petitioner/Respondent] [________________________________] respectfully moves the Administrative Law Judge to continue the hearing currently scheduled for [__/__/____], and in support states:

I. CURRENT HEARING DATE

1. This matter is currently scheduled for hearing on [__/__/____] at [____:____] [☐ AM / ☐ PM].

2. The hearing is scheduled to be held at [________________________________].

II. GROUNDS FOR CONTINUANCE

3. Good cause exists for a continuance because (select all that apply):

☐ Unavailability of counsel - Undersigned counsel is unavailable on the scheduled date due to: [________________________________]

☐ Unavailability of party - [Petitioner/Respondent] is unavailable due to: [________________________________]

☐ Unavailability of essential witness - [________________________________] is unavailable due to: [________________________________]

☐ Incomplete discovery - Discovery is not yet complete because: [________________________________]

☐ Recent retention of counsel - [Petitioner/Respondent] recently retained current counsel on [__/__/____] and additional time is needed to prepare.

☐ Settlement negotiations - The parties are engaged in settlement discussions and additional time may result in resolution.

☐ Medical reasons - [________________________________]

☐ Other good cause - [________________________________]

III. PRIOR CONTINUANCES

4. ☐ No previous continuances have been granted in this matter.

☐ Previous continuance(s) were granted on: [________________________________]

IV. POSITION OF OPPOSING PARTY

5. ☐ The opposing party consents to this continuance.

☐ The opposing party opposes this continuance.

☐ Undersigned counsel has been unable to determine the opposing party's position despite good faith efforts.

V. REQUESTED NEW DATES

6. [Petitioner/Respondent] is available for hearing on the following dates: [________________________________]

WHEREFORE, [Petitioner/Respondent] respectfully requests that the ALJ grant this Motion for Continuance and reschedule the hearing to a mutually convenient date.

Respectfully submitted,

Signature: [________________________________]

Printed Name: [________________________________]

NC State Bar No.: [________________]

Date: [__/__/____]

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Section 10.3: Motion for Stay of Agency Action

STATE OF NORTH CAROLINA
IN THE OFFICE OF ADMINISTRATIVE HEARINGS

[________________________________],
Petitioner,	Case No. [________________]
v.	MOTION FOR STAY OF
[________________________________],	AGENCY ACTION
Respondent Agency.

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[Petitioner] [________________________________] respectfully moves the Administrative Law Judge to stay the agency action pending resolution of this contested case, and in support states:

I. AGENCY ACTION AT ISSUE

1. On [__/__/____], Respondent issued [________________________________].

2. The agency action becomes effective on [__/__/____].

3. Unless stayed, the agency action will [________________________________].

II. GROUNDS FOR STAY

4. A stay is appropriate because:

☐ Likelihood of success on the merits - Petitioner is likely to prevail in this contested case because: [________________________________]

☐ Irreparable harm - Petitioner will suffer irreparable harm if the agency action is not stayed because: [________________________________]

☐ Balance of equities - The balance of equities favors a stay because: [________________________________]

☐ Public interest - A stay is in the public interest because: [________________________________]

III. SPECIFIC HARM TO PETITIONER

5. If the agency action is not stayed, Petitioner will suffer the following specific harm:

[________________________________]

[________________________________]

IV. HARM TO AGENCY/PUBLIC IF STAY GRANTED

6. Petitioner is not aware of any significant harm to Respondent or the public if a stay is granted. [OR] The potential harm to Respondent/public is [________________________________], which is outweighed by the harm to Petitioner.

V. BOND OR SECURITY

7. ☐ Petitioner offers to post a bond or security in the amount of $[________________] to protect Respondent's interests during the pendency of the stay.

☐ No bond or security should be required because: [________________________________]

WHEREFORE, Petitioner respectfully requests that the ALJ enter an Order staying the agency action pending final resolution of this contested case.

Respectfully submitted,

Signature: [________________________________]

Printed Name: [________________________________]

NC State Bar No.: [________________]

Date: [__/__/____]

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PART ELEVEN: OAH FILING INFORMATION

Section 11.1: Filing Methods

Office of Administrative Hearings
1711 New Hope Church Road
Raleigh, NC 27609

Mailing Address:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714

Electronic Filing (e-OAH):

• Registration required at: https://www.oah.nc.gov
• Registered e-filers must use Word or PDF format
• E-filing portal available 24/7

Facsimile Filing:
Fax Number: (984) 236-1871

Email Filing (non-registered filers):
[email protected]

• Attachments must be PDF or Word format

In-Person Filing:
Office hours: Monday - Friday, 8:00 AM - 5:00 PM

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Section 11.2: Key Contacts

Clerk's Office: (984) 236-1850

General Information: (984) 236-1850

Website: https://www.oah.nc.gov

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Section 11.3: Critical Deadlines Summary

Event	Deadline
File Petition	60 days from notice (unless statute specifies otherwise)
ALJ Assignment	Within 5 days of petition filing
Hearing Scheduled	120-150 days from petition filing
Notice of Hearing Sent	At least 15 days before hearing
Discovery Response	15 days from receipt of request
Discovery Cutoff	At least 2 weeks before hearing
Prehearing Statement	As ordered by ALJ (typically 30 days after scheduling order)
Mediator Selection	21 days after mediation order
Mediation Conference	90-120 days after mediation order
Motion Response	10 days from service
ALJ Final Decision	Within 45 days after hearing conclusion

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Section 11.4: Document Checklist for Filing

Initial Filing Checklist:

☐ Petition for Contested Case Hearing (original)
☐ Filing fee ($125.00) or Indigent Status Petition
☐ Certificate of Service
☐ Copy of agency decision/notice being appealed
☐ Notice of Appearance (if represented by attorney)
☐ Notice of Non-Attorney Representation (if business entity with non-attorney rep)
☐ Written authorization (if employee or 25%+ owner representing business)

Pre-Hearing Filing Checklist:

☐ Prehearing Statement (by deadline in scheduling order)
☐ Witness and Exhibit Lists
☐ Discovery requests served on opposing party
☐ Subpoenas issued and served (with proof of service)
☐ Motions (with certificate of service)
☐ Designation of Mediator (if mediation ordered)

Hearing Day Checklist:

☐ Original exhibits (organized and tabbed)
☐ Copies of exhibits for ALJ and opposing party
☐ Witness list
☐ Subpoenaed witnesses present or on call
☐ Proof of service for all subpoenas
☐ Copies of key statutes and regulations
☐ Proposed findings of fact and conclusions of law (if requested)

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PART TWELVE: PRACTITIONER NOTES

Section 12.1: Article 3 vs. Article 3A Quick Reference

Article 3 Cases (N.C.G.S. § 150B-22 through 150B-37):

• Heard by OAH Administrative Law Judge
• ALJ makes final decision (cases filed 1/1/2012 or later)
• Full NC Rules of Civil Procedure discovery available
• Detailed procedural requirements in statute and 26 NCAC 03
• Examples: DHHS, DEQ, DMV, Employment Security Commission

Article 3A Cases (N.C.G.S. § 150B-38 through 150B-42):

• Heard by the agency/board that made the decision
• Board/agency makes final decision
• Less detailed statutory procedures
• Agency's own procedural rules apply
• Examples: Medical Board, Board of Nursing, Board of Pharmacy, all occupational licensing boards, Department of Insurance, Banking Commission

Section 12.2: Burden of Proof

General Rule: The party with the burden of proof must establish the facts by a preponderance of the evidence (N.C.G.S. § 150B-25.1).

Petitioner typically bears burden when:

• Challenging denial of license/permit/benefit
• Seeking reversal of agency interpretation

Agency bears burden when:

• Seeking to revoke or suspend an existing license
• Imposing penalties or fines
• Medicaid cases (agency bears burden per statute)

Section 12.3: Evidence Rules

Applicable Rules: NC Rules of Evidence (Chapter 8C) apply, except as modified by:

• N.C.G.S. § 150B-29
• 26 NCAC 03 .0122

Key Modifications:

• Hearsay may be admitted if it is the type reasonably relied upon by prudent persons
• Official notice may be taken of matters within the agency's specialized knowledge
• Stipulations encouraged and given effect

Section 12.4: Post-Hearing Procedures

ALJ Decision Timeline:

• Final decision due within 45 days after hearing conclusion
• Decision must contain findings of fact and conclusions of law

Judicial Review (Article 4, N.C.G.S. § 150B-43 through 150B-52):

• Petition for judicial review filed in Superior Court
• Must be filed within 30 days of final decision
• Review is on the record; no new evidence
• Standard: Whole record test

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This packet is designed for use in contested case proceedings before the North Carolina Office of Administrative Hearings. Practitioners should verify all statutory citations and procedural requirements are current at the time of filing. OAH rules and procedures may be amended; always check the OAH website for the most recent versions.