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1. Local Government Name
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2a. Type
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City/Town
County or County Department
Water & Sewer Auth. (Ch. 162A Art. 1)
Joint Regional Agency (Ch. 160A Art. 20)
Public Health Authority (Ch. 130A Art. 2)
Metro. Sewerage Dist. (Ch. 162A Art. 5)
Sanitary District (Ch. 130A Art. 2)
Housing Authority (Ch. 157)
Regional Solid Waste Management Authority (Ch. 153A Art. 22)
Vendor/Third-party administrator
Other
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2a. If Other, please specify
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3. What is the status of your Local Government with the Debt Setoff Clearinghouse?
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Active (currently submitting debts)
Inactive (submitted forms but not debts)
New (no forms or debts submitted)
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4. Have you ever attended a Debt Setoff Clearinghouse Workshop?
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Yes
No
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5. Location (all sessions 9:30 a.m. - 12:00 p.m.)
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a) Hickory - Tue., Oct. 12, 2021 - Western Piedmont COG - Conference Room A1 & A2, 1880 2nd Avenue NW, Hickory 28601
b) Waynesville - Wed., Oct. 13, 2021 - Town of Waynesville - Board Room, 16 South Main St., Waynesville 28786
c) Asheboro - Thur., Oct. 14, 2021 - Randolph County Courthouse - 145 Worth Street, Asheboro 27203
d) Wilmington - Tue., Oct. 26, 2021 - New Hanover County Library, New Hanover Room, 201 Chestnut St, Wilmington 28401
e) Washington - Wed., Oct. 27, 2021 - Beaufort County Community College, Bldg. 8 Auditorium, 5337 Hwy 264 East, Washington 27889
f) Raleigh - Thur., Oct. 28, 2021 - Local Govt. Federal Credit Union Corporate Office, 3600 Wake Forest Rd., Raleigh 27609
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6) Are there any topics or issues you would like covered?
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7a. Name
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7b. Email Address
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7c. Department
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7d. Job Title or Description
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7e. Phone Number
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8a. Name of Attendee #2
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8b. Email Address of Attendee #2
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8c. Department of Attendee #2
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8d. Job Title or Description of Attendee #2
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9a. Name of Attendee #3
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9b. Email Address of Attendee #3
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9c. Department of Attendee #3
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9d. Job Title or Description of Attendee #3
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10a. Name of Attendee #4
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10b. Email of Attendee #4
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10c. Department of Attendee #4
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10d. Job Title or Description of Attendee #4
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11a. Name of Attendee #5
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11b. Email of Attendee #5
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11c. Department of Attendee #5
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11d. Job Title or Description of Attendee #5
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