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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) Waynesville - Tue., Oct. 11, 2022 - Town of Waynesville, Board Room, 9 South Main St., Waynesville 28786
b) Newton - Wed., Oct. 12, 2022 - Catawba County Library, 115 West C Street, Newton 28658
c) Asheboro - Thur., Oct. 13, 2022 - 1909 Historic Courthouse, 145 Worth St., Asheboro 27203
d) Washington - Tue., Oct. 25, 2022 - Beaufort County Community College, Bldg. 9 Auditorium, 5337 Hwy 264 East, Washington 27889
e) Wilmington - Wed., Oct. 26, 2022 - New Hanover County Government Center, 230 Government Dr., Wilmington 28403
f) Raleigh - Thur., Oct. 27, 2022 - NC Medical Society, 222 N. Person Street, Raleigh 27601
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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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