Submit an Incident Online

 For Spaces application support please choose the appropriate option from the I am drop down and provide a detailed explanation regarding your case.
 For security request changes or application development requests please submit a ticket through the work management system.

*Phone:	(7012223333)
*First Name:
*Last Name:
*Email:
*I am:	North Dakota resident applying for or completing a review for SNAP, TANF, Medicaid or Child Care Assistance Child Care Provider
*Details:
Additional Information:	Please select the checkbox if you wish to enter additional sensitive information.
Attachment(s):	Add Attachment (5Mb Limit)

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