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Submit an Incident Online

If you are applying or completing a review for SNAP, TANF, Medicaid, Child Care Assistance or LIHEAP and are having technical issues, complete this form. Please only attach screen shots of error messages. No case documentation should be submitted with this form.

If you have questions about your benefits, filling out an application/review, or submitting supporting documentation, please contact the Customer Support Center:

Email: applyforhelp@nd.gov
Phone: 1.866.614.6005 or 701-328-1000; 711 (TTY)

You may also visit your local human service zone office (formerly called county social service office) for in-person assistance.

*I am:

North Dakota resident applying for services

Child Care Provider

LIHEAP Vendor

HPE Provider

*Phone:

(7012223333)

*First Name:

*Last Name:

*Email:

*Issue Type:

ND Login User ID:

Case Number:

Client ID:

What device are you using:

What Browser are you using:

Preferred method of contact:

*Details:

Additional Information:

Please select the checkbox if you wish to enter additional sensitive information.

Attachment(s):

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