A request for waiver of a rule in this Chapter shall be in writing and shall include:

1. (1) the requestor's:

   1. (a) name;
   2. (b) mailing address;
   3. (c) email address; and
   4. (d) preferred telephone number for contact;

2. (2) for a request filed on behalf of an entity:

   1. (a) the name of the entity;
   2. (b) the requestor's position with the entity and authority to file the request on behalf of the entity;
   3. (c) the mailing and business addresses of the entity;
   4. (d) the telephone number for the entity; and
   5. (e) the email address for the entity;
3. (3) the specific rule and paragraph number for which waiver is requested;
4. (4) an explanation of the reason for the request, including facts supporting the request;
5. (5) any additional information related to the factors in Rule .0108 of this Section that the requestor wishes the Department to consider;
6. (6) supporting documentation, if any;
7. (7) a description of any previous waiver requests filed with the Department; and
8. (8) the signature of the requestor and the date signed.

History Note: Authority G.S. 10B-4;
Eff. July 1, 2024.