North Carolina recently passed House Bill 926 (Session Law 2025-94), which requires the North Carolina Medical Board to verify social security information on each applicant applying for a license. The new law applies to all license application types.

Applicants are required to complete form SSA-89. The SSA Authorization Form must be physically signed in ink and must be mailed to the North Carolina Medical Board, 3127 Smoketree Court, Raleigh, NC 27604 Attn: License Associates.”

Key points:
- The form cannot be uploaded to the gateway portal.
- Must be completed with a physical signature in ink.
- The form must be mailed in.
- Forms that are not completed will not be accepted.
- Please indicate the reason is “to meet licensing requirements.”

All applications received after 5/21/2026 will be required to provide the completed SSA-89 form. Please check your gateway portal for updated notifications.

Access and print the form.
See an example of the SSA-89 filled out with the necessary information.

To inquire if a completed SSA-89 form was received, email SSA_CBSV@ncmedboard.org. This email should be used ONLY to confirm receipt - NCMB will not accept emailed copies of the SSA-89.