Deaf And Hard Of Hearing Smoke Alarm Request Application

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Available only to residents of North Carolina.

Fire Department Request Form

NC DOI-OSFM is pleased to provide the Lifetone HLAC151 bedside fire alarm and clock for individuals who are deaf or hard of hearing. Due to current funding and cost of the device, our inventory is very limited. Please assist us with proper usage of grant funds by reserving your request for high-risk, low income homes and individuals.

This Request Form is to be completed by Fire Departments or County Fire Marshals who identify a need for a deaf and hard of hearing alarm in their district. If one of these agencies identify someone who is deaf or cannot hear a smoke alarm with or without hearing devices, they can submit the request form below.  Requests are filled based on current inventory.

Review the Lifetone HLAC151 User’s Manual before completing the application.


Contact information of Fire Department/Fire Marshal/EMS requesting and installing alarm


Contact information of person needing alarm


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