Dss forms ny. The following About DHS.

Dss forms ny form _____ 0f _____ x . Box 687, Schoharie, NY 12157 Hours: 8:30am – 5:00pm Phone: 518-295-8334 Fax: 518-295-8499 (Admin. Please visit our FAQ Page to see a full list of our department phone Adult Care Facilities Forms DOH Forms. Changed orientation of document from portrait . Erie County Day Care Unit 95 Franklin Street, Room 448, Buffalo, New York 14202 [716] 858-8953. 9/24) PAGE 2 SIMPLIFIED REPORTING RULES: As a SNAP household under the “Simplified Reporting” rules, you are only required to report changes at the time of your next recertification, except for the following three situations: 1. 38 Mailing Address - PO Box 240 Owego, NY 13827 Main Phone: 607-687-8300 Rensselaer County 99 Troy Road East Greenbush, NY 12061. These services include Medicaid, SNAP (formerly known as Food Stamps), Temporary Assistance and Homeless services. The Rockland County Department of Social Services (DSS) offers a wide range of eligibility programs and services to families and individuals to assist them in meeting their basic needs for food, shelter and medical care. About HRA. If you are blind or seriously visually impaired, would you like to receive written notices in an alternative format? The Department of Social Services provides assistance and service support to meet individual and family needs in a timely and courteous manner so they may achieve the greatest degree of self-responsibility and independence possible. Hours: Mon-Fri, 8am-4pm New York State Department of Health ASSISTED LIVING RESIDENCE Division of Assisted Living MEDICAL EVALUATION DOH 3122 (3/09) Rev. gov allows you to access online services from multiple New York State agencies with a single username and password. Form 1040NR English Earned Income Tax Credit (EITC) Schedule EIC English Form IT-215 English Worksheet I authorize the examining physician to disclose to the Department of Social Services any information provided, any diagnoses made, Please forward this completed form to Social Services Contact: Author: New York State Office of Temporary and Disability Assistance Created Date: 6/17/2010 8:22:10 AM City of New York. × \kàÉ çà®uƒ›{ H˜‘-K The Broome County Department of Social Services has detected dozens of applications submitted by Broome County residents that their benefits were stolen due to Electronic Benefits Transfer (EBT) “skimming. Applications can be made in person at: Albany County Department of Social Services 162 Washington Ave. Outside of New York City each district corresponds to one of the fifty-seven counties that make up the remainder of the state. NEW YORK STATE . Please print clearly and sign the form in Section 9. (6 pages). Recertification form for Public Assistance, Supplemental Nutrition Assistance Program (SNAP), Medicaid and SNAP, and Medicaid and Public Assistance. Mailing Address: P. Return this recertification to the address listed. Adoption; Child Protective Services; Foster Care; White Plains, NY 10607. O. HEAP applications are mailed and accepted starting November 1, 2024 at the Livingston County Department of Social Services, 1 Murray Hill The forms below can be downloaded, printed, filled, signed and either mailed back to DSS or can be dropped off at: Nassau County Department of Social Services Attn: Day Care New Applications 60 Charles Lindbergh Blvd. Albion, New York 14411 Phone: (585) 589-3170 Fax: (585) 589-7479 Forms and Links Apply for Jobs/ Get Permit Traffic Diversion Program If you need help completing the form(s), or have questions, please call us toll free at 1-(855)-488-0541. date received by agency employed by: social services district provider agency specify: pa authorization period ma authorization period snap authorization period services authorization period from to from to from to from to . Form 1040 English. 83 Seneca St. Contact local law enforcement to file a police report. Forms in English. For Vendors seeking lost or stolen checks: [716] 858-6676 Contact your local department of social services' fraud unit to notify them that your benefits have been stolen. Syracuse NY, 13202. The Fulton County Department of Social Services provides various forms of assistance to citizens of Fulton County; Study in a New York State registered or regionally accredited college or university or a business school registered by New York State which includes a course in typing, keyboarding or word processing may be substituted for the Livingston County residents that are unable to apply online may request an application be mailed by calling (585) 243-7300. Liens Amount; Liens & Recovery Fact Sheet; Liens Request Fax; New York City Department of Social Services/HRA Office of Legal Affairs – SLRLU P. gov website. Box 414312 Boston, MA 02241-4312. Accounting NY 12932. Rensselaer, NY 12144-2834. , White Plains, NY 10607. Day Care Application Form OCFS-6025 (English / Spanish) and Instructions OCFS-6026 (English / Spanish) Social Services. gov/ and/or call 1-855-355-5777 for more information or to apply, or you may use the MA-only paper application To view all the local Department of Social Services forms, please click on the appropriate link. SNAP: NY State SNAP Page; NYS OTDA (TA/Cash): NY State OTDA Page; Medicaid; HEAP: Apply to NY State Program; Child Support Enforcement: NY State Child Support Online; NYS OCFS; Contact Information. I, _____ do certify that on _____ I was present while the counselor read and explained the consent Sterilization Consent Form Author: New York State Department of Health - Office of Health Insurance Programs Subject: LDSS Keywords Questions regarding the HEAP program should be directed to your HEAP Local District Contact or the OTDA Hotline at 1-800-342-3009. Photo Credit: Fred McCag DSS 2015 Annual Report (PDF) DSS 2014 Annual Report (PDF) DSS 2013 Annual Report (PDF) DSS 2012 Annual Report (PDF) _____ "New York State of Health" the official Health Plan Marketplace is now open to assist you. STATEMENT OF PURPOSE . ) Staff: Administration Division. Applications may be completed and mailed, or hand-delivered to Clinton County Department of Social Services, 13 Durkee Street, Plattsburgh, NY 12901 – or faxed to 518-561-8101. Department of Social Services; Adult, Child and Family Services. Phone: 716-661-8200. Box 120 - Buffalo, NY 14201 - Attention: SNAP Division weeks or tax forms and/or ledgers to verify self-employment; or Monthly VA Benefits, Pension, Alimony and Child Support, Compensation or Disability payments, New York 14202. Beginning July 1, 2024, those seeking immediate in-person assistance from the Cayuga County Department of Social Services may visit our temporary office located at:. The following About DHS. ADDRESS . , Suite 160 Uniondale, New York 11553 Attention : Day Care . DOH-4441 – Medicaid Presumptive Eligibility (PE) for Children Screening Form (PDF); DOH-5224 – Medicaid Presumptive Eligibility for Pregnant Women Screening Checklist (PDF); DOH-5298 – Request for Assessment – Spousal Impoverishment (PDF); LDSS-3113 – Acknowledgement of Hysterectomy Information (PDF); Department of Social Services. A lock Change Report Form for information about the change reporting rules that apply to your Commissioners Office John H. Phone: 516-227-7976 Fax: 516-227-8710. Residential Institutional Abuse Reports: A paper copy of the form LDSS 2221A, originally signed, must be submitted directly to the State Central Register, This assignment is executed as security for the payment to me of any Safety Net Assistance benefits by the social services district or its successors and assigns pursuant to Title 3 of Article 5 of the Social Services Law of the State of New York. By Telephone: You should apply through Clinton County Department of Social Services as Non-MAGI. This notice is being sent pursuant to section 445. Local social services districts are not allowed to issue SNAP replacement benefits for theft that occurs on or after December 21, 2024. If you need immediate assistance with a housing situation, you may contact the Department of Social Services during business hours from 8 a. -5 p. Share sensitive information only on official, secure websites. NYS Office of Children and Family Services Child Care Licensing and Information 295 Main Street Buffalo, New York 14202 [716] 847-3828. New York State's shared login service. Apply Online: nystateofhealth. Fax items to 607-873-1815. Adult Care Facility Incident Report - Resident Comment DOH-5789 (PDF); 30 Day Notice of Termination DOH-5237 (PDF); ACF Resident Safety Plan Checklist DOH-5265 (PDF); Adult Care Facility Annual Financial Report Certificate of Operation DOH-5780 (PDF); Adult Care Facility Chronological Admission and Discharge Register DOH-5177 (DSS-3026) (PDF) Adult NEW YORK STATE . Department of Health (Medicaid) Office of Temporary and Disability Assistance. 2025 All Rights Reserved, NYC is a trademark and service mark of the City of New York. of Health: (518) 474-8161 or 1 (800) 342-3005 Click here for additional LDSS/DOH Public Forms. Tel: 1-800-342-9871 Name:Nassau County Department of Social Services (DSS) (HHS) Adoption Services: 315-867-1216: Adult Protection Services: 315-867-1543: Alternatives in Long Term Care: 315-867-1322: Child Abuse Hotline: 1-800-342-3720 111 Main Street, Suite 4 Delhi, NY 13753 Phone: 607-832-5300 Fax: 607-832-6030 To access forms and applications for TA, please visit our forms page. NY. Nondiscrimination 111 Main Street, Suite 4 Delhi, NY 13753 Phone: 607-832-5300 Fax: 607-832-6030 * Please use this NYS OTDA form to report fraud in New York State for only these programs: Public/Cash Assistance, SNAP (Supplemental Nutrition Assistance Program, formerly called Food Stamps) and HEAP (Home Energy Assistance Program). Form 1040NR English Child and Dependent Care Tax Credit. New York State Deaprtment of Health Subject: Statement of Purpose - Medical Evaluation The Lewis County Warming Center located at 5499 Jackson Street, Lowville, is now currently open. For Emergency Services: Emergency Services Voicemail 858-6265 Emergency Services Fax 858-6852 TAEmergencyServices@erie. The Warren County Department of Social Services provides free or low cost child care services for eligible families residing in Pandemic EBT Benefit. or contact the local, county social services department’s Adult Protective Service bureau. SNAP 858-7239 Volunteer Today Request Form Training Site Use Form Training Site Activity Report The mission of the Oneida County Department of Social Services is to provide for financial and social services to eligible residents of Oneida County in accordance with federal, state and county laws. additional space is needed, please use the reverse side. We will attempt to contact you the same day for an Welcome to the Essex County Department of Social Services website. ny. Adult Residential Care Programs provide 24 hour residential care settings for dependent adults. Home Energy Assistance Program Application . Donna Becker, Commissioner Stephen Munford, Overview Find out how to use SNAP benefits to order nutritious food online. Box 1930 Albany, NY 12201-1930. Resident Name: Department of Social Services; Adult, Child and Family Services. Geneva Office. The hours are Monday through Friday, 9 a. gov Screen your eligibility for Assistance Programs, tax credits or health insurance: www. No other assignment of wages by me exists in connection with the above described transaction or (Rev 5/23) New York State Office of Temporary and Disability Assistance . State landmarks will be lit in the colors of red, yellow If you have a question regarding your benefits or would like to contact a local Temporary Assistance (TA) representative, you may call us at 607-778-1100 Michael Iapoce, Commissioner. Please fax all updated or final lien requests to the number shown above. Sign the Form on the Back Page. FAX FORM Fax #: (844) 449-3445 The Department of Social Services Division of Liens and Recovery work to collect Medicaid and Public Assistance liens. Applications for SNAP benefits may be submitted online at My Orleans Department of Social Services, Temporary Assistance, Child Support. A Fair Hearing is a chance for you to tell an Administrative Law Judge from the New York State Office of Temporary and Disability Assistance, Office of Administrative The five boroughs of New York City comprise one district. Fax completed complaint form to: 518-873-3472. ” This illegal A ny. Or call the Publications Hotline: 518-473-0971 The main entrance and parking for the Department of Social Services is located at the rear of the building on Massey Street. An interview with a DSS worker is a condition of TA eligibility. , Suite 160 Uniondale, New York 11553 Mailing Address Nassau County Department of Social Services 60 Charles Lindbergh Blvd. Pregnant individuals and children can apply at many clinics, hospitals, and provider offices. To order hard copies of available OCFS forms and publications, submit form OCFS-4627: Request for Forms and Publications to: OCFS Forms and Publications Unit 52 Washington Street Room 134 North Bldg. Canandaigua, NY 14424 Phone: 585-396-4060 or: 877-814-6907 Fax: 585-393-2960 Map. Goshen, NY 10924 Mailing Address Orange County Department of Social Services, Box Z 11 Quarry Rd. Note: Complete and submit your enrollment form to your local child support office. A lock icon or https:// means you’ve safely connected to a ny. Please read the instructions attached to the back of the application. Albany, NY 12210-2304 Hours: Monday - Friday (8:30 AM - New York State Child Care Assistance Program (CCAP) Each local social services district (LSSD) manages the CCAP with funding and support from the Office of Children and Family Services (OCFS). Resident will receive assistance with all medications unless physician indicates that resident is capable of self- Prompt submission of this completed form to the Local Department of Social Services (LDSS) responsible for the client will ensure timely payment by Computer Sciences Corporation/Medicaid Managed Care plan New York State Department of Health Subject: LDSS FORM Keywords: RESIDENTIAL, HEALTH, CARE, FACILITY REPORT OF, MEDICAID, RECIPIENT - Erie County Department of Social Services - P. As the forms are referenced in the ACF regulations by their DSS form numbers, the DSS numbers will remain along with the newly assigned DOH form numbers. Upload Your Documents using the NYDocSubmit App: If you would like to upload your documents using the above mentioned app, please read the information provided in this link and then upload your documents as a secure means of efficiently providing documents to DSS. ACF Waiver Request/Equivalency Notification Form (DOH-4235) (PDF) Assisted Living Residence Medical Evaluation (DOH-3122, Rev 5/12) (PDF) Assisted Living Residence Resident Evaluation Form (DOH-4397 Part B) (PDF **ALR Resident Personal Data and ALR Resident Evaluation Instructions (Rev. Social Services Forms. Please click on a link below to find information about that program, or click on a tab. Answer all questions. The five boroughs of New York City comprise one district. Mail information to the Chemung County Department of Social Services @ P. Most common forms, Department of Social Services (DSS) Please note that this form should NOT be used to authorize the release of any protected health Office of Constituent Affairs, 150 Greenwich Street, 35th Floor, New York, NY 10007. 12/2019) DCCS version Instructions for Completing the Statewide Central Register Database Check Form LDSS-3370, DCCS version ALL information on the LDSS-3370, DCCS version must be easily read so that data entry and results are accurate. 87 N. New York State Dept. Call the Child Care Assistance Office at (914) 995-6521 for more information. Are you requesting a DSS Landlord/Tenant Security Agreement? Yes (*Please read the directions on the back of this form) No Are you requesting rent be paid directly by DSS? Yes (Vendor # _____) No If you have any questions, you may call our Landlord Hotline at (585) 753-6034. In financial services, our goal is to help the needy receive benefits and to help them not need them. gov. County Departments of Social Services (DSS) provide or administer the full range of publicly funded social services and cash assistance programs. Skip to main content. - 4:30 p. / To Obtain a Vendor Number, Call: 753-6663. Applying for Medicaid. Closed for legal Drop off items using the secure white mailbox labeled Department of Social Services located on the parking lot side of the building at 425 Pennsylvania Avenue. For additional information regarding the types of formats available, contact your social services district or visit www. gov website belongs to an official New York State government organization. Please select the program of interest on the left for specific program office locations. Please visit our FAQ Page to see a full list of our department phone Department of Social Services – Economic Security : Hours of Operation: 8am-4pm Monday-Friday. Close trusted identity banner. If. Office of Administrative The New York State Office of Temporary and Disability Assistance supervises support programs for families and individuals. You may also fax the request form to (914) 813-4309 or e-mail to . General Social Services; Litigation and Collections; Family Court Divisions; Child Support Enforcement New York State; Cornell University Geospatial Data Information Repository (CUGIR) child care statement, work schedule form and absent parent form (if applicable) and send it to: Department of Human Services 111 Westfall Rd. Foster Care Ombudsperson Complaint Form. Adoption; The Child Care Provider Form 536 is required to establish or change an authorized child care schedule <Need Link> White Plains, NY 10601 (914) 995-2000. Department of Social Services – Economic Security : Hours of Operation: 8am-4pm Monday-Friday. The guide is available in the following languages: English (Pub1159) Arabic (Pub1159-AR) Bengali (Pub1159-BN) Chinese, traditional (Pub1159-TC) French (Pub1159-FR) Haitian Creole We would like to show you a description here but the site won’t allow us. Overview. Overall Apartment/House (continued) YES NO N/A Information k) If 3j is NO - is the date of construction 1978 or earlier? Welcome to Erie County, NY. Your support ID is: 9953093351140943299. Forms; How to Apply; Warning. For questions related to the Pandemic EBT - Please visit www. Find & Apply for Assistance; Adults; Children; Employment; Food; Financial; Health & Insurance This form may be faxed to 518-473-6735 or mailed to the following address: New York State Office of Temporary and Disability Assistance Office of Administrative Hearings P. 09/2024) . Seeber Commissioner of Department of Social Services DSS 2015 Annual Report (PDF) DSS 2014 Annual Report (PDF) DSS 2013 Annual Report (PDF) DSS 2012 Annual Report (PDF) _____ "New York State of Health" the official Health Plan Marketplace is now open to assist you. NY Connects is your trusted place to go for free, unbiased information about long term services and supports in New York State for people of all ages or with any type of disability. Please return the requested information: by mail to: NYS OTDA State Supplement Program PO Box 1740 Albany, New York 12201 by email to: Adult Services (607)753-5265 Child Day Care (607)753-5230 Child Support (888)208-4485 Child Services (607)753-5347 CPS Hotline (800)342-3720 Employment DSS-4449C (Rev. Goshen, NY 10924 . Main navigation menu. Email CSE Steuben County; NYS Child Support Customer Service Helpline: 888-208-4485; Toll-Free Child Abuse/Neglect 24-Hour State Hotline: 1-800-342-3720 LDSS-3151 (Rev. If you have an immediate need for personal I authorize the payment to me or members of my household for health or accident insurance benefits be made directly to the appropriate Social Services official for medical and other What You Should Know About Social Services Programs (LDSS- 4148B) This booklet gives information about different programs – such as Temporary Assistance and Food Stamps, as Forms. OFFICE OF CHILDREN AND FAMILY SERVICES . CONTACT THE DEPARTMENT OF SOCIAL SERVICES (607) 547-4355 FOR MORE INFORMATION AND CLASS SCHEDULE. 6 Month Reassessment . Some districts use local equivalent forms of the application (OCFS-6025 Application for Child Care Assistance) and do not utilize the application How Can We Help You Get Services? If you are experiencing an emergency, please call 911. CHILD IN FOSTER CARE - SCHOOL NOTIFICATION. DOH - 5178A 8/15 (page 1 of 8) DOH -51 Supplement A (Supplement to Access NY Health Care Application DOH-4220) This Supplement must be completed if anyone who is applying is: The Yates County Department of Social Services will be recognized as a leader and a partner in building a healthy, safe and caring community through our compassionate and respectful services to individuals and families. In New York City, contact the Human Resources Administration by calling (718) 557-1399. A convenient way to report this information is to complete and submit an online SNAP change report form (https://www This publication provides mandated reporters with an overview of their obligations and a conceptual framework of New York State's child protective services system. Phone: (716) 858-8000. OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE Fill out the form completely and accurately. Madison County NY 138 N Court Street Wampsville, NY 13163. Print and mail or fax the SNAP Application form to your local SOCIAL SERVICES DISTRICT PROVIDER AGENCY SPECIFY: PA AUTHORIZATION PERIOD . MyBenefits Form LDSS-639 "Disability Review Team Certificate" is a required element for admission/continuation in the Care at Home (CAH) III, IV and VI Waiver Programs. org The Orange County Department of Social Services, a part of the New York State Office of Children and Family Services, offers various services to Orange County residents. Phone: 315-253-1382 New York State Office of Temporary and Disability Assistance: www. Services may include; investigation and assessment of the adult's needs and risk of harm, counseling for the victimized adult and their family and advocacy. Property Search Pay for services Citizen Request. Fraud. gov websites use HTTPS. NEW YORK STATE RECERTIFICATION FORM FOR CERTAIN BENEFITS AND SERVICES; If you are blind or seriously visually impaired and need this recertification form in The mission of Otsego County Department of Social Services is to assist and protect vulnerable individuals in our community by promoting safety, healthy families and enhanced economic stability. Phil Bauso Director. gov Please navigate the menu to the left for information regarding our programs. If you use assistive technologies to read PDFs, the preferred method is to download the PDF and view it directly with your preferred assistive Child Care Services is a funded service through the New York State Child Care Block Grant (NYSCCBG) which is a grant consisting of Federal and State funds which are allocated to each county throughout NY State. gov After 5 PM, Call 2-1-1 for assistance. DSS-8f (E) 06/26/2023 (page 1 of 3) CityFHEPS Landlord Information Form – Apartment Rentals Unit Information Address: Name of Owner: The unit indicated above (the “Unit”) is being rented for at least a one-year period beginning on If you are blind or seriously visually impaired and need this form and/or the Request for Replacement of Stolen Supplemental Nutrition Assistance Program SNAP and/or Temporary Assistance (TA) Cash Benefits application in an alternative format, you may request them from your local Social Services District (district). If you require further assistance please call the DSS OneNumber at 718-557-1399. Canton, New York 13617 View Map to Department of Social Services. The completed online Supplemental Nutrition Assistance application will be sent to the agency and you will be screened for expedited Supplemental Nutrition Assistance within five days and have a scheduled You must apply for health insurance through the New York State To obtain these forms and submit your request please contact the Medicaid Department at (315) 253-1382. Small cian's order is subject to the new york state department of health regulations at parts 515, 516, 517 and 518 of title 18 nycrr, which permit the department to impose monetary penalties on, or sanction and recover overpayments from, providers or prescribers of medical care, services or supplies when medical care, services or supplies that are A ny. Scammers offer phony SNAP If you wish to only apply for MA, you can go online at https://nystateofhealth. new york state application for certain benefits and services LDSS-2999 (Rev. If your request involves an issue about health benefits or services provided under your Managed Care Plan or Managed Long Term Care you can Buffalo, New York 14216 [716] 877-6666. The case management agency and/or the local Department of Social Services are responsible to complete all necessary steps to obtain the initial and subsequent Disability Review Team The New York State Office of Temporary and Disability Assistance supervises support programs for families and individuals. Office of Child Support Enforcement. Skip to Main Content. Medicaid. and 8 p. Food Stamps or SNAP (Supplemental Nutrition Assistance Program) is a federally funded program administered by the Department of Social Services for the United States Department of Agriculture. For help applying for the Child Care Assistance Program, visit the Child Care Assistance Program Training to view video tutorials, guides, and other You may also use New York State's My Benefits web portal -- a quick and easy way to apply for and find answers to questions about New York State's programs and services. otda. ) 518-295-8492 (Gen. For Medicaid, SSI Disability or SNAP vendor fraud, please refer to the previous Reporting Welfare Fraud page for contact information. Secure ny. 5/12 Page 3 of 3 Patient/Resident Name: _____ Date: _____. Services; Programs To report adult abuse, call (within New York State only): 1-844-697-3505 between 8:30 a. Clinton Avenue Rochester, NY 14604 navigator@nysnavigator. NY Connects. Keep pages 1-2 for your reference. The center is located in the basement of the New Beginnings building and open 7pm – 7am daily. Description: Preserving the right of self-determination and supported decision making for adults. , Monday-Friday, excluding holidays, at 845-292-0100 or visit us at 16 Community Lane, Liberty, NY. The goal of the program is to provide a higher level of nutrition to income eligible individuals and families by enhancing their ability to purchase food. Each Statewide Central Register Database Check form LDSS-3370, DCCS version submitted should be Physical Address - 1062 State Rt. 4/97, 05/13, 9/13) ALP MEDICAL EVALUATION Check all that apply: AH EHP ALP Initial Rug Category Change 12 month Other UAS-NY Summary Report is attached for RUG Category Change, 12 month and other assessments This form may be used to verify that an individual’s health/safety needs can appropriately be met in an adult home, enriched housing What You Should Know About Social Services Programs (LDSS- 4148B) This booklet gives information about different programs – such as Temporary Assistance and Food Stamps, as well as Medical Assistance. Most Frequently Requested Telephone Numbers Skimming/Phishing prevention (Spanish) Foster Care Ombudsman Brochure. The New York State Office of Temporary and Disability Assistance is warning customers to watch out for Electronic Benefits Orange County Department of Social Services 40 Matthew St. New York State City of Oswego City of Fulton Municipalities. Erie County Department of Social Services. Department of Social Services Edward A Rath County Office Building 95 Franklin Street, 8th Floor Buffalo, New York 14202. Date: I. mybenefits. Phone: 845-615-5452 Fax: 845-568-5136. Located at 141 Broadway in Newburgh, New York, the department can be reached at 845-291-4000. Government. 05/2023) FRONT Month: NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES CHILD CARE ATTENDANCE SHEET Facility: Year: Program Name: INSTRUCTIONS: Actual times in and out must be recorded in the Commissioners Office John H. This page contains links to PDF documents. The Human Resources Administration (HRA) is the nation's largest social services agency and assists over three million low‐income and vulnerable New Yorkers annually through the effective and efficient administration of more than 12 major public benefits programs, which reflects this Administration's priority of addressing poverty and income inequality. These pages contain important information you need to know DSS-3122 (Revised 12/79) MEDICAL EVALUATION (Resident) NAME . COMMON FORMS AND APPLICATIONS - Social Services. Hearing is a chance for you to tell a hearing officer from OTDA why you think a decision about your case made by a local social services agency is wrong. We do this through innovative strategies and by providing coordinated, compassionate, high-quality services and supports. Use the self-scanning stations located in the Reception Area. Get quick answers to questions about New York State’s Programs and Services. Visitor Information. Use the links below for more information. . NEW YORK STATE DEPARTMENT OF HEALTH Adult Care Facility/Assisted Living Incident Report DSS-3123 (Revised 05/12, 11/15 ) DOH-5175 (DSS-3123) (12/15) Page 2 of 3 For DOH Internal Use: Regional Office Staff Assigned: Review Date: Regional Office Action Taken (describe): Central Office Notified: YES NO Date: VIII. If you are blind or visually impaired many of OTDA's forms are available in alternative format. Please provide a reliable phone number on your application. OTDA Home Programs & Services Fair Hearings. THE FOLLOWING MUST BE COMPLETED FOR STERILIZATIONS PERFORMED IN NEW YORK CITY -- WITNESS CERTIFICATION . MA AUTHORIZATION PERIOD : SNAP AUTHORIZATION PERIOD : FROM TO FROM TO FROM TO . INSTRUCTIONS: This evaluation must be conducted and completed no less frequently than once every 6 months. Applications for Emergency Assistance may be (1) faxed to: 716-858-2628, (2) mailed to: Erie County Department of Social Services, Unit FA6/75000, P. 4/14) ASSISTED LIVING PROGRAM MEDICAL EVALUATION – INTERIM . For a complete listing of Common Forms and Applications from the NYS Office of Temporary and In New York City, contact the Human Resources Administration by If you want to recertify only for the Medicare Savings Program (MSP), you must apply with Form DOH-4328, which your worker can provide to you. New York 13501. Rochester New York State Social Services Law §152-D allowed New York State to replace Temporary Assistance cash benefits that were stolen through electronic means such as EBT card skimming, cloning, third party misrepresentation, or other similar fraudulent methods like phishing (scam-related benefit theft). Forms. DOH-5176 (DSS 2900): Daily Resident Census Report. Contact Us. Small businesses and consumers not eligible for Medicaid may inquire about health insurance in the following ways: New York State: Online application/form in an alternative format, you may request one from your social services district. For More Information On How To Protect Your Benefits, Visit the OTDA EBT Scam Alert Site Department of Social Services where the subjects of the report reside. Download Acrobat Reader to view these documents. Families must meet certain eligibility requirements in order to qualify for child care at low or no cost through the Child Care Assistance Program. 6 Judson Street Canton, New York 13617 View Map to Department of Social Services. If you do not have Adobe Reader, download and install it now. To see if you may be eligible to apply, view our eligibility requirements. - 4 p. Emergency Services; The following are two versions of the Daycare Daily Attendance Record Form 2165 that Day Care Providers must complete and submit on a monthly basis: 2nd Fl. This can be done in-person or by phone. Physical Address: Offices are located in Jamestown, Dunkirk and Mayville. Foster Parents & the Courts. County Clerk: 518-270-4080 Sheriff: 518-266-1900 County Office Building: 518-270-2900. OTDA Home Programs & Services Home Energy Assistance Program. View a list of stores in New York State that participate in USDA's Online Purchasing Pilot. Plaintiff Name: SSN: Date of Birth: The Greene County Department of Social Services strives to meet the needs of the County’s population, as provided by Federal and State statutes, in a consistent, courteous, and efficient manner while promoting optimum independence of each individual. Your total household gross monthly income for your household size LDSS-4443 (Rev. gov or Call 1-833-452-0096 Friday, May 10, 2024 New York State Office of Children and Family Services Celebrates Early Childhood Educator and Child Care Provider Appreciation Week New York State Office of Children and Family Services today concludes the celebration of Early Childhood Educator and Child Care Provider Appreciation Week. Mulroy Civic Center 421 Montgomery St. If your household’s gross monthly income exceeds 130% of the poverty level, you MUST report this monthly amount to your social OTDA Home Programs Forms. 4. Email the Department The Department of Social Services adheres to rules, regulations and mandates from various agencies within New York State. Schenectady County Department of Social Services 388 Broadway, Schenectady, NY 12305 . You can to Apartment Review Checklist - Outside New York City Utility Form for Outside NYC Statewide CityFHEPS Frequently Asked Questions for Landlords and Property Owners DSS-10a (E) 03/12/2019 (page 4 of 12) Department of Social Services Prior Version 10/26/2018 3. Privacy Policy. Visit your local department of social services or in New York City a SNAP Center. Hours: Monday-Friday 8 a. It also provides information on other services including child care, foster care, child welfare, adoptions and other programs. With our partners, the Department of Homeless Services (DHS) provides temporary, emergency shelter to all New Yorkers in need and helps individuals and families transition rapidly into permanent housing and self-sufficiency. Hours Monday - Friday 8:30 a. The app is Phone: 877-454-6463 TTY: New York Relay 711 or 1-800-421-1220 Fax: (585) 456-1676. OCFS Forms; OCFS Publications; Data and Reports; Language Assistance; Site Map; Webmail; News. Tourism Web The Department of Social Services is a complex agency, one which administers many programs with many clients. To access forms and applications for SNAP, please visit our forms page. Resources & Links Administrative Services. m. New York State Home. us Write, phone, or go to your local department of social services. Providing temporary, safe, and nurturing homes for children is the essential To view or print these documents, you will need Adobe Reader. LOCAL DISTRICT NAME AND ADDRESS I also assign to the Department of Social Services any rights I have to pursue support from persons having Form 1040 English. The following revised forms are attached and highlights of the revisions are described below. The mission of the Oswego County Department of Social Services is to strengthen families, assure safety, promote self-sufficiency and improve the quality of life in our community. Or simply file a complaint/report to our Fraud Investigations Unit directly via phone at: (518) 873-3636 or (518) 873-3638. Feedback. Form 2441 English. In the event of a specific emergency, you can call: Child Abuse Hotline (800) 342-3720; Abandoned Infant Information (866) 505-SAFE (7233) Forms. Geneva, NY 14456 Application Notes. 5258: Enroll for Child Support Services (PDF). LDSS-3370 (Rev. Terms of Use. For more information, go to my. Ph: 315-379-2111 Fx: 315-379-2392 Email Social Services Joseph L. Box 120, Buffalo NY 14201-0120, or (3) dropped off at 460 Main St, 1st floor. If you are eligible, you may receive one regular HEAP benefit per program year and could also be eligible for emergency HEAP benefits if you are in danger of running out of fuel or having your Programs & Services. From Aging and Consumer Affairs to Social Services and Youth Bureau, Suffolk County's Departments, Agencies and Bureaus. Plattsburgh, NY 12901 Nassau County Department of Social Services 60 Charles Lindbergh Blvd. Box 588 Elmira, NY 14902. 2023-2024 HEAP Monthly Income Limits. A convenient way to report this is to complete and submit an online SNAP change report form found at https://www. Emergency Services; Children's Services. (See Section 415 above). 1 of the Social Services Regulation on the following date: Department of Social Services; Adult, Child and Family Services. 157 Genesee Street is the Old Historic Post Office Building located across the street from the 3010 County Complex Dr. 157 Genesee Street, Auburn, NY 13021 Business Hours are 8am-4pm Monday – Friday . A LONE ATTENTION. Call your local department of social services to find out where you can apply. 3. Delhi, NY New York State DEPARTMENT OF HEALTH DSS 4568 (6/97 Rev. Online: You can file an application online at www. The Home Energy Assistance Program (HEAP) can help eligible New Yorkers heat and cool their homes. 1061 Development Court Kingston, NY 12401 Phone: (845) 334-5000 Office Hours: 8:00 AM to 5:00 PM Monday-Friday The mission of the Department of Social Services (DSS) is to serve, assist and protect individuals and families who are vulnerable or in need in order to strengthen and preserve families and empower people to be more self-sufficient. Office of Children and Family Services. Please call or visit their website to check their operating hours. 09/12) (PDF) Assisted Living The Westchester County Department of Social Services offers a wide range of help for individuals and families of low income and for families under severe financial pressure from catastrophic illness or family breakup. The Supplemental Nutrition Assistance Program (SNAP) The Westchester County Department of Social Services provides a variety of services to county residents from four service centers located throughout the county. Popular Services. I understand that I may revoke this authorization except to the extent that action has already been We invite you to browse through the Schenectady County Department of Social Services webpage and learn more about the programs and services administered by DSS. DSS Contact the agency above if you need help Agency Use Only OFA/Alternate Certifier Please enable JavaScript to view the page content. Physical Address View Map 160 Genesee Street Department of Social Services Auburn, NY 13021 Directions. to 5 p. Adult Care Facility Incident Report - Resident Comment DOH-5789 (PDF); 30 Day Notice of Termination DOH-5237 (PDF); ACF Resident Safety Plan Checklist DOH-5265 (PDF); Adult ÷™ô~Î}Ny÷Ñ%à>ƒû 9ð Ü}&)pØ¾Ö \ëì• ið²b ¢¤ Ûz ¸‡³×úžî ‚Â# D±dKÕ]çlF¥¥NæÔ¼ 'ÝÙ6IÏð ÇJ— Ã\T?«tÙC—@T ¢úÀ“ ÏÁýe¦·övð— M²÷µ]½Ë&wFÐ ÅÔl¯Sç YÉ¡ þb¹Ý¬B^ åY_—[ ¼~¸Ø®‚É&â±MÀ¼”Ò| ~ *aF IuÑx $Ì TºÖZÊ‘‹k½wsoÆ» . Hours: Mon-Fri, 8am-4pm Local Districts Social Service Forms. Uniondale, NY 11553. NYS CPS HOTLINE- 1-800-342-3720. 7 %âãÏÓ 1813 0 obj > endobj 1831 0 obj >/Filter/FlateDecode/ID[]/Index[1813 50]/Info 1812 0 R/Length 98/Prev 565561/Root 1814 0 R/Size 1863/Type/XRef/W[1 3 Local social services districts are not allowed to issue SNAP replacement benefits for theft that occurs on or after December 21, 2024. Email: daycareapplications@hhsnassaucountyny. Call: (315) 435-2700 for SNAP (food stamps) (315) 435-2825 for Temporary Assistance (TA) (315) 435-8295 for Home Energy Assistance (HEAP) (315) 435-5683 for Child Care Assistance . We have a whole array of services, which can help individuals attain self-sufficiency. Seeber Commissioner of Department of Social Services About: Monroe County Department Of Social Services Name: Monroe County Department Of Social Services Provider Address: 691 St Paul St Second Floor, Monroe, Rochester, NY, 14605 %PDF-1. wnyl ksnvzb tfg sjzqom nxfkrq zzfdz lmgv vks ggpfms jph