- Social Services Forms
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Favorites
| Name Sort descending | Modified | Size | Description |
|---|---|---|---|
| 2008 release form.pdf | 2/18/20 12:13 PM | 61.83 KB | 2008 Release Form |
| 2019 Poverty Level Figures.docx | 2/18/20 12:15 PM | 12.94 KB | 2019 POVERTY LEVEL FIGURES |
| 3785.pdf | 2/18/20 12:28 PM | 989.72 KB | HEAP-Self Employment Form-3785 |
| 3829.pdf | 2/18/20 12:31 PM | 122.24 KB | Low Income Worksheet-3829 |
| APPT of AUTH REP.pdf | 2/18/20 12:17 PM | 21.02 KB | APPOINTMENT OF AUTHORIZED REPRESENTATIVE |
| Application for Child Care Assistance OCFS-6025 (rev 05-2019).pdf | 2/18/20 12:14 PM | 1.18 MB | 2019 APPLICATION FOR CHILD CARE ASSISTANCE |
| Child Care Market Rates 2019.pdf | 2/18/20 12:19 PM | 123.35 KB | CHILD CARE MARKET RATES 2019 |
| Child Visitation Form (IM-1988).pdf | 2/18/20 12:20 PM | 94.19 KB | CHILD VISITATION |
| Child and Family Services Plan 2018 - 2023.pdf | 2/18/20 12:18 PM | 140.41 KB | CHILD AND FAMILY SERVICES PLAN CHILD CARE 2019 |
| Client Reimbursement Form.pdf | 2/18/20 12:22 PM | 290.78 KB | DAYCARE - CLIENT REIMBURSEMENT |
| DAY CARE OCCUPANCY STATEMENT.pdf | 2/18/20 12:23 PM | 4.30 KB | DAYCARE OCCUPANCY STATEMENT |
| DayCare cover.pdf | 2/18/20 12:20 PM | 71.92 KB | Day Care Cover |
| EMPLOYER SPONSORED HEALTH INSURANCE form .pdf | 2/18/20 12:27 PM | 38.52 KB | Employer Sponsored Health Insurance |
| Employment Verification Form.pdf | 2/18/20 12:23 PM | 521.75 KB | DAYCARE - EMPLOYMENT VERIFICATION |
| Fill in CS statement.pdf | 2/18/20 12:27 PM | 23.41 KB | Fill in CS Statement |
| HEAP No Income Statement.pdf | 2/18/20 12:31 PM | 14.31 KB | HEAP No Income Statement |
| How to Complete the Application for Child Care Assistance OCFS-6026 (rev 05-2019).pdf | 2/18/20 12:15 PM | 341.87 KB | 2019 HOW TO COMPLETE THE APPLICATION FOR CHILD CARE ASSISTANCE |
| Instructions for completing the Employment Verification Form.pdf | 2/18/20 12:24 PM | 399.98 KB | DAYCARE - INSTRUCTIONS FOR EMPLOYMENT VERIFICATION |
| LANDLORD STATEMENT.pdf | 2/18/20 12:29 PM | 15.40 KB | LANDLORD STATEMENT FOR MEDICAL ASSISTANCE ONLY |
| Landlord Statement 5-2018.pdf | 2/18/20 12:29 PM | 64.21 KB | LANDLORD STATEMENT FOR FS ONLY |
| NOTICE TO DAY CARE RECIPIENTS.pdf | 2/18/20 12:32 PM | 88.75 KB | Notice to Day Care Recipients |
| New folder | 9/7/22 2:38 PM | 0 bytes | |
| New folder 1 | 9/7/22 2:41 PM | 0 bytes | |
| New folder 2 | 9/7/22 2:44 PM | 0 bytes | |
| Occupancy Statement.pdf | 2/18/20 12:32 PM | 29.13 KB | OCCUPANCY STATEMENT |
| Provider Reimbursement.pdf | 2/18/20 12:25 PM | 284.53 KB | DAYCARE - PROVIDER REIMBURSEMENT |
| RECERT DOCUMENTATION REQUREMENTS REQUEST.pdf | 2/18/20 12:33 PM | 48.42 KB | RECERT DOCUMENTATION - MEDICAL ASSISTANCE |
| RESOURCE CHECKLIST.pdf | 2/18/20 12:34 PM | 136.33 KB | Adult Medicaid/FHP Resource Check List |
| Self Employment Log 1886.pdf | 2/18/20 12:34 PM | 36.91 KB | SELF EMPLOYMENT LOG |
| Temporary Assistance Landlord Statement IM-1871.pdf | 2/18/20 12:30 PM | 16.90 KB | LANDLORD STATEMENT FOR TEMPORARY ASSISTANCE ONLY |
| add_to_active_form..pdf | 2/18/20 12:16 PM | 190.82 KB | APPLICATION FOR ADD TO ACTIVE CASE |
| provider information.pdf | 2/18/20 12:33 PM | 78.82 KB | Provider Information |