NY OCFS LDSS-2221A 2008-2023 free printable template

LDSS 2221A is a form used in New York State for applications for Temporary Assistance. The form is typically used when applying for cash assistance, medical assistance, and SNAP (food stamps).

1. Complete the “Applicant Information” section at the top of the form: • Enter your full name • Enter your address • Enter your phone number • Enter your Social Security Number 2. Describe the changes to report in the “Changes to Report” section: • Indicate the type of change that you are reporting • Enter the date the change occurred • Describe the details of the change 3. Confirm the accuracy of the information in the “Applicant’s Statement” section: • Read the statement and initial in the box provided 4. Sign and date the form in the “Signature” section: • Sign and date the form in the boxes provided 5. Submit the form: • Submit the form to the local Social Security office or the appropriate state agency.

LDSS 2221A is a form used by the New York State Office of Children and Family Services (OCFS) to verify that a child is eligible for subsidized child care. It is used to document the applicant's family size, gross income, and other information necessary to determine if the family meets the eligibility requirements. The information on this form is used to determine the family's child care subsidy for payment to the child care provider.

The deadline to file LDSS 2221A in 2023 is October 15th, 2023.

The penalty for the late filing of LD-221a is a $50 fee per day until the filing is complete.

The LDSS-2221A form is typically filed by a parent or legal guardian who is applying for child care assistance in the state of New York. This form helps in determining the eligibility for child care subsidies.

The LDSS-2221A form is used to report changes in income, resources, household composition, and other circumstances that may affect eligibility for public assistance programs such as Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP). The specific information that must be reported on the LDSS-2221A may vary depending on the state or local social services agency, but generally, the following information is required: 1. Personal information: Name, address, social security number, date of birth, and contact information for all household members. 2. Household composition: List all individuals living in the household and their relationship to the head of household. 3. Income: Report all sources of income for household members, including wages, self-employment income, Social Security benefits, child support, unemployment benefits, and any other types of income. 4. Changes in income: If there has been any change in income, such as a job loss, wage increase, or decrease, it must be reported on the form. 5. Resources: Report all assets and resources owned by household members, such as bank accounts, vehicles, property, and investments. 6. Expenses: Include information about household expenses, such as rent or mortgage payments, utilities, child care costs, and medical expenses. 7. Changes in circumstance: Report any changes in household composition, address, marital status, or other circumstances that may affect eligibility for assistance programs. 8. Certification: The LDSS-2221A form typically requires a signature from the head of household to certify the accuracy of the information provided. It is worth noting that this information is not exhaustive, and the specific requirements and instructions for completing the LDSS-2221A may vary depending on the state or local agency. It is essential to follow the instructions provided on the form or consult with the relevant agency to ensure accurate completion.

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