Category

Name

Document type

Number

Adult Protective Services

Residents Special Needs Expenditure Log(WORD)

Form

OCFS-3913

Adult Protective Services

Health and Safety Equipment and Substitute Care Expenditure Log(PDF)

Form

OCFS-3914

Adult Protective Services

Health and Safety Equipment and Substitute Care Expenditure Log(WORD)

Form

OCFS-3914

Adult Protective Services

Individual Resident Fund Record Account(PDF)

Form

LDSS-3633

Adult Protective Services

Individual Resident Fund Record Account(WORD)

Form

LDSS-3633

Adult Protective Services

Resident Medication Record(PDF)

Form

LDSS-3634

Adult Protective Services

Resident Medication Record(WORD)

Form

LDSS-3634

Adult Protective Services

Family Type Home for Adults Certification of Child Support Obligations(PDF)

Form

LDSS-4505

Adult Protective Services

Family Type Home for Adults Certification of Child Support Obligations(WORD)

Form

LDSS-4505

Adult Protective Services

Personal History of Applicant Family Type Home for Adults(PDF)

Form

OCFS-LDSS-7014

Adult Protective Services

Personal History of Applicant Family Type Home for Adults(WORD)

Form

OCFS-LDSS-7014

Adult Protective Services

Medical Evaluation (Operator)(PDF)

Form

LDSS-3239

Adult Protective Services

Medical Evaluation (Operator)(WORD)

Form

LDSS-3239

Adult Protective Services

Plan for Fire, Disaster or Other Emergency Evactuation of Residents Operator or Substitute Caretaker(PDF)

Form

OCFS-LDSS-7016

Adult Protective Services

Plan for Fire, Disaster or Other Emergency Evactuation of Residents Operator or Substitute Caretaker(WORD)

Form

OCFS-LDSS-7016

Adult Protective Services

Application for Approval Family-Type Home for Adults

Form

LDSS-2865

Adult Protective Services

Application for Approval Family-Type Home for Adults(PDF)

Form

LDSS-2865

Adult Protective Services

Application for Approval Family-Type Home for Adults(WORD)

Form

LDSS-2865

Adult Protective Services

MEDICATION LOG(PDF)

Form

LDSS-3635

Adult Protective Services

MEDICATION LOG(WORD)

Form

LDSS-3635

Adult Protective Services

Special Needs Fund Individual Resident Log(PDF)

Form

LDSS-3705

Adult Protective Services

Special Needs Fund Individual Resident Log(WORD)

Form

LDSS-3705

Adult Protective Services

Statement Offering Personal Allowance Account(PDF)

Form

OCFS-LDSS-2853

Adult Protective Services

Statement Offering Personal Allowance Account(WORD)

Form

OCFS-LDSS-2853

Adult Protective Services

Personal Allowance Register(PDF)

Form

OCFS-LDSS-2854

Adult Protective Services

Personal Allowance Register(WORD)

Form

OCFS-LDSS-2854

Adult Protective Services

Personal Allowance Summary(PDF)

Form

OCFS-LDSS-2855

Adult Protective Services

Personal Allowance Summary(WORD)

Form

OCFS-LDSS-2855

Adult Protective Services

Personal Data Sheet(PDF)

Form

OCFS-LDSS-2949

Adult Protective Services

Personal Data Sheet(WORD)

Form

OCFS-LDSS-2949

Adult Protective Services

Chronological Admission and Discharge Register(PDF)

Form

OCFS-LDSS-3026

Adult Protective Services

Chronological Admission and Discharge Register(WORD)

Form

OCFS-LDSS-3026

Adult Protective Services

Inventory of Residents Property Held by Facility for Safe Keeping(PDF)

Form

OCFS-LDSS-3027

Adult Protective Services

Inventory of Residents Property Held by Facility for Safe Keeping(WORD)

Form

OCFS-LDSS-3027

Adult Protective Services

Incident Report (DARC)(DAS)(PDF)

Form

LDSS-3123

Adult Protective Services

Incident Report (DARC)(DAS)(WORD)

Form

LDSS-3123

Adult Protective Services

Request for Forms and Publications(PDF)

Form

OCFS-4627

Adult Protective Services

Request for Forms and Publications(WORD)

Form

OCFS-4627

Adult Protective Services

FTHA Application Independent-Verification Check List(PDF)

Form

LDSS-2865B

Adult Protective Services

FTHA Application Independent-Verification Check List(WORD)

Form

LDSS-2865B

Adult Protective Services

FTHA Application Independent-Verification Check List

Form

LDSS-2865B

Adult Protective Services

Family Type Homes for Adults - Medical Evaluation (Resident)(PDF)

Form

OCFS-3122

Adult Protective Services

Family Type Homes for Adults - Medical Evaluation (Resident)(WORD)

Form

OCFS-3122