All Forms

Order Hard Copies of Forms

To order hard copies of available forms developed by the New York State Office of Children and Family Services (OCFS), complete the "Request for Forms and Publications" form (OCFS-4627) and mail your request to:

OCFS Resource Distribution Center
11 Fourth Ave
Rensselaer, NY 12144-2629
OR
Call the Forms Hotline: 518-473-0971

QUICK LINKS

Adoption, Child Care: Licensed/Registered Provider, Legally-Exempt Provider, Local Department of Social Services; Child Welfare and Community Services Forms, Child Protective Services / State Central Register, Commission for the Blind and Visually Handicapped, Contracts and Grants, Domestic Violence Program Application, Electronic Payments, Foster Care, Home and Community-Based Services Waiver (B2H), Juvenile Justice and Opportunities for Youth, Kinship, Management Services, Protective Services for Adults, Services Systems (WMS/CCRS) Input Documents and Reference Materials, Youth Development

Adoption

Autism Awareness Brochure-Pub 4998
(Autism PDF 1524 KB) (Autism PDF 126 KB)(Autism PDF 62 KB)(Autism PDF 54 KB)
ICPC-100A Instructions for Completing Form ICPC-100A Interstate Compact on the Placement of Children Request
(ICPC-100A 88 KB) (ICPC-100A PDF 39 KB)
ICPC-100B Instructions for completing Form ICPC-100B Interstate Compact on the Placement of Childs Placement Status
(ICPC-100B 71 KB) (ICPC-100B PDF 26 KB)
LDSS-0570 Adoptive Placement Agreement
(LDSS-0570 Word 48 KB) (LDSS-0570 PDF 45 KB)
LDSS-0570S Acuerdo de Colocacion Adoptiva
(LDSS-0570S Word 50 KB) (LDSS-0570S PDF 45 KB)
LDSS-0571 Medical Report of Prospective Adoptive Parent
(LDSS-0571 Word 70 KB) (LDSS-0571 PDF 40 KB)
LDSS-0857 Application to Adopt - Part 1 Family Adoption Registry Information
(LDSS-0857 232 KB) (LDSS-0857 PDF 52 KB)
LDSS-2724 Notice of Intent to Claim Paternity of a Child Born Out of Wedlock
(LDSS-2724 Word 39 KB) (LDSS-2724 PDF 23 KB)
LDSS-2724S Notificacion del Intento de Demandar la Paternidad de un Nino(a) Nacido Fuera del Matrimonio
(LDSS-2724S Word 38 KB) (LDSS-2724S PDF 15 KB)
LDSS-2725 Request-Response for Name and-or Address of Father of Child Born Out of Wedlock
(LDSS-2725 Word 59 KB) (LDSS-2725 PDF 33 KB)
LDSS-2726 Court Determination of Parentage
(LDSS-2726 Word 142 KB) (LDSS-2726 PDF 107 KB)
LDSS-3416 Religious Designation of a Child (Model Form)
(LDSS-3416 Word 42 KB) (LDSS-3416 PDF 20 KB)
LDSS-3416S Designacion Religiosa de un Nino(a)
(LDSS-3416S 48 KB)
LDSS-3912 Adoption Assistance Eligibility Checklist
(LDSS-3912 PDF 44 KB)
LDSS-4291 Adoption Fee Disclosure Statement
(LDSS-4291 Word 96 KB) (LDSS-4291 PDF 68 KB)
LDSS-4315 Judicial Surrender
(LDSS-4315 54 KB)
LDSS-4315S Entrega Judicial
(LDSS-4315S 48 KB)
LDSS-4623 Adoption Subsidy Agreement And Non-Recurring Adoption Expenses Agreement - Cover Sheet
(LDSS-4623 Word 81 KB) (LDSS-4623 PDF 24 KB)
LDSS-4623A Adoption Subsidy and Non-Recurring Adoption Expenses Agreement - Initial Application
(LDSS-4623A Word 204 KB) (LDSS-4623A PDF 111 KB)
LDSS-4623B Adoption Subsidy and Non-Recuring Adoption Expenses Agreement - Post Fianalization Application
(LDSS-4623B Word 200 KB) (LDSS-4623B PDF 109 KB)
LDSS-4623C-1 Adoption Subsidy and Non-Recurring Adoption Expenses Agreement - Technical Amendment
(LDSS-4623C-1 Word 62 KB) (LDSS-4623C-1 PDF 29 KB)
LDSS-4623C-2 Adoption Subsidy and Non-Recurring Adotion Expenses Agreement - Upgrade or Substantive Amendment
(LDSS-4623C-2 Word 150 KB) (LDSS-4623C-2 PDF 66 KB)
LDSS-4623D Adoption Subsidy and Non-Recurring Adoption Expenses Agreement - Non-Recurring Adoption Expenses Reimbursement Form
(LDSS-4623D Word 73 KB) (LDSS-4623D PDF 23 KB)
OCFS-3780 Instrument to Acknowledge Paternity of an Out-of-Wedlock Child
(OCFS-3780 Word 57 KB) (OCFS-3780 PDF 74 KB)
OCFS-3780S Escritura para Reconocer la Paternidad de un Hijo(a) Natural (Nacido Fuera de Matrimonio)
(OCFS-3780S Word 58 KB) (OCFS-3780S PDF 75 KB)
OCFS-4251 Financial and Medical Plan
(OCFS-4251 Word 46 KB) (OCFS-4251 PDF 19 KB)
OCFS-4732 Information on Foster Placements of Children Adopted from Other Countries
(OCFS-4732 Word 64 KB) (OCFS-4732 PDF 76 KB)
OCFS-4930ASFA Request for NYS Fingerprinting Services - Information Form
(OCFS-4930ASFA Word 76 KB)
OCFS-4930ASFA-S Solicitud de Servicios de Impresiones Digitales - Formulario Informativo
(OCFS-4930ASFA-S Word 71 KB)
OCFS-7060 Declaration of Intent to Adopt
(OCFS-7060 Word 37 KB) (OCFS-7060 PDF 9 KB)
OCFS-7069 Parental Certification of Continued Support and Educational Status of Child
(OCFS-7069 Word 81 KB) (OCFS-7069 PDF 14 KB)
OCFS-7073 Parental Certification of Adopted Childs Status
(OCFS-7073 82 KB)
OCFS-LDSS-7000 Health Care Plan for the Administration of Medication for Legally-Exempt Provider
(OCFS-LDSS-7000 PDF 105 KB)
OCFS-LDSS-7015 Amendment to a Fully Executed and Approved Adoption Subsidy Agreement
(OCFS-LDSS-7015 Word 42 KB) (OCFS-LDSS-7015 PDF 32 KB)
OCFS-LDSS-7031 Transmittal for Parent Locator Service Search
(OCFS-LDSS-7031 Word 59 KB) (OCFS-LDSS-7031 PDF 17 KB)

Child Care

Licensed/Registered Provider

LDSS-4434-1 Caregiver Medical Statement (All Modalities)
(LDSS-4434-1 Word 100 KB)
LDSS-4434-4 Household Member Medical Statement
(LDSS-4434-4 Word 121 KB) (LDSS-4434-4 PDF 46 KB)
LDSS-4436 Incident Report for Child Day Care
(LDSS-4436 57 KB) (LDSS-4436 PDF 17 KB)
LDSS-4438DCC Emergency Planning Guide
(LDSS-4438DCC PDF 1219 KB)
LDSS-4438FDC-GFDC Emergency Planning Guide
(LDSS-4438FDC-GFDC PDF 1209 KB)
LDSS-4438SACC Emergency Planning Guide
(LDSS-4438SACC PDF 1264 KB)
LDSS-4439 Record of Fire Drills for Child Day Care
(LDSS-4439 Word 90 KB) (LDSS-4439 PDF 66 KB)
LDSS-4440 Schedule of Program Activities for Child Day Care
(LDSS-4440 Word 86 KB) (LDSS-4440 PDF 55 KB)
LDSS-4441 Discipline Policy Statement for Child Day Care
(LDSS-4441 Word 44 KB) (LDSS-4441 PDF 49 KB)
LDSS-4442 Menu Planning for Child Day Care
(LDSS-4442 Word 54 KB) (LDSS-4442 PDF 45 KB)
LDSS-4443 Daily Attendance Record Child Day Care
(LDSS-4443 Word 398 KB) (LDSS-4443 PDF 18 KB)
OCFS-4411 Potassium Iodide-KI Refusal-Opt-Out Form
(OCFS-4411 34 KB) (OCFS-4411 PDF 11 KB)
OCFS-4411S Formulario Para Rehusar El Yoduro De Potasio-KI
(OCFS-4411S 38 KB) (OCFS-4411S PDF 11 KB)
OCFS-4622 Notice to Expunge Associated Fingerprint Cards
(OCFS-4622 40 KB) (OCFS-4622 PDF 11 KB)
OCFS-4659 Waiver for Submission of a Duplicate Fingerprint Card
(OCFS-4659 72 KB) (OCFS-4659 PDF 21 KB)
OCFS-4879 Day Care Program Training Tracking Chart
(OCFS-4879 Word 233 KB) (OCFS-4879 PDF 18 KB)
OCFS-4879S HOJA PARA REGISTRAR LA CAPACITACION DEL PERSONAL EN UN PROGRAMA DE CUIDADO DIURNO
(OCFS-4879S Word 202 KB) (OCFS-4879S PDF 18 KB)
OCFS-4880 Individual Training Tracking Form for Child Care Personnel
(OCFS-4880 Word 221 KB) (OCFS-4880 PDF 17 KB)
OCFS-4880S HOJA PARA REGISTRAR LA CAPACITACION INDIVIDUAL EN UN PROGRAMA DE CUIDADO DIURNO
(OCFS-4880S Word 208 KB) (OCFS-4880S PDF 17 KB)
OCFS-4887 Request for Waiver
(OCFS-4887 44 KB) (OCFS-4887 PDF 10 KB)
OCFS-4887S Solicitud de Exencion o Dispensacion
(OCFS-4887S 44 KB)
OCFS-4890 Report of Death of Child Care
(OCFS-4890 Word 87 KB) (OCFS-4890 PDF 14 KB)
OCFS-4926 Fuel Burning System Inspection
(OCFS-4926 Word 118 KB)
OCFS-4930 Request for NYS Fingerprinting Services Info Form
(OCFS-4930 Word 74 KB) (OCFS-4930 PDF 21 KB)
OCFS-4930-1 Guidelines for Fingerprinting
(OCFS-4930-1 Word 35 KB)
OCFS-4930-1S Guia para Obtener Impresiones Digitales
(OCFS-4930-1S Word 34 KB)
OCFS-4930S Solicitud de Servicios de Impresiones Digitales
(OCFS-4930S Word 70 KB)
OCFS-4932 FAMILY AND GROUP FAMILY DAY CARE PROVIDER REQUEST TO REMOVE STREET ADDRESS AND MAP FROM THE OFFICE OF CHILDREN AND FAMILY SERVICES WEBSITE
(OCFS-4932 Word 49 KB)
OCFS-4932S SOLICITUD PARA RETIRAR DEL PORTAL DE LA AGENCIA DIRECCION Y EL MAPA ASOCIADO CON LA DIRECCION DE UN HOGAR DE CUIDADO DIURNO EN FAMILIA O DE UN GRUPO EN FAMILIA
(OCFS-4932S Word 55 KB)
OCFS-4939 Provider Notification of Licensing or Registration to Fire and Police or Sheriff Departments
(OCFS-4939 Word 74 KB) (OCFS-4939 PDF 14 KB)
OCFS-4939S Notificacion del Proveedor(a) de Cuidado Infantil a los Departamentos de Bomberos y de la Policia sobre su Licencia o Registro
(OCFS-4939S Word 71 KB)
OCFS-LDSS-0792 Day Care Registration
(OCFS-LDSS-0792 Word 79 KB) (OCFS-LDSS-0792 PDF 57 KB)
OCFS-LDSS-4433 Medical Statement of Child in Childcare
(OCFS-LDSS-4433 Word 163 KB) (OCFS-LDSS-4433 PDF 40 KB)
OCFS-LDSS-4838 DCC-Monthly Fire-Safety Inspection for DCC Director or Designee
(OCFS-LDSS-4838 Word 454 KB) (OCFS-LDSS-4838 PDF 227 KB)
OCFS-LDSS-7002 Written Medication Consent Form
(OCFS-LDSS-7002 PDF 36 KB)
OCFS-LDSS-7002S Formulario de Consentimiento Escrito para Medicamentos
(OCFS-LDSS-7002S 174 KB)
OCFS-LDSS-7003 Verbal Medication Consent Form and Log of Administration
(OCFS-LDSS-7003 PDF 25 KB)
OCFS-LDSS-7003S- Formulario de Consentimiento Verbal y Administacion del Registro
(OCFS-LDSS-7003S- PDF 26 KB)
OCFS-LDSS-7004 Log of Medication Administration
(OCFS-LDSS-7004 PDF 36 KB)
OCFS-LDSS-7005 Medication Error Report Form
(OCFS-LDSS-7005 PDF 30 KB)
OCFS-LDSS-7005S Formulario de Informe de Error de Medicacion
(OCFS-LDSS-7005S PDF 25 KB)
OCFS-LDSS-7006 Individual Health Care Plan for a Child with Special Health Care Needs
(OCFS-LDSS-7006 PDF 29 KB)
OCFS-LDSS-7006S Plan Individual de Cuidado de la Salud para un Nino(a) con Necesidades Especiales de Cuidado de la Salud
(OCFS-LDSS-7006S PDF 32 KB)
OCFS-LDSS-7019 Illness Injury and Indicators of Abuse Log
(OCFS-LDSS-7019 Word 238 KB) (OCFS-LDSS-7019 PDF 29 KB)
OCFS-LDSS-7019S Registro de Enfermedades, Lesiones e Indicadores de Abuso
(OCFS-LDSS-7019S Word 234 KB) (OCFS-LDSS-7019S PDF 33 KB)
OCFS-LDSS-7020 Health Care Plan - Day Care Center
(OCFS-LDSS-7020 Word 616 KB) (OCFS-LDSS-7020 1 KB)
OCFS-LDSS-7020S Plan De Atencion Medica-Centro de Cuidado Infantil-Guarderia Infantil
(OCFS-LDSS-7020S 586 KB) (OCFS-LDSS-7020S PDF 157 KB)
OCFS-LDSS-7021 Health Care Plan - Family Day Care Center - Group Family Day Care Center - Small Day Care Centers
(OCFS-LDSS-7021 Word 602 KB)
OCFS-LDSS-7021S Plan De Atencion Medica - Hogar de Cuidado Diurno en Familia - Hogar de Cuidado Diurno de un Grupo en Familia - Centro Pequeno de Cuidado Infantil
(OCFS-LDSS-7021S 553 KB) (OCFS-LDSS-7021S PDF 190 KB)
OCFS-LDSS-7022 Health Care Plan - School Age Child Care
(OCFS-LDSS-7022 Word 574 KB)
OCFS-LDSS-7024 Evaluation of my Most Recent Licensing-Registration Experience
(OCFS-LDSS-7024 Word 68 KB) (OCFS-LDSS-7024 PDF 13 KB)
OCFS-LDSS-7035 Assistant Information-Group Family Day Care
(OCFS-LDSS-7035 Word 44 KB) (OCFS-LDSS-7035 PDF 22 KB)
OCFS-LDSS-7036 Assistant Qualifications
(OCFS-LDSS-7036 Word 70 KB) (OCFS-LDSS-7036 PDF 36 KB)
OCFS-LDSS-7037 Assistant References
(OCFS-LDSS-7037 Word 68 KB) (OCFS-LDSS-7037 PDF 23 KB)
OCFS-LDSS-7038 Assistant Criminal History Review
(OCFS-LDSS-7038 Word 62 KB) (OCFS-LDSS-7038 PDF 34 KB)
OCFS-LDSS-7040 Environmental Hazards Guidance Sheet
(OCFS-LDSS-7040 Word 85 KB) (OCFS-LDSS-7040 PDF 99 KB)
OCFS-LDSS-7041 Directions for Completing the Environmental Hazards Statement
(OCFS-LDSS-7041 Word 50 KB) (OCFS-LDSS-7041 PDF 80 KB)
OCFS-LDSS-7042 Environmental Hazard Information Form Parts I and II
(OCFS-LDSS-7042 Word 71 KB) (OCFS-LDSS-7042 PDF 127 KB)
OCFS-LDSS-7043 Plan of Study Commitment for Head of Group for Preschoolers Infants and Toddlers
(OCFS-LDSS-7043 Word 51 KB) (OCFS-LDSS-7043 PDF 28 KB)
OCFS-LDSS-7044 Plan of Study Commitment for Director of Day Care Center
(OCFS-LDSS-7044 Word 60 KB) (OCFS-LDSS-7044 PDF 33 KB)

We appreciate your interest in learning more about the application process to become a child day care provider. The application forms you can download from this site are sample forms only. Each type of child day care requires slightly different forms and information. Reviewing the sample forms at this website prior to requesting an "official" application package will assist you in determining which type of child day care you might be interested in pursuing.

You may request an official application package, which will be specifically tailored to your needs and include the identification number required for processing, by going to http://opal.gorr.state.ny.us

Day Care Center Application Package - SAMPLE
( PDF 2136 KB)
Day Care Center Renewal Package - SAMPLE
( PDF 225 KB)
Family Day Care Application Package - SAMPLE
( PDF 2660 KB)
Group Family Day Care Application Package - SAMPLE
( PDF 6834 KB)
Group Family Day Care Renewal Package - SAMPLE
( PDF 595 KB)
School-Age Child Care Application Package - SAMPLE
( PDF 5415 KB)
School-Age Child Care Renewal Package - SAMPLE
( PDF 325 KB)
Small Day Care Center Application Package - SAMPLE
( PDF 719 KB)

Legally-Exempt Provider

OCFS-4915 History of Criminal Convictions and Parental Acknowledgment
(OCFS-4915 42 KB) (OCFS-4915 PDF 11 KB)
OCFS-4915-S Historial de Convicciones Criminales y Reconocimiento del Padre-Madre
(OCFS-4915-S 48 KB) (OCFS-4915-S PDF 9 KB)
OCFS-4916 History of Day Care Enforcement and Parental Acknowledgment
(OCFS-4916 42 KB) (OCFS-4916 PDF 15 KB)
OCFS-4916S Historial de Ejecutoria de Cuidado Diurno y Reconocimiento del Padre-Madre
(OCFS-4916S 45 KB) (OCFS-4916S PDF 15 KB)
OCFS-4917 History of Termination of Parental Rights and-or Court Ordered Article 10 - Removal of a Child and Parental Acknowledgment
(OCFS-4917 46 KB) (OCFS-4917 PDF 16 KB)
OCFS-4917-S Historial de Terminacion de Derechos Paternos-Maternos y-o Retiro de Ninos por Orden del Tribunal Segun Articulo 10 y Reconocimiento Paterno-Materno
(OCFS-4917-S 50 KB) (OCFS-4917-S PDF 17 KB)
OCFS-7026 Enrollment Information Packet for Legally-Exempt Providers
(OCFS-7026 Word 278 KB) (OCFS-7026 PDF 333 KB)
OCFS-7026-S Paquete de Informacion Sobre la Inscripcion para Proveedores Legalmente Exentos
(OCFS-7026-S Word 369 KB) (OCFS-7026-S PDF 347 KB)
OCFS-LDSS-4699 Enrollment Form for Provider of Legally-Exempt Family Child Care and Legally -Exempt in-Home Child Care
(OCFS-LDSS-4699 594 KB) (OCFS-LDSS-4699 608 KB)(OCFS-LDSS-4699 PDF 611 KB)
OCFS-LDSS-4699-1 Employment of Minors
(OCFS-LDSS-4699-1 52 KB) (OCFS-LDSS-4699-1 PDF 17 KB)
OCFS-LDSS-4699-1A Employment of Minors -Information
(OCFS-LDSS-4699-1A 46 KB) (OCFS-LDSS-4699-1A PDF 112 KB)
OCFS-LDSS-4699-1AS Informacion Sobre el Empleo de Menores
(OCFS-LDSS-4699-1AS 64 KB) (OCFS-LDSS-4699-1AS PDF 24 KB)
OCFS-LDSS-4699-1S Empleo de Menores
(OCFS-LDSS-4699-1S 52 KB) (OCFS-LDSS-4699-1S PDF 17 KB)
OCFS-LDSS-4699-2 Legally Exempt In-Home Child Care Provider Agreement Form
(OCFS-LDSS-4699-2 42 KB) (OCFS-LDSS-4699-2 PDF 78 KB)
OCFS-LDSS-4699-2A Parental Responsibilities When Employing a Legally Exempt In-Home Child Care Provider
(OCFS-LDSS-4699-2A 35 KB) (OCFS-LDSS-4699-2A PDF 106 KB)
OCFS-LDSS-4699-2AS Responsabilidades de los Padres al Emplear un Proveedora de Cuidado Infantil en el Hogar Legalmente Exento
(OCFS-LDSS-4699-2AS 36 KB) (OCFS-LDSS-4699-2AS PDF 71 KB)
OCFS-LDSS-4699-2S Acuerdo del Proveedor(a) de Cuidado Infantil a Domicilio Legalmente Exento
(OCFS-LDSS-4699-2S 44 KB) (OCFS-LDSS-4699-2S PDF 11 KB)
OCFS-LDSS-4699-3 Legally-Exempt Provider Training Record Form
(OCFS-LDSS-4699-3 Word 50 KB) (OCFS-LDSS-4699-3 PDF 23 KB)
OCFS-LDSS-4699-3S Registro de Entrenamiento para Proveedores de Cuidado Infantil Legalmente Exento
(OCFS-LDSS-4699-3S Word 48 KB) (OCFS-LDSS-4699-3S PDF 22 KB)
OCFS-LDSS-4699S Formulario de Inscripcion para Proveedores de Servicios de Cuidado Infantil en Familia Legalmente Exento y de Cuidado Infantil a Domicilio Legalmente Exento
(OCFS-LDSS-4699S 631 KB) (OCFS-LDSS-4699S PDF 224 KB)
OCFS-LDSS-4700 Enrollment form for Provider of Legally-Exempt Group Child Care
(OCFS-LDSS-4700 438 KB) (OCFS-LDSS-4700 PDF 422 KB)
OCFS-LDSS-7000 Health Care Plan for the Administration of Medication for Legally-Exempt Provider
(OCFS-LDSS-7000 244 KB) (OCFS-LDSS-7000 PDF 66 KB)
OCFS-LDSS-7000S Instrucciones para Completar el Plan de Salud para la Administracion de Medicamentos para Proveedores Legalmente Exentos
(OCFS-LDSS-7000S 293 KB) (OCFS-LDSS-7000S PDF 72 KB)
OCFS-LDSS-7001 Instructions for Completing the Health Care Plan for the Administration of Medication for Legally-Exempt Provider
(OCFS-LDSS-7001 Word 106 KB) (OCFS-LDSS-7001 PDF 109 KB)
OCFS-LDSS-7001S Instrucciones para Completar el Plan de Salud para la Administracion de Medicamentos del Proveedor Legalmente Exento
(OCFS-LDSS-7001S Word 102 KB) (OCFS-LDSS-7001S PDF 123 KB)
OCFS-LDSS-7002 Written Medication Consent Form
(OCFS-LDSS-7002 Word 146 KB)
OCFS-LDSS-7003 Verbal Medication Consent Form and Log of Administration
(OCFS-LDSS-7003 141 KB)
OCFS-LDSS-7003S- Formulario de Consentimiento Verbal y Administacion del Registro
(OCFS-LDSS-7003S- 151 KB)
OCFS-LDSS-7004 Log of Medication Administration
(OCFS-LDSS-7004 Word 208 KB)
OCFS-LDSS-7004S Registro de Administracion de Medicamentos
(OCFS-LDSS-7004S 182 KB)
OCFS-LDSS-7005 Medication Error Report Form
(OCFS-LDSS-7005 Word 115 KB)
OCFS-LDSS-7005S Formulario de Informe de Error de Medicacion
(OCFS-LDSS-7005S Word 116 KB)
OCFS-LDSS-7006 Individual Health Care Plan for A Child With Special Health Care Needs
(OCFS-LDSS-7006 Word 83 KB)
OCFS-LDSS-7006S Plan Individual de Cuidado de la Salud para un Nino(a) con Necesidades Especiales de Cuidado de la Salud
(OCFS-LDSS-7006S Word 83 KB)
OCFS-LDSS-7007 Obtaining Authorization to Administer Medication to Subsidized Children in Legally Exempt Care
(OCFS-LDSS-7007 Word 66 KB) (OCFS-LDSS-7007 PDF 58 KB)
OCFS-LDSS-7008 Administration of Medication by Legally-Exempt Child Care Provider
(OCFS-LDSS-7008 Word 47 KB) (OCFS-LDSS-7008 PDF 44 KB)
OCFS-LDSS-7008S Administracion de Medicamentos por el Proveedor de Cuidado Infantil Legalmente Exento
(OCFS-LDSS-7008S Word 51 KB) (OCFS-LDSS-7008S PDF 72 KB)
OCFS-LDSS-7028-1 Home Inspection Report for Legally Exempt Family Child Care Provider
(OCFS-LDSS-7028-1 Word 462 KB) (OCFS-LDSS-7028-1 PDF 79 KB)
OCFS-LDSS-7028-2 Corrective Action Plan for Legally Exempt Child Care Provider
(OCFS-LDSS-7028-2 Word 96 KB) (OCFS-LDSS-7028-2 PDF 23 KB)
OCFS-LDSS-7028-3 Attachment to the Home Inspection Report for Legally Exempt Family Child Care Provider
(OCFS-LDSS-7028-3 Word 114 KB) (OCFS-LDSS-7028-3 PDF 35 KB)

Local Department of Social Services

Autism Awareness Brochure-Pub 4998
(Autism PDF 1524 KB) (Autism PDF 126 KB)(Autism PDF 62 KB)(Autism PDF 54 KB)
OCFS-LDSS-4433 Medical Statement of Child in Childcare
(OCFS-LDSS-4433 Word 163 KB) (OCFS-LDSS-4433 PDF 40 KB)
OCFS-LDSS-4779 Approval of Your Application for Child Care Benefits
(OCFS-LDSS-4779 Word 85 KB)
OCFS-LDSS-4779S APROBACION DE SU SOLICITUD PARA BENEFICIOS DE CUIDADO DE NINOS
(OCFS-LDSS-4779S Word 86 KB)
OCFS-LDSS-4780 DENIAL OF YOUR APPLICATION FOR CHILD CARE BENEFITS
(OCFS-LDSS-4780 Word 67 KB)
OCFS-LDSS-4780S DENEGACION DE SU SOLICITUD PARA BENEFICIOS DE CUIDADO DE NINOS
(OCFS-LDSS-4780S Word 69 KB)
OCFS-LDSS-4781 NOTICE OF INTENT TO CHANGE CHILD CARE BENEFITS
(OCFS-LDSS-4781 Word 86 KB)
OCFS-LDSS-4781S NOTIFICACION SOBRE EL INTENTO DE CAMBIAR LOS BENEFICIOS DE CUIDADO DE NINOS
(OCFS-LDSS-4781S Word 78 KB)
OCFS-LDSS-4782 NOTICE OF INTENT TO DISCONTINUE CHILD CARE BENEFITS
(OCFS-LDSS-4782 Word 63 KB)
OCFS-LDSS-4782S NOTIFICACION SOBRE EL INTENTO DE DISCONTINUAR BENEFICIOS DE CUIDADO DE NINOS
(OCFS-LDSS-4782S Word 66 KB)
OCFS-LDSS-7009 Notice of Child Care Assistance Overpayment and Repayment Requirements
(OCFS-LDSS-7009 Word 88 KB) (OCFS-LDSS-7009 PDF 42 KB)
OCFS-LDSS-7009S Notificacion de Sobrepago de Asistencia Para Cuidado Infantil Y Requisitos de Devolucion
(OCFS-LDSS-7009S Word 97 KB)
OCFS-LDSS-7010 notice of Fraud Determination-Disqualification for Child Care Benefits and Repayment Plan
(OCFS-LDSS-7010 Word 96 KB) (OCFS-LDSS-7010 PDF 44 KB)
OCFS-LDSS-7010S Notificacion de Determinacion de Fraude Descalificacion Para Recibir Beneficios de Cuidado Infantil Y Plan de Devolucion de Pagos
(OCFS-LDSS-7010S Word 125 KB)

Child Welfare and Community Services Forms

Regional Operations

Autism Awareness Brochure-Pub 4998
(Autism PDF 1524 KB) (Autism PDF 126 KB)(Autism PDF 62 KB)(Autism PDF 54 KB)
OCFS-4722 Voluntary Agency Licensing - Application for OCFS Approval of Certificate of Incorporation
(OCFS-4722 134 KB) (OCFS-4722 PDF 32 KB)

Child Protective Services / State Central Register

Guidelines for determining if an indicated report is relevant and reasonably related to employment, licensure or certification in the child care field
(Guidelines Word 50 KB)
LDSS-2221A Report of Suspected Child Abuse or Maltreatment
(LDSS-2221A Word 204 KB) (LDSS-2221A PDF 32 KB)
LDSS-3370 Statewide Central Register Database Check -see note below
(LDSS-3370 313 KB) (LDSS-3370 PDF 205 KB)
LDSS-3370a Organizations Entitled to Conduct Database Checks Under Section 424-A of the Social Services Law
(LDSS-3370a 46 KB) (LDSS-3370a PDF 22 KB)
OCFS-3909 Request for Information Guardianship Form - For Court Use Only
(OCFS-3909 Word 277 KB) (OCFS-3909 PDF 23 KB)
OCFS-3937 Request for Information - Private Adoption - For Use by Courts or Disinterested Persons Only
(OCFS-3937 115 KB) (OCFS-3937 PDF 22 KB)
OCFS-3937-S Solicitud de Informacion - Adopcion Privada - Para Uso de Tribunales o Personas Desinteresadas Solamente
(OCFS-3937-S Word 142 KB) (OCFS-3937-S PDF 21 KB)
OCFS-4156 Order of Adoption Family Court-Surrogate Court Request Form
(OCFS-4156 Word 124 KB) (OCFS-4156 PDF 18 KB)
OCFS-4190 Inquiry Concerning Visitation Statewide Central Register Database Form
(OCFS-4190 Word 152 KB) (OCFS-4190 PDF 20 KB)
OCFS-7065 Agency Reporting Form for Serious Injuries, Accidents, or Deaths of Children in Foster Care and Deaths of Childern in Open Child Protectice or Preventive Cases
(OCFS-7065 Word 69 KB) (OCFS-7065 PDF 20 KB)
OCFS-7067 Adam Walsh Child Protective and Safety Act of 2006
(OCFS-7067 Word 87 KB)

Commission for the Blind and Visually Handicapped

OCFS-1002 Application for Service
(OCFS-1002 Word 52 KB) (OCFS-1002 PDF 39 KB)
OCFS-1002S Solicitud de Servicios
(OCFS-1002S Word 54 KB) (OCFS-1002S PDF 40 KB)
OCFS-3598 Individual Private Vendor Application
(OCFS-3598 Word 79 KB)
OCFS-4584 Application Form for Equipment Loan Fund for the Disabled
(OCFS-4584 Word 95 KB) (OCFS-4584 PDF 105 KB)
OCFS-4599 Report of Legal Blindness-Request for Information
(OCFS-4599 Word 123 KB) (OCFS-4599 PDF 110 KB)
OCFS-4812 Childrens Services Application
(OCFS-4812 Word 60 KB) (OCFS-4812 PDF 13 KB)
OCFS-4812S Solicitud de Servicios para Ninos
(OCFS-4812S Word 62 KB) (OCFS-4812S PDF 13 KB)

Contracts and Grants

OCFS-4552 Board of Directors Profile
(OCFS-4552 50 KB) (OCFS-4552 PDF 19 KB)

OCFS-4553 Bidder Identification Formpro
(OCFS-4553 58 KB)

OCFS-4555 Non-Discrimination, Non-Sectarian Compliance
(OCFS-4555 Word 59 KB) (OCFS-4555 PDF 54 KB)

OCFS-4595 Application Checklist
(OCFS-4595 32 KB)

OCFS-4596 Appendix D-Application Cover Page-Agreement
(OCFS-4596 86 KB) (OCFS-4596 PDF 23 KB)

OCFS-4597 Outcomes-Performance Targets
(OCFS-4597 47 KB)

OCFS-4629 Project Staffing Plan
(OCFS-4629 Word 121 KB) (OCFS-4629 PDF 111 KB)

OCFS-4630 MWBE Subcontractors and Suppliers - Letter of Intent to Participate
(OCFS-4630 Word 62 KB) (OCFS-4630 PDF 56 KB)

OCFS-4631 Subcontracting Utilization Form
(OCFS-4631 Word 62 KB) (OCFS-4631 PDF 53 KB)

OCFS-4715 Contractor Employee Confidentiality Certification
(OCFS-4715 42 KB)

OCFS-4716 Contractor Employee Background Certification
(OCFS-4716 48 KB)

OCFS-4822 Procurement Lobbying Act - Offerer Certification Form
(OCFS-4822 Word 64 KB) (OCFS-4822 PDF 38 KB)

OCFS-4842 State Consultant Services-Contractors Planned Employment
(OCFS-4842 Word 81 KB) (OCFS-4842 PDF 62 KB)

OCFS-4843 State Consultant Services-Contractors Annual Employment Record
(OCFS-4843 Word 86 KB) (OCFS-4843 PDF 47 KB)

OCFS-4895 Vendor and Contract Contact Update Request Form
(OCFS-4895 Word 80 KB) (OCFS-4895 PDF 56 KB)

ST-220-CA Contractor Certification to Covered Agency
(ST-220-CA PDF 79 KB)

ST-220-TD Contractor Certification
(ST-220-TD PDF 108 KB)

Vendor Responsibility Quesionnaire - Not-for-Profit Business Entity OCFS-7050
(Vendor Word 299 KB) (Vendor PDF 91 KB)

Vendor Responsibility Questionnaire - For Profit Business Entity

Domestic Violence Program Application

OCFS-4639 Domestic Violence New Application
(OCFS-4639 Word 256 KB) (OCFS-4639 PDF 148 KB)
OCFS-4640 Domestic Violence Operating Certificate Application Request
(OCFS-4640 Word 92 KB) (OCFS-4640 PDF 31 KB)
OCFS-4641 Domestic Violence Recertification
(OCFS-4641 Word 248 KB) (OCFS-4641 PDF 145 KB)

Electronic Payments

OCFS-4744 Direct Deposit Authorization Form Enrollment-Cancellation - Autorizacion para Deposito Directo Incripcion-Cancelacion
(OCFS-4744 PDF 64 KB)

Foster Care

Authorizing (SILP) Letter
(Authorizing Word 34 KB)
Autism Awareness Brochure-Pub 4998
(Autism PDF 1524 KB) (Autism PDF 126 KB)(Autism PDF 62 KB)(Autism PDF 54 KB)
B2H Rates (1-1-08) 081229
(B2H PDF 31 KB)
Connections Job Aid
(Connections Word 97 KB)
Foster Parent Reference
(Foster PDF 34 KB)
Immigration and Special Immigrant Juvenile Status (SIJS) resources
(Immigration Word 40 KB) (Immigration PDF 24 KB)
LDSS-0850 Consent for Childs Special or Emergency Medical or Surgical Treatment (By Parent or Guardian)
(LDSS-0850 31 KB)
LDSS-0850S Consentimiento para Proveer Tratamiento Especial a un Nino(a) o Tratamiento de Emergencia Medica o Cirugia (Para el Padre-Madre o Guardian-Tutor(a)
(LDSS-0850S PDF 7 KB)
LDSS-0882 Consent for Childs Routine Medical and Dental Care
(LDSS-0882 Word 47 KB)
LDSS-0882S Consentimiento para la Atencion Medica y Dental de Rutina del Nino(a)
(LDSS-0882S PDF 8 KB)
LDSS-0893 Boarding Home Register
(LDSS-0893 567 KB) (LDSS-0893 PDF 48 KB)
LDSS-2999 School District Notification of Foster Child Placed in a Foster Family, Agency Boarding, Or Group Home
(LDSS-2999 Word 44 KB) (LDSS-2999 PDF 28 KB)
LDSS-3416 Religious Designation of a Child (Model Form)
(LDSS-3416 Word 43 KB) (LDSS-3416 PDF 20 KB)
LDSS-3416S Designacion Religiosa de un Nino(a)
(LDSS-3416S 48 KB) (LDSS-3416S PDF 11 KB)
LDSS-3424 School District Notification of Financial Responsibility for Educationally Handicapped Foster Child Placed in a Child Care Institution
(LDSS-3424 137 KB) (LDSS-3424 PDF 30 KB)
LDSS-3751 Fire Safety Review for Foster Parent Applicants or Foster Homes
(LDSS-3751 Word 110 KB) (LDSS-3751 PDF 77 KB)
LDSS-3806 Notice to be Given Applicants for or Recipients of Services When Requesting Social Security Numbers
(LDSS-3806 PDF 16 KB) (LDSS-3806 Word 30 KB)
LDSS-4315 Judicial Surrender
(LDSS-4315 54 KB)
LDSS-4315S Entrega Judicial
(LDSS-4315S 48 KB)
LDSS-4809 Initial Foster Child Eligibility Checklist
(LDSS-4809 PDF 79 KB)
LDSS-4810 Re-determination of Title IV-E Eligibility Checklist (Foster Care)
(LDSS-4810 PDF 28 KB)
OCFS-0711 Childs Medical Record
(OCFS-0711 146 KB)
OCFS-2656 Voluntary Agency Application for Supervised Independent Living Program (SILP)
(OCFS-2656 Word 91 KB) (OCFS-2656 PDF 18 KB)
OCFS-2657 NOTICE OF SILP CLOSING, TRANSFERRING, RECERTIFICATION AND OPENING
(OCFS-2657 Word 44 KB) (OCFS-2657 PDF 9 KB)
OCFS-4415 Re-entry into Foster Care Ages 18-19 Checklist
(OCFS-4415 78 KB)
OCFS-4883 AGENCY CHECKLIST FOR SILP OPERATION
(OCFS-4883 Word 34 KB)
OCFS-4884 SUPERVISED INDEPENDENT LIVING PROGRAMS
(OCFS-4884 Word 275 KB)
OCFS-4922 Transition Plan Form - Part One - Transition Plan Discussion
(OCFS-4922 238 KB)
OCFS-4923 Transition Plan Form - Part Two - Transition Plan Update and Summary
(OCFS-4923 84 KB)
OCFS-4930 ASFA Request for NYS Fingerprinting Services - Information Form
(OCFS-4930 Word 76 KB) (OCFS-4930 Word 70 KB)
OCFS-4948 Attorney Notification of a Childs Change of Foster Care Placement
(OCFS-4948 56 KB)
OCFS-7065 Agency Reporting Form for Serious Injuries, Accidents, or Deaths of Children in Foster Care and Deaths of Childern in Open Child Protectice or Preventive Cases
(OCFS-7065 Word 69 KB) (OCFS-7065 PDF 20 KB)
OCFS-741 Foster Care Placement Agreement
(OCFS-741 PDF 63 KB)
OCFS-LDSS-0738 Medical History of Prospective or Certified Foster Parent(s)
(OCFS-LDSS-0738 Word 32 KB) (OCFS-LDSS-0738 PDF 15 KB)
OCFS-LDSS-7018 Notification of Foster Care Level of Care and Room and Board Payment
(OCFS-LDSS-7018 Word 75 KB) (OCFS-LDSS-7018 PDF 33 KB)
OCFS-LDSS-7031 Transmittal for Parent Locator Service Search
(OCFS-LDSS-7031 Word 58 KB) (OCFS-LDSS-7031 PDF 17 KB)
Youth Voice Questions
(Youth 38 KB)

Home and Community-Based Services Waiver (B2H)

OCFS-8000 Referral Form
(OCFS-8000 58 KB) (OCFS-8000 PDF 16 KB)
OCFS-8001 Authorization for Release of Health Information
(OCFS-8001 70 KB) (OCFS-8001 PDF 16 KB)
OCFS-8002 Understanding the Bridges to Health Medicaid Waiver Program
(OCFS-8002 43 KB) (OCFS-8002 PDF 20 KB)
OCFS-8003 Freedom of Choice Form
(OCFS-8003 37 KB) (OCFS-8003 PDF 8 KB)
OCFS-8004 Application Form for Enrollment
(OCFS-8004 72 KB) (OCFS-8004 PDF 22 KB)
OCFS-8005A Level of Care for Children with Serious Emotional Disturbances - SED
(OCFS-8005A 74 KB) (OCFS-8005A PDF 24 KB)
OCFS-8005B ICF-MR Level of Care Eligibility Determination-LCED Form
(OCFS-8005B 1060 KB) (OCFS-8005B PDF 45 KB)
OCFS-8005C Level of Care for Children with Medical Fragility (MedF) Pediatric Patient Review Instrument
(OCFS-8005C 214 KB) (OCFS-8005C PDF 24 KB)
OCFS-8006 Change of Provider Form
(OCFS-8006 64 KB) (OCFS-8006 PDF 12 KB)
OCFS-8007 Health Care Integrator Selection Form
(OCFS-8007 44 KB) (OCFS-8007 PDF 11 KB)
OCFS-8008 Waiver Participants Rights Form
(OCFS-8008 49 KB) (OCFS-8008 PDF 19 KB)
OCFS-8009 Notice of Decision- Authorization
(OCFS-8009 64 KB) (OCFS-8009 PDF 20 KB)
OCFS-8010A Notice of Decision - Denial of Enrollment
(OCFS-8010A 70 KB) (OCFS-8010A PDF 20 KB)
OCFS-8010B Notice of Decision - Denial of Waiver Services
(OCFS-8010B 76 KB) (OCFS-8010B PDF 21 KB)
OCFS-8011A Notice of Decision - Discontinuance from Waiver Program
(OCFS-8011A 79 KB) (OCFS-8011A PDF 23 KB)
OCFS-8011B notice of Decision Discontinuance of Waiver Services - Service Providers and or Reduction of Services
(OCFS-8011B 91 KB) (OCFS-8011B PDF 24 KB)
OCFS-8012 Wait List Notification Form
(OCFS-8012 50 KB) (OCFS-8012 PDF 11 KB)
OCFS-8014 Reauthorization Form
(OCFS-8014 58 KB) (OCFS-8014 PDF 36 KB)
OCFS-8015A Health Care Integration Agency Quarterly-Annual Report
(OCFS-8015A 176 KB) (OCFS-8015A PDF 21 KB)
OCFS-8015B Serious Incident Review Committee Quarterly Report
(OCFS-8015B 74 KB) (OCFS-8015B PDF 18 KB)
OCFS-8017 Individualized Health Plan-IHP
(OCFS-8017 178 KB) (OCFS-8017 PDF 51 KB)(OCFS-8017 Excel 34 KB)
OCFS-8018 Service Summary Form
(OCFS-8018 85 KB) (OCFS-8018 PDF 226 KB)
OCFS-8019 Progress Notes
(OCFS-8019 38 KB) (OCFS-8019 PDF 9 KB)
OCFS-8020 Detailed Service Plan
(OCFS-8020 84 KB) (OCFS-8020 PDF 34 KB)
OCFS-8021 Serious Reportable Incident Form
(OCFS-8021 100 KB) (OCFS-8021 PDF 16 KB)
OCFS-8022 Status Progress Report
(OCFS-8022 58 KB)
OCFS-8023 Serious Reportable Incident Response Form
(OCFS-8023 60 KB) (OCFS-8023 PDF 14 KB)
OCFS-8024 Grievance - Complaint Packet
(OCFS-8024 110 KB) (OCFS-8024 PDF 22 KB)
OCFS-8025 Certificate of Attendance
(OCFS-8025 32 KB) (OCFS-8025 PDF 7 KB)
OCFS-8026 Loss of Eligibility Recommendation Form
(OCFS-8026 76 KB) (OCFS-8026 PDF 15 KB)
OCFS-8027 Contact Information List
(OCFS-8027 105 KB) (OCFS-8027 PDF 16 KB)
OCFS-8028 Accessibility Modifications and or Adaptive and Assistive Equipment Discription Cost Projection and Final Cost
(OCFS-8028 78 KB) (OCFS-8028 PDF 17 KB)
OCFS-8030 Transition Plan
(OCFS-8030 86 KB) (OCFS-8030 PDF 15 KB)
OCFS-8034 Qualification Form
(OCFS-8034 59 KB) (OCFS-8034 PDF 14 KB)
OCFS-8035 Schedule A - Waiver Service Provider Commitment form
(OCFS-8035 106 KB) (OCFS-8035 PDF 34 KB)
OCFS-8036 Medication Error Report
(OCFS-8036 50 KB) (OCFS-8036 PDF 8 KB)

Kinship

OCFS-4430 Application for the Kinship Guardianship Assistance and Non-Recurring Guardianship Expenses Programs (KinGap)
(OCFS-4430 136 KB) (OCFS-4430 PDF 38 KB)
OCFS-4431 Kinship Guardianship Assistance and Non-Recurring Guardianship Expenses Agreement
(OCFS-4431 152 KB) (OCFS-4431 PDF 59 KB)
OCFS-4432 Kinship Guardianship Assistance and Non-Recurring Guardianship Expenses Amendment
(OCFS-4432 84 KB) (OCFS-4432 PDF 30 KB)
OCFS-4433 Kinship Guardianship Assistance Program Certification Form
(OCFS-4433 94 KB) (OCFS-4433 PDF 23 KB)
OCFS-4434 Non-Recurring Kinship Guardianship Reimbursement Form
(OCFS-4434 60 KB)
OCFS-4434S Formulario de Reembolso Por Gastos de Tutoria No Recurrentes Para Parientes Tutorespro
(OCFS-4434S 62 KB) (OCFS-4434S PDF 28 KB)
OCFS-4940 Designation of Person in Parental Relationship
(OCFS-4940 PDF 47 KB)
OCFS-4940S Designacion de una Persona en una Relacion Paternal-Maternal
(OCFS-4940S PDF 31 KB)

Juvenile Justice and Opportunities for Youth

Autism Awareness Brochure-Pub 4998
(Autism PDF 1524 KB) (Autism PDF 126 KB)(Autism PDF 62 KB)(Autism PDF 54 KB)
OCFS-0014 Detention Care Provided and Fiscal Summary
(OCFS-0014 Word 70 KB) (OCFS-0014 PDF 36 KB)
OCFS-0290 Application to Operate a Family Boarding Facility
(OCFS-0290 Word 68 KB) (OCFS-0290 PDF 60 KB)
OCFS-0291 Application to Operate a Detention Facility
(OCFS-0291 Word 89 KB) (OCFS-0291 PDF 75 KB)
OCFS-0292 Firearms Certification Family Boarding Care Facility
(OCFS-0292 Word 73 KB) (OCFS-0292 PDF 44 KB)
OCFS-0293 Fire Safety Checklist Non-Secure Detention Family Boarding Homes
(OCFS-0293 Word 82 KB) (OCFS-0293 PDF 46 KB)
OCFS-0295 Family Boarding Care Driver Information
(OCFS-0295 Word 49 KB) (OCFS-0295 PDF 39 KB)
OCFS-0390 Family Boarding Care Facility Home Study
(OCFS-0390 Word 184 KB) (OCFS-0390 PDF 122 KB)
OCFS-0700B Application for Certificate to Board Children
(OCFS-0700B Word 124 KB) (OCFS-0700B PDF 79 KB)
OCFS-1518 Notice to Court
(OCFS-1518 Word 75 KB) (OCFS-1518 PDF 60 KB)
OCFS-4751 Volunteer Application-Registration
(OCFS-4751 Word 306 KB) (OCFS-4751 PDF 186 KB)
OCFS-4830 Detention Services Unusual Incident Report
(OCFS-4830 Word 66 KB) (OCFS-4830 PDF 42 KB)
OCFS-4924 DJJOY Transition Plan
(OCFS-4924 236 KB)
OCFS-4934 ADVISORY BOARD APPLICATION
(OCFS-4934 119 KB)
OCFS-DET Detention Cost Report Instructions
(OCFS-DET Word 80 KB) (OCFS-DET PDF 147 KB)
OCFS-DET-2651 Detention Program Statistics
(OCFS-DET-2651 Excel 16 KB)
OCFS-DET-2652 Detention Program Cost Report
(OCFS-DET-2652 Excel 27 KB)
OCFS-DET-2654 Detention Program Income Report
(OCFS-DET-2654 Excel 16 KB)
OCFS-DET-2668 Detention Program Salary Itemization
(OCFS-DET-2668 Excel 44 KB)

Management Services

OCFS-4627 Request for Forms and Publications
(OCFS-4627 Word 72 KB) (OCFS-4627 PDF 54 KB)

Protective Services for Adults

LDSS-2865 Application for Approval Family-Type Home for Adults
(LDSS-2865 Word 121 KB) (LDSS-2865 PDF 23 KB)
LDSS-2865B FTHA Application Independent-Verification Check List
(LDSS-2865B Word 46 KB) (LDSS-2865B PDF 28 KB)
LDSS-3123 Incident Report (DARC)(DAS)
(LDSS-3123 Word 62 KB) (LDSS-3123 PDF 43 KB)
LDSS-3239 Medical Evaluation (Operator)
(LDSS-3239 Word 33 KB) (LDSS-3239 PDF 19 KB)
LDSS-3633 Individual Resident Fund Record Account
(LDSS-3633 Word 100 KB) (LDSS-3633 PDF 44 KB)
LDSS-3634 Resident Medication Record
(LDSS-3634 Word 63 KB) (LDSS-3634 PDF 31 KB)
LDSS-3635 MEDICATION LOG
(LDSS-3635 331 KB) (LDSS-3635 PDF 13 KB)
LDSS-3705 Special Needs Fund Individual Resident Log
(LDSS-3705 Word 32 KB) (LDSS-3705 PDF 16 KB)
LDSS-4505 Family Type Home for Adults Certification of Child Support Obligations
(LDSS-4505 Word 41 KB) (LDSS-4505 PDF 26 KB)
OCFS-3122 Family Type Homes for Adults - Medical Evaluation (Resident)
(OCFS-3122 Word 76 KB) (OCFS-3122 PDF 46 KB)
OCFS-3913 Residents Special Needs Expenditure Log
(OCFS-3913 64 KB)
OCFS-3914 Health and Safety Equipment and Substitute Care Expenditure Log
(OCFS-3914 Word 75 KB) (OCFS-3914 PDF 11 KB)
OCFS-LDSS-2853 Statement Offering Personal Allowance Account
(OCFS-LDSS-2853 Word 36 KB) (OCFS-LDSS-2853 PDF 18 KB)
OCFS-LDSS-2854 Personal Allowance Register
(OCFS-LDSS-2854 Word 145 KB) (OCFS-LDSS-2854 PDF 69 KB)
OCFS-LDSS-2855 Personal Allowance Summary
(OCFS-LDSS-2855 Word 252 KB) (OCFS-LDSS-2855 PDF 122 KB)
OCFS-LDSS-2949 Personal Data Sheet
(OCFS-LDSS-2949 Word 77 KB) (OCFS-LDSS-2949 PDF 50 KB)
OCFS-LDSS-3026 Chronological Admission and Discharge Register
(OCFS-LDSS-3026 Word 126 KB) (OCFS-LDSS-3026 PDF 58 KB)
OCFS-LDSS-3027 Inventory of Residents Property Held by Facility for Safe Keeping
(OCFS-LDSS-3027 Word 74 KB) (OCFS-LDSS-3027 PDF 34 KB)
OCFS-LDSS-7014 Personal History of Applicant Family Type Home for Adults
(OCFS-LDSS-7014 Word 44 KB) (OCFS-LDSS-7014 PDF 23 KB)
OCFS-LDSS-7016 Plan for Fire, Disaster or Other Emergency Evactuation of Residents Operator or Substitute Caretaker
(OCFS-LDSS-7016 Word 74 KB) (OCFS-LDSS-7016 PDF 41 KB)

Services Systems (WMS/CCRS) Input Documents and Reference Materials

LDSS-3316 CCRS Supplemental Information
(LDSS-3316 Word 218 KB) (LDSS-3316 PDF 19 KB)

Youth Development

Autism Awareness Brochure-Pub 4998
(Autism PDF 1524 KB) (Autism PDF 126 KB)(Autism PDF 62 KB)(Autism PDF 54 KB)
OCFS-2001 Report of Collections-Youth in OCFS Facilities
(OCFS-2001 102 KB) (OCFS-2001 PDF 16 KB)
OCFS-3114 Waiver of State Aid Eligibility or State Aid Reimbursement
(OCFS-3114 Word 50 KB) (OCFS-3114 PDF 39 KB)
OCFS-3118 Instructions for RHYA Programs
(OCFS-3118 PDF 24 KB)
OCFS-3125 Program Expenditure Summary
(OCFS-3125 Word 75 KB) (OCFS-3125 PDF 77 KB)
OCFS-3126 Program Expenditure Report - Salaries
(OCFS-3126 Word 136 KB) (OCFS-3126 PDF 120 KB)
OCFS-3127 Program Expenditure Report - Fringe Benefits
(OCFS-3127 Word 140 KB) (OCFS-3127 PDF 14 KB)
OCFS-3128 Program Expenditure Report - Contracted Services & Stipends
(OCFS-3128 Word 134 KB) (OCFS-3128 PDF 121 KB)
OCFS-3129 Program Expenditure Report - M&O and Facility Repairs
(OCFS-3129 Word 138 KB) (OCFS-3129 PDF 109 KB)
OCFS-4836 Application For an Approved Runaway Program or Transitional Independent Living Program
(OCFS-4836 Word 98 KB) (OCFS-4836 PDF 71 KB)
OCFS-4837 Report of Inquiry for New Runaway and Homeless Youth (RHYA) Programs
(OCFS-4837 Word 99 KB) (OCFS-4837 PDF 65 KB)
OCFS-5001 Individual Program Application - Program Information
(OCFS-5001 98 KB) (OCFS-5001 PDF 82 KB)
OCFS-5002 Agency Program Profile
(OCFS-5002 106 KB) (OCFS-5002 PDF 91 KB)
OCFS-5003 Individual Program Application - Program Summary-Program Components
(OCFS-5003 363 KB) (OCFS-5003 PDF 138 KB)
OCFS-5005 Program Budget - Appendix B
(OCFS-5005 134 KB) (OCFS-5005 PDF 25 KB)
OCFS-5007 Program Annual Assessment
(OCFS-5007 74 KB)
OCFS-7058 Instructions for Notification of Allegation of Institutional Abuse in RHY Residential Program
(OCFS-7058 Word 54 KB) (OCFS-7058 PDF 47 KB)

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