Get the free Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97) - otda ny
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This letter informs local social services districts of revised language for recipients to request voluntary restricted payments for utility and shelter costs under the Welfare Reform Act of 1997.
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How to fill out revised request for voluntary
How to fill out Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97)
01
Obtain the Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97) from the relevant authority or website.
02
Read the instructions carefully to understand the purpose of the form and the information required.
03
Fill out the personal information section, including your name, address, and contact details.
04
Indicate the type of restriction you are requesting and provide any necessary supporting documentation.
05
Review the filled form for accuracy and completeness.
06
Sign and date the form as required.
07
Submit the completed form to the specified authority or location.
Who needs Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97)?
01
Individuals seeking to voluntarily restrict access to their information held by state agencies.
02
Persons who wish to limit or control the sharing of their personal or sensitive information.
03
Those who are affected by situations that require privacy or confidentiality concerning their records.
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What is Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97)?
The Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97) is a document used by individuals to voluntarily request a restriction on certain services or benefits provided by the Department of Social Services.
Who is required to file Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97)?
Individuals who wish to restrict their participation in certain programs or services administered by the Department of Social Services are required to file this form.
How to fill out Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97)?
To fill out the form, you must provide personal information, specify the type of services you wish to restrict, and sign the document to indicate your consent and understanding.
What is the purpose of Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97)?
The purpose of the form is to allow individuals to voluntarily limit their interaction with specific services or benefits based on their personal circumstances or preferences.
What information must be reported on Revised Request for Voluntary Restriction Form (DSS-4580 Rev.12/97)?
The form requires reporting personal identification information, details of the services to be restricted, reasons for the request, and a signature to verify the request.
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