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LDSS-4623C-2 (Rev. 9/2009) NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES ADOPTION SUBSIDY AND NON-RECURRING ADOPTION EXPENSES AGREEMENT Upgrade or Substantive Amendment This is an amendment

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What is ldss 4623c 2?

ldss 4623c 2 is a form used by the New York State Office of Temporary and Disability Assistance (OTDA) to collect information about household composition and income for individuals applying for various assistance programs.

Who is required to file ldss 4623c 2?

Individuals who are applying for assistance programs administered by OTDA, such as Temporary Assistance, Medicaid, or Supplemental Nutrition Assistance Program (SNAP), may be required to fill out ldss 4623c 2.

How to fill out ldss 4623c 2?

To fill out ldss 4623c 2, you need to provide accurate and complete information about your household members, income, assets, and other relevant details. The form should be completed neatly and signed before submitting it to the appropriate OTDA office.

What is the purpose of ldss 4623c 2?

The purpose of ldss 4623c 2 is to determine eligibility for various assistance programs by assessing household composition and income. This information helps OTDA determine the appropriate level of support an individual or family may be eligible to receive.

What information must be reported on ldss 4623c 2?

ldss 4623c 2 requires reporting of household members' names, ages, relationships, income sources, assets, expenses, and other relevant details. The specific information required may vary depending on the assistance program being applied for.

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