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This document serves as a receipt for applicants and recipients who submit documentation for Temporary Assistance, Food Stamp Benefits, Medicaid, and/or Child Health Plus A, ensuring they receive
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How to fill out LDSS-4847

01
Start by downloading the LDSS-4847 form from the official website or obtaining a physical copy.
02
Fill in your personal information, including your name, address, and contact details in the designated sections.
03
Provide details about your household members, including their names, ages, and relationships to you.
04
Report your income sources and amounts, including any employment, government assistance, or other forms of income.
05
List any assets you own, such as bank accounts, vehicles, and real estate, in the appropriate section.
06
Answer any questions related to your living situation, such as rent or mortgage payments.
07
Review the form for any errors or omissions before finalizing it.
08
Sign and date the form at the bottom to certify the information provided is accurate.
09
Submit the completed form as instructed, either by mail or electronically.

Who needs LDSS-4847?

01
Individuals or families applying for assistance programs such as food stamps, medical assistance, or public assistance in New York.
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LDSS-4847 is a form used in New York State for reporting the income and resources of individuals applying for or receiving public assistance benefits.
Individuals applying for or receiving public assistance benefits in New York State are required to file LDSS-4847.
To fill out LDSS-4847, individuals should provide accurate information regarding their income, resources, and household composition as outlined in the form's sections, ensuring that all required fields are completed.
The purpose of LDSS-4847 is to assess an individual's financial situation to determine eligibility for public assistance programs.
LDSS-4847 requires reporting of personal information, income sources, amounts, benefits received, and any other relevant financial information.
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