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LDSS4863 (11/05) NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE MEDICAL INFORMATION RELEASE FORM I authorize the release of any health related information about me and any members of

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What is ldss4863 1105 new york?

ldss4863 1105 new york is a form used for reporting certain information related to social services in the state of New York.

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Individuals or organizations who receive social services in New York may be required to file ldss4863 1105.

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The purpose of ldss4863 1105 new york is to gather information for social service programs and ensure eligibility requirements are met.

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Information such as income, household size, expenses, and other pertinent details relating to social service eligibility must be reported on ldss4863 1105.