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DO NOT WRITE IN THE SHADED AREAS OF THIS APPLICATION LDSS2921 Statewide (Rev. 1/05) CENTER/ OFFICE APPLICATION DATE UNIT ID WORKER ID CASE TYPE SERVE. IND CASE NUMBER REGISTRY NUMBER LIFELINE EFFECTIVE
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Center - OTDA NY stands for Center for Temporary Disability Assistance in New York. It is a government agency that helps individuals and families in need.
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