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NY LDSS-4530 - Suffolk County 2007-2025 free printable template

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LDSS-4530 (Rev. 2/07) NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE local address added 3/07 ASSIGNMENT OF WAGES, SALARY, COMMISSIONS OR OTHER COMPENSATION FOR SERVICES NOTE: THIS AGREEMENT
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How to fill out NY LDSS-4530 - Suffolk County

01
Obtain a copy of the NY LDSS-4530 form from the official Suffolk County website or local DSS office.
02
Fill out Section 1: Provide your personal information, including your name, address, and contact details.
03
In Section 2, indicate the type of assistance you are applying for.
04
Complete Section 3 by detailing your household information, including the number of people living with you.
05
Section 4 requires financial information; list all sources of income and assets.
06
Review Section 5 and provide any necessary signatures and dates.
07
It is advisable to double-check all information for accuracy before submission.
08
Submit the completed form to your local Department of Social Services office either in person or by mail.

Who needs NY LDSS-4530 - Suffolk County?

01
Individuals or families seeking public assistance or social services in Suffolk County.
02
Those applying for specific programs like Temporary Assistance, Food Assistance, or Medicaid may need this form.
03
Residents experiencing financial hardship who need support from governmental aid programs.
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NY LDSS-4530 is a form used in Suffolk County, New York, primarily for reporting certain details related to social services programs.
Individuals or families applying for or receiving benefits from social services programs in Suffolk County are required to file NY LDSS-4530.
To fill out NY LDSS-4530, individuals must provide personal information, details regarding household members, income, expenses, and any other information relevant to their eligibility for assistance.
The purpose of NY LDSS-4530 is to collect information that determines the eligibility of applicants for various social services programs offered in Suffolk County.
The information required includes personal identification details, household composition, income sources, expenses, and any pertinent circumstances affecting eligibility.
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