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REPORT DATELDSS2221A (Rev. 09/2016) FRONTIER YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES/REPORT OF SUSPECTED CHILD ABUSE OR MALTREATMENT CASE IDC ALL ID/TIME AM:LOCAL CASE #LOCAL DIST./AGENCYSUBJECTS
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The LDSS-2221A PDF is a form used by individuals to report certain information for public assistance and benefits in New York State.
Individuals applying for or receiving public assistance, Medicaid, or related benefits in New York State are required to file the LDSS-2221A.
To fill out the LDSS-2221A PDF, individuals must provide personal information, details about their household, income, and any relevant changes in circumstances.
The purpose of the LDSS-2221A PDF is to gather necessary information for the determination of eligibility for public assistance programs.
Information such as personal identification, income sources, household composition, and changes in circumstances must be reported on the LDSS-2221A.
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