NY LDSS-5038 2021 free printable template

Part Form 49aLDSS5038 (9/21)Important Notice If you are issuing a Spousal Support Only Income Withholding Order, you must serve the completed LDSS5038 as follows: Part A: serve only upon the employer/income

How to fill out NY LDSS-5038

How to fill out NY LDSS-5038

1. Obtain a copy of the NY LDSS-5038 form from your local Department of Social Services or online.
2. Read the instructions carefully to understand the information required.
3. Fill in your personal information, including your name, address, and contact details in the designated fields.
4. Provide information regarding your household members, including their names, relationships to you, and ages.
5. Report your income sources and amounts accurately, including wages, benefits, and any other financial assistance.
6. Indicate any resources you and your household members have, such as bank accounts, properties, etc.
7. Complete all sections as required, ensuring that the information is clear and legible.
8. Review your form for accuracy and completeness before submitting it.
9. Sign and date the form where indicated, affirming that the information provided is truthful.
10. Submit the completed form either by mail or in person to your local Department of Social Services office.

Who needs NY LDSS-5038?

1. Individuals and families applying for public assistance programs in New York, such as Temporary Assistance, Medicaid, or Supplemental Nutrition Assistance Program (SNAP), need to complete the NY LDSS-5038 form.

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What is NY LDSS-5038?

The NY LDSS-5038 is a form used in New York State to report information regarding the number of children who are not living with a parent or guardian and are potentially eligible for assistance under public assistance programs.

Who is required to file NY LDSS-5038?

Organizations and agencies that provide services to children who are not living with their parents or guardians are required to file the NY LDSS-5038.

How to fill out NY LDSS-5038?

To fill out the NY LDSS-5038, provide accurate information regarding the children being reported, including their names, dates of birth, and the reasons for their current living arrangements. Follow the instructions provided on the form carefully.

What is the purpose of NY LDSS-5038?

The purpose of the NY LDSS-5038 is to gather information about children living apart from their families to ensure eligibility for public assistance programs and to facilitate proper resource allocation.

What information must be reported on NY LDSS-5038?

The information that must be reported on the NY LDSS-5038 includes the child's name, date of birth, address, legal status, and details regarding the living situation, such as who they are living with and the reasons for the separation from parents or guardians.