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NY LDSS-5038 2024-2025 free printable template

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Part A Form 4-9a-LDSS-5038 (1/24) Important Notice If you are issuing a Spousal Support Only Income Withholding Order, you must serve the completed LDSS-5038 as follows: • Part A: serve only upon
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How to fill out NY LDSS-5038

01
Begin by downloading the NY LDSS-5038 form from the official website.
02
Fill in your personal information at the top, including your name, address, and date of birth.
03
Indicate the type of assistance you are applying for in the appropriate section.
04
Provide any required household information, including details of all members living with you.
05
Complete the income section by listing all sources of income for you and your household members.
06
Answer all relevant questions related to assets, expenses, and any special circumstances.
07
Review your completed form for accuracy and completeness.
08
Sign and date the form where indicated.
09
Submit the form to your local social services office either by mail or in person.

Who needs NY LDSS-5038?

01
Individuals or families seeking public assistance or benefits in New York must fill out the NY LDSS-5038 form.
02
People who are applying for programs such as Temporary Assistance, Food Stamps, or Medicaid may need to complete this form.
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NY LDSS-5038 is a form used by the New York State Department of Social Services to report certain information regarding assistance applications and recipients.
The form is required to be filed by individuals or entities who are responsible for reporting information related to public assistance or related benefits.
To fill out the NY LDSS-5038, individuals should provide accurate information as requested on the form, including personal details, income information, and assistance history as required.
The purpose of NY LDSS-5038 is to collect necessary data for the evaluation and management of public assistance programs in New York.
The form requires reporting of information such as personal identification details, household composition, income, and any changes in circumstances related to assistance.
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