03-OCFS-INF-09___November 5, 2003


George E. Pataki
Governor / New York State
Office of children & family services
52 washington street
rensselaer, NY 12144 / John A. Johnson
Commissioner

Informational Letter

Transmittal: / 03-OCFS-INF-09
To: / Local District Commissioners
Issuing Division/Office: / Division of Development & Prevention Services
Date: / November 5, 2003
Subject: / Child Care Subsidy Forms
Suggested Distribution: / Child Care Unit Supervisors and Staff
Services and Temporary Assistance Directors
Temporary Assistance Supervisors and Staff
Employment Unit Supervisors and Staff
Contact Person(s): / Rhonda Finlayson (518) 402-6785 USER ID
Attachments: / NONE
Attachment Available On – Line:

Filing References

Previous ADMs/INFs / Releases Cancelled / Dept. Regs. / Soc. Serv. Law & Other Legal Ref. / Manual Ref. / Misc. Ref.
  1. Purpose

The purpose of this release is to advise local social services districts that the client notification forms, legally exempt providers’ health and safety enrollment forms, and legally exempt supplemental forms are available through the OCFS’s Forms Management Unit.

Local districts can order these forms from the Forms Management Unit by completing form OCFS-4627 (County Request Form), by calling (518) 473-0971, or by e-mailing a request to . For more detailed information on ordering forms, please refer to 03-OCFS-INF-03, dated February 3, 2003. When ordering these forms, please use the following form names and numbers:

Client Notification Forms

LDSS 4779 Approval Of Your Application For Child Care Benefits

LDSS 4780 Denial Of Your Application For Child Care Benefits

LDSS 4781 Notice Of Intent To Change Child Care Benefits

LDSS 4782 Notice Of Intent To Discontinue Child Care Benefits

LDSS 4783 Delinquent Family Share For Child Care Benefits

Legally-Exempt Forms

LDSS 4699 Enrollment Form For A Provider Of Legally-Exempt Family Child Care and Legally-Exempt In-Home Child Care

LDSS 4700 Enrollment Form: Provider Of Legally-Exempt Group Child Care

LDSS 4812 Legally-Exempt Supplemental Forms

All of the above forms are available in Spanish, except LDSS 4812 (Legally-Exempt Supplemental Forms). OCFS hopes to make this form available in Spanish in the near future. When ordering a form in Spanish, please use the same form number, with an “S” placed at the end to designate that the Spanish version is being ordered.

Please remember that the local equivalents of these required forms must be approved by the Bureau of Early Childhood Services prior to their use by local districts.

Larry G. Brown s/s

Issued By

Larry G. Brown

Deputy Commissioner

Division of Development and Prevention Services

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