OCFS-2114. District Notification to Legally -Exempt Caregiver Enrollment Agency

Form OCFS-2114 is a district notification form for legally-exempt caregiver enrollment agencies. It is used by agencies to inform the district office of the agency’s intent to provide care for children who are in the custody of the state. This form is required for agencies who wish to enroll as legally-exempt caregivers in order to provide care for children in the custody of the state.

The participants in this form include the legally-exempt caregiver enrollment agency and the district office. The form consists of two parts. The first part is the Request for Approval of Legally-Exempt Caregiver Enrollment Agency and the second part is the District Notification to Legally-Exempt Caregiver Enrollment Agency. The Request for Approval must be completed and submitted by the agency to the district office and the District Notification must be completed by the district office in order to approve the agency.

Important fields in this form include the name of the agency, the address of the agency, the start date of the agency's enrollment, the end date of the agency's enrollment, the agency's contact information, and the signatures of the district office and the agency. Specific instructions for completing the form include providing all required information and signing the form. Accurate and timely completion of the form is important in order to ensure the agency is approved to provide care for children in the custody of the state.

An example scenario where this form would be used is when an agency is first applying to become a legally-exempt caregiver enrollment agency. In order to become approved, the agency must complete the Request for Approval of Legally-Exempt Caregiver Enrollment Agency and submit it to the district office. The district office will then review the form and, if approved, will complete the District Notification to Legally-Exempt Caregiver Enrollment Agency and return it to the agency. The benefits of using this form include providing an official record of the agency's enrollment as a legally-exempt caregiver.

Additional documents that may be required to complete the form include financial records and background checks. Related forms or alternatives that may exist for similar transactions or purposes include the Request for Approval of Legally-Exempt Caregiver Agency and the District Notification to Legally-Exempt Caregiver Enrollment Agency.