OCFS-2121.1. Request for Rollover Waiver Form

Form OCFS-2121.1, Request for Rollover Waiver Form, is a document used by child care providers in New York State in order to request a waiver from the Office of Children and Family Services (OCFS) for the rollover of funds. The form must be completed and submitted by providers in order to request the rollover of funds from their current fiscal year into the next fiscal year. This form is required for all types of providers, including daycare, family daycare, and group daycare.

When completing the form, parties involved include the provider, the OCFS, and the provider's accountant. The form consists of four main sections which include the provider's information, the provider's request, the accountant's information, and the provider's signature. Within each section, there are various fields that must be completed in order to properly submit the form. Important fields in this form include the provider's name and address, the type of provider, the fiscal year for which the rollover is requested, the amount of the requested rollover, and the accountant's name and contact information. Providers must also provide a detailed explanation of why the rollover is needed and why it should be approved. Any additional documents that are needed to complete the form must be attached.

An example of when the form would be used is when a provider wishes to rollover excess funds from their current fiscal year into the next fiscal year in order to cover any unexpected costs. The form is important for providers to submit as it is required in order to receive the rollover of funds. Without the completion and submission of the form, the OCFS will not approve the request. In addition, the form is the only way for providers to request a waiver from the OCFS. If the request is denied, the provider may need to submit an alternative form in order to request an appeal or to reapply.