OCFS-4584. Application Form for Equipment Loan Fund for the Disabled

Form OCFS-4584 is an Application Form for the Equipment Loan Fund for the Disabled provided by the New York State Office of Children and Family Services. The purpose of this form is to allow disabled individuals to apply for loans to acquire necessary assistive equipment and devices that improve their independence and quality of life.

The form consists of sections where the applicant provides personal information, details about the specific equipment needed, and financial information to determine eligibility for the loan program. The form may also require documentation from healthcare professionals or experts supporting the need for the requested equipment.

Important fields in this form include accurate information about the applicant's disability, medical condition, and the specific equipment needed. Additionally, the financial details provided by the applicant will be essential in assessing their eligibility for the loan program.

Application Example: A person with a disability who requires a wheelchair-accessible vehicle to maintain their job and independence would use this form to apply for financial assistance to purchase the vehicle. They would provide details about their disability, the type of vehicle needed, and their financial situation to demonstrate the need for the loan.

Additional documents that may need to be submitted with the form include medical records, doctor's prescriptions, and estimates or quotes for the equipment to be purchased.

Related Form: There might not be an exact analogue for this form within the same agency, but some state and federal programs may offer similar assistance for disabled individuals in acquiring assistive equipment.