OCFS-5570. Local Department of Social Services Referral for a Qualified Individual Assessment

Form OCFS-5570, the Local Department of Social Services Referral for a Qualified Individual Assessment, is used by local social services departments to refer individuals for a Qualified Individual Assessment, which helps determine eligibility for certain services or programs.

The form consists of sections where the referring department provides information about the individual being referred, their circumstances, and the specific services or programs they may be eligible for. It includes sections related to the individual's needs, goals, and background.

Important fields in this form include sections outlining the individual's information, referral details, and the reasons for the assessment. Accurate completion ensures that individuals are assessed for their eligibility accurately and efficiently.

Application Example: A local social services department refers an individual to an assessment to determine their eligibility for specific services. By completing Form OCFS-5570, the department initiates the assessment process and ensures that the individual's needs are properly evaluated.