LDSS-2865B. FTHA Application Independent-Verification Check List

Form LDSS-2865B is a NYS Office of Children and Family Services form used for performing independent verification checks. It is typically used to perform verification checks for an application for a Family Team Decision-Making (FTDM) program.

The form consists of several sections, including a section for identifying the family, a section for verifying the family's residence, a section for verifying the family's income, and a section for verifying the family's assets. Additionally, there are sections for providing additional information about the family, such as their family size, marital status, and other information that may be relevant to the application process.

Important fields in this form include the family's information, such as their name, address, and contact information, as well as the family's income and assets. It is important to accurately complete this form, as it is used to assess the family's financial eligibility for the FTDM program. Failure to provide accurate information may result in the family being denied eligibility.

An example scenario where this form would be used is when a family is applying for FTDM services. They must complete the LDSS-2865B form to provide the necessary verification of their financial status. Specific instructions for completing the form can be found on the form itself. The purpose of using this form is to ensure that the family is eligible for the FTDM program.

Related forms that may be used for similar transactions include the LDSS-2868 (Income Verification Form) and the LDSS-2867 (Asset Verification Form). In addition to the LDSS-2865B, these forms must also be completed in order to provide the necessary verification of the family's financial status. Additionally, any additional documents that are necessary to complete the form, such as proof of income or assets, must also be provided.