LDSS-4055. Residential Placement Assessment Form

Form LDSS-4055 Residential Placement Assessment Form is a New York State Office of Children and Family Services form used to assess the needs of an individual to ensure they have access to the right resources and services for their unique situation.

The form consists of several sections, including background information, current living situation, family history, and legal history. It also includes questions regarding the individual’s medical and mental health history, educational background, and employment history. Additional sections or fields that may be present in the form include financial information, social services information, and any prior or current involvement in the criminal justice system.

Important fields in this form include the individual’s name, date of birth, and contact information. It is also important to provide accurate and detailed information regarding the individual’s current living situation, family history, and criminal history. Additionally, it is important to include any information regarding medical, mental health, and educational history. When completing the form, it is important to follow any specific instructions or guidelines as provided by the NYS Office of Children and Family Services.

This form may be used in a variety of scenarios, such as when an individual is in need of residential placement, when an individual is seeking to enter a residential placement program, or when an individual is transitioning from a residential placement program to independent living. The form is used to assess the individual’s needs and ensure they have access to the appropriate resources and services. It is also used to ensure that the individual is receiving the best possible care and services for their unique situation.

When filling out this form, it is important to provide accurate and complete information regarding the individual’s background and current living situation. Additionally, it is important to provide any relevant documents, such as medical records or court documents, that may be necessary to complete the form. Related forms that may be used in similar scenarios include the NYS Office of Children and Family Services Form LDSS-4054 Residential Placement Application Form and the NYS Office of Children and Family Services Form LDSS-4056 Residential Placement Discharge Form.