LDSS-4623A. Adoption Subsidy and Non-Recurring Adoption Expenses Agreement - Initial Application

Form LDSS-4623A, the Adoption Subsidy and Non-Recurring Adoption Expenses Agreement - Initial Application, is used to apply for financial assistance with adopton-related costs and adoption subsidies in New York State. This form is administered by the New York State Office of Children and Family Services (OCFS).

The form is composed of four sections. The first section requires basic information about the adopting parent(s), such as names, address, and contact information. The second section is for the child information, including the child's name, age, and other identifying information. The third section is for documentation of the adoption-related costs and expenses, including details of the actual expenses, when they were incurred, and the amount. The fourth section is for the signature of both the adopting parent(s) and the representative of the OCFS.

Important fields in this form include the child's name and age, the adopting parent(s)'s contact information, the date of the adoption, and the amount of the adoption-related costs and expenses. It is important to accurately fill out the form, as the information provided will be used to determine eligibility for the adoption subsidy and non-recurring adoption expenses. Inaccurate or incomplete information may result in a delay or denial of the adoption subsidy.

An example of a situation where this form would be used is when a family is applying for financial assistance with the costs of adopting a child. By providing the information and documentation required, the family can receive a subsidy to help cover the costs of the adoption process. The form also serves to document the family's adoption-related expenses, which can be used to provide evidence of the adoption process and the costs incurred during the adoption process.

Specific instructions for filling out the form include providing accurate and complete information in all the required fields, and signing the form with both the adopting parent(s) and the representative of the OCFS. Related forms include the LDSS-4624A Adoption Subsidy and Non-Recurring Adoption Expenses Agreement - Follow-up Application, which is used to apply for additional financial assistance after the initial application, and the LDSS-4605 Adoption Subsidy and Non-Recurring Adoption Expenses Program Summary, which is a summary of the