OCFS-LDSS-4781. Notice of Intent to Change Child Care Benefits and Family Share Payments (Sample Only)

Form OCFS-LDSS-4781, "Notice of Intent to Change Child Care Benefits and Family Share Payments," serves as a communication tool between the New York State Office of Children and Family Services and the recipient of child care benefits. This form is utilized to inform the recipient about an upcoming change in their child care benefits or family share payments, allowing them to anticipate modifications to their financial responsibilities.

The form consists of sections where the agency provides information regarding the impending changes, including the effective date and details of the alteration. It may also include a section for the recipient's acknowledgement of the change. It is important for the recipient to understand the adjustments and prepare accordingly.

Important fields in this form include the recipient's personal information, such as their name, address, and case number. Accurate completion of these fields is crucial to ensure proper identification and communication. Failing to respond or provide accurate information may result in confusion or potential disruption of child care services.

Application Example: A family receiving child care benefits might receive this form notifying them of a change in their benefits due to an alteration in their financial circumstances. The family should carefully review the details, ensure the accuracy of their information, and take necessary actions if required. By promptly responding and adhering to the instructions, the family can avoid interruptions in child care services and ensure a smooth transition.

Related forms: An alternative form could be OCFS-LDSS-4782, "Notice of Intent to Discontinue Child Care Benefits." This form might be used if the recipient's circumstances have changed to the extent that they no longer qualify for child care benefits. The difference between these forms lies in the purpose: one informs about changes, while the other pertains to discontinuation.