Form LDSS-4438, Emergency Plan for Child Day Care Centers, School Age Child Care Programs, and Legally Exempt Group Child Care Programs is a form used by the New York State Office of Children and Family Services (OCFS). This form is used by child care providers to develop an emergency plan to protect the health and safety of the children in their care.
Form Fire Safety Inspection For Family Type Homes For Adults is a form used to check and inspect fire safety systems and equipment in residential homes.
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.
Form LDSS-3806 is a Notice to be Given Applicants for or Recipients of Services When Requesting Social Security Numbers. This form is used when an applicant or recipient of services needs to provide their Social Security Number (SSN) for identification purposes. The form is used to ensure that the applicant is aware of their rights and obligations when providing the SSN and that the applicant is aware of the consequences if the SSN is not provided.
Form LDSS-3705- Special Needs Fund Individual Resident Log is a form used to document the personal information of individuals who have been approved to receive funds from the Special Needs Fund (SNF). The form is used by the New York State Office of Children and Family Services (OCFS) to track the distribution of funds and to ensure that they are being allocated appropriately.
Form LDSS-3635 (Medication Log) is a NYS Office of Children and Family Services form used to document and track medication intake and reactions for individuals in their care. The form requires the individual's name, date of birth, and/or medical record number, and is used to document any medication administered and any reactions that may occur. This form is typically filled out by a provider, such as a doctor or nurse, who is responsible for administering the medication.
Form LDSS-3634, the Resident Medication Record, is a document used by staff in residential health care facilities to document medications administered to residents. It is used to ensure that all medications are administered accurately and in accordance with the specific instructions of the prescribing physician. The form is intended to be used in conjunction with other documents such as the physician’s orders, the resident’s medical record, and the facility’s medication administration policy.
Form LDSS-3633, the Individual Resident Fund Record Account, is used to document the financial information of a resident of a long-term care facility and to track their income and expenses. It is typically used by facilities providing services such as nursing homes, intermediate care facilities, and adult homes. The form is maintained by the facility and must be updated regularly. This form includes sections for the resident's name, date of birth, Social Security number, and address, as well as the name of the facility, the name of the account manager, and the date the account was opened.
Form LDSS-3424 is a NYS Office of Children and Family Services form used to notify a school district of financial responsibility for an educationally handicapped foster child placed in a child care institution.
Form LDSS-3416 - Religious Designation of a Child is a document used to designate the religious preference of a child or minor. It is an official New York State Office of Children and Family Services (OCFS) form that must be completed and submitted to the local social services district whenever a child or minor is placed in foster care.
