Forms OCFS 0014 - 4410

As part of the daily operations of the New York State Office of Children and Family Services (OCFS), various forms and applications are required to be completed by individuals and organizations providing child care services. The following is a list of some of the forms commonly used by OCFS for facilities operating under its jurisdiction.

• OCFS-0014 - Detention Care Provided and Fiscal Summary: A form to provide a summary of detention care provided along with the fiscal information.
• OCFS-0290 - Application to Operate a Family Boarding Facility: A form to apply for operating a family boarding facility.
• OCFS-0291 - Application to Operate a Detention Facility: A form to apply for operating a detention facility.
• OCFS-0291a - Application to Operate a New Specialized Secure Detention Facility: A form to apply for operating a new specialized secure detention facility.
• OCFS-0291b - Application Guidelines for Construction and Substantial Remodeling-Specialized Secure Detention (SDD) Facility: A form providing guidelines for the construction and substantial remodeling of a specialized secure detention facility.
• OCFS-0292 - Firearms Certification Family Boarding Care Facility: A form to certify firearms for a family boarding care facility.
• OCFS-0293 - Fire Safety Checklist Non-Secure Detention Family Boarding Home: A checklist to ensure fire safety in a non-secure detention family boarding home.
• OCFS-0295 - Family Boarding Care Driver Information: A form to provide driver information for family boarding care.
• OCFS-0300 - Ombudsman Contact Form: A form to contact the ombudsman.
• OCFS-0390 - Family Boarding Care Facility Home Study: A form for conducting a home study before operating a family boarding care facility.
• OCFS-0700B - Application for Certificate to Board Children: A form to apply for a certificate to board children.
• OCFS-0711 - Child's Medical Record: A form to keep a child's medical record.
• OCFS-0910 - Request for Bid: A form to request a bid.
• OCFS-1002 - Application for Service: A form to apply for services.
• OCFS-1119 - Low Vision Evaluation Report: A report to evaluate low vision.
• OCFS-1518 - Notice to Court: A notice to the court.
• OCFS-2001 - Report of Collections - Youth in OCFS Facilities(PDF): A report on the collections for youth in OCFS facilities.
• OCFS-2113 - Notice of Foster Home or Adoptive Home Closure: A notice of closure for a foster or adoptive home.
• OCFS-2114 - District Notification to Legally-Exempt Caregiver Enrollment Agency: A notification to the legally-exempt caregiver enrollment agency.
• OCFS-2121 - Supervision and Treatment Services for Juveniles Program (STSJP) Annual Plan: A form to create an annual plan for supervision and treatment services for juveniles program.
• OCFS-2121.1 - Request for Rollover Waiver Form: A form to request a waiver for rollover.
• OCFS-2125 - Bureau of Financial Operations -Title IV-E Unit: A form related to the financial operations of Title IV-E unit.
• OCFS-2132 - Bill of Rights for Children and Youth in Foster Care: A bill of rights for children and youth in foster care.
• OCFS-2133 - Notification to OCFS of an Extended Length of Stay in a Residential RHY Program: A notification to OCFS regarding an extended stay in a residential runaway and homeless youth program.
• OCFS-2134 - Runaway and Homeless Youth-Interim Family Certification Application: A form to apply for interim family certification for runaway and homeless youth.
• OCFS-2135 - Runaway and Homeless Youth-Interim Family Home Study Report: A report for a home study of runaway and homeless youth for interim family certification.
• OCFS-2136 - Runaway and Homeless Youth-Interim Family Home Annual Report: An annual report for interim family certification of runaway and homeless youth.
• OCFS-2137 - Inspection Instrument for Runaway and Homeless Youth Programs: An inspection instrument for programs catering to runaway and homeless youth.
• OCFS-2150 - State Rehabilitation Council Application Form: An application form for state rehabilitation council.
• OCFS-2154a - Application to Request a Reasonable Accommodation of a Disability: A form to request reasonable accommodation for people with disabilities.
• OCFS-2156a - Reasonable Accommodation for Members of the Public with Disabilities: A form for reasonable accommodation for members of the public with disabilities.
• OCFS-2161 - Adoption Agency Business Plan: A business plan for adoption agencies.
• OCFS-2171 - Workforce Utilization Report: A report on workforce utilization.
• OCFS-2171A - Instructions for Workforce Utilization Report: Instructions for filling out the workforce utilization report.
• OCFS-2196 - Plan of Safe Care: A plan for safe care.
• OCFS-2200 - District of Fiscal Responsibility (PDF): A form related to the district of fiscal responsibility.
• OCFS-2201 - Domestic Violence Release of Information: A form to release information regarding domestic violence.
• OCFS-2202 - Voluntary Placement Agreement: A form for voluntary placement agreement.
• OCFS-2210 - Raising the Lower age of Juvenile Delinquency Differential Response Referral Form: A referral form for raising the lower age of juvenile delinquency differential response.
• OCFS-2211 - Raising the Lower Age of Juvenile Delinquency Differential Response for Children Under 12 Years of Age 2022 Annual Plan: An annual plan for raising the lower age of juvenile delinquency differential response for children under 12 years of age.
• OCFS-2400 - Detention Cost Report Instructions: Instructions for detention cost report.
• OCFS-2633 - MacBride Fair Employment Principles Certification Form.dotx: A certification form for MacBride fair employment principles.
• OCFS-2634 - NON-COLLUSIVE BIDDING CERTIFICATION - Required by Section 139-D of the State Finance: A certification required by section 139-D of the state finance for non-collusive bidding.
• OCFS-2647 - EO 177 Certification: A certification related to executive order 177.
• OCFS-2651 - Detention Program Statistics: Statistics related to the detention program.
• OCFS-2652 - Detention Program Cost Report: A report on the cost of the detention program.
• OCFS-2654 - Detention Program Income Report: A report on the income of the detention program.
• OCFS-2660 - Notice Regarding Fingerprinting Requirements: A notice regarding fingerprinting requirements.
• OCFS-2668 - Detention Program Salary Itemization: A report itemizing the salaries related to the detention program.
• OCFS-2723 - Notice of Intent to Claim Parentage of a Child Born Out of Wedlock: A notice of intent to claim parentage for children born out of wedlock.
• OCFS-2724 - Notice of Intent to Claim Paternity of a Child Born Out of Wedlock: A notice of intent to claim paternity for children born out of wedlock.
• OCFS-2725 - Request-Response for Name and/or Address of Father of Child Born Out of Wedlock (PDF): A form to request or respond to information about the father of a child born out of wedlock.
• OCFS-2726 - Court Determination of Parentage: A determination of parentage by the court.
• OCFS-2981 - Application Cover Sheet for Operating Certificate Request: A cover sheet for the application for an operating certificate.
• OCFS-3114 - Waiver of State Aid Eligibility or State Aid Reimbursement: A waiver for state aid eligibility or reimbursement.
• OCFS-3118 - Instructions for RHYA Programs: Instructions for programs related to Runaway and Homeless Youth Act.
• OCFS-3119 - Program Description: A description of the program.
• OCFS-3122 - Family Type Homes for Adults - Medical Evaluation (Resident)(PDF): A medical evaluation form for residents in family type homes for adults.
• OCFS-3125 - Program Expenditure Summary: A summary of program expenditures.
• OCFS-3144 - Standard Orders - Laboratory and Clinical Monitoring for Youth Prescribed Psychiatric Medicine: Standard orders for laboratory and clinical monitoring for youth prescribed psychiatric medicine.
• OCFS-3148 - Claim Form: A form to claim something.
• OCFS-3160 - Supervision and Treatment Services for Juveniles Program-STSJP: A program for supervision and treatment services for juveniles.
• OCFS-3165 - Foster Youth College Success Initiative Program: A program to promote the college success of foster youth.
• OCFS-3376 - Grant Application for NYSCB Small Grant Program: A grant application for the NY State Commission for the Blind Small Grant Program.
• OCFS-3378 - Report of Legal Blindness/Data Change: A report of legal blindness or a data change related to it.
• OCFS-3440 - Individual Service Plan: A plan for individualized services.
• OCFS-3445 - Children’s Services Release of Confidential Information: A form to release confidential information related to children's services.
• OCFS-3446 - Release of Confidential Information: A form to release confidential information.
• OCFS-3460 - M-WBE Equal Employment Opportunity Policy Statement: A policy statement regarding equal employment opportunity for minority and women-owned business enterprises.
• OCFS-3461 - Waiver of Interest Agreement Justification Form: A form to justify the waiver of interest agreement.
• OCFS-3463 - Children's Services Release of Confidential Information for School Records: A form to release confidential information related to children's services for school records.
• OCFS-3598 - Individual Private Vendor Application: An application for individual private vendors.
• OCFS-3780 - Instrument to Acknowledge Paternity of a Child Born Out of Wedlock (PDF): A legal instrument to acknowledge paternity for children born out of wedlock.
• OCFS-3900 - Federal Fund Advance Request Form: A form to request advance funds from federal funds.
• OCFS-3909 - Request for Information Guardianship Form - For Court Use Only: A form to request information related to guardianship for court use only.
• OCFS-3914 - Health and Safety Equipment and Substitute Care Expenditure Log (PDF): A log to record expenditures related to health and safety equipment and substitute care.
• OCFS-3917 - Transition Plan Amendment for youth age 18-21: An amendment to the transition plan for youth aged 18-21.
• OCFS-3920 - Child Sex Trafficking Indicators: Indicators of child sex trafficking.
• OCFS-3921 - Rapid Indicator Tool To Identify Children Who May Be Sex Trafficking Victims Or At Risk Of Being A Sex Trafficking Victim: A tool to identify children who may be at risk of being a victim of sex trafficking.
• OCFS-3922 - Law Enforcement Report Of A Child Sex Trafficking Victim: A report by law enforcement related to a child sex trafficking victim.
• OCFS-3937 - Request for Information - Private Adoption (For Use by Courts or Disinterested Persons Only): A request for information related to private adoption for use by courts or disinterested parties only.
• OCFS-4156 - Order of Adoption Family Court-Surrogate Court Request Form (PDF): A request form for an order of adoption from family court or surrogate court.
• OCFS-4190 - Inquiry Concerning Visitation Statewide Central Register Database Form (PDF): A form to inquire about visitation in the statewide central register database.
• OCFS-4251 - Financial and Medical Plan (PDF): A plan related to finances and medical care.
• OCFS-4282 - Youth Detention Out-of-County Bed Request Form: A form to request a bed for youth detention outside the county.
• OCFS-4315 - Judicial Surrender form: A form for judicial surrender.
• OCFS-4315A - Attachment A to a Judicial Conditional Surrender: An attachment to a judicial conditional surrender.
• OCFS-4316 - Extra-Judicial Surrender: A form for extra-judicial surrender.
• OCFS-4316A - Attachment A-Extra Judicial Surrender: An attachment to extra-judicial surrender.
• OCFS-4362 - Application to Relaunch a Child Protective Services (CPS) Family Assessment Response (FAR) program: An application to relaunch the CPS Family Assessment Response program.
• OCFS-4363 - Family Assessment Response (FAR) Change Request Form: A form to request changes to the Family Assessment Response program.
• OCFS-4364 - Family Assessment Response (FAR) Implementation Guidelines: Guidelines for implementing the Family Assessment Response program.
• OCFS-4365 - Application to Provide a Child Protective Services (CPS) Differential Response System by Adding Family Assessment Responses (FAR): An application to provide a CPS differential response system by adding Family Assessment Responses.
• OCFS-4401 - Adoption Subsidy Eligibility Documentation File-Title IV-E Adoption Assistance: Documentation related to adoption subsidy eligibility for Title IV-E Adoption Assistance.
• OCFS-4409 - Prospective KinGAP Successor Guardian Criminal Conviction History Attestation: An attestation of criminal conviction history for prospective KinGAP successor guardians.
• OCFS-4410 - Notification Of Interest To Be An Approved Successor Guardian(s): A notification of interest to be approved as a successor guardian.

The forms listed above are just a sampling of the many forms and applications that may be required by OCFS. It is important for individuals and organizations working with children in the state of New York to be familiar with these forms and to ensure that they are properly completed and submitted in a timely manner. By doing so, we can help ensure the safety and well-being of the children in our care.