Contact Us

Contact Us Online

John F. O'Neill
Commissioner
Address:
3085 Veterans Memorial Hwy
Ronkonkoma, NY 11779

Click here to find the Center serving you:  

Service Center Hours: Monday through Friday 8:00AM-3:00PM, excluding county holiday closures. Language Services available at all sitesAccess to Services in Your Language: Complaint Form

Phone: (631) 854-9930

Emergencies (After 4:30 PM & Weekends): (631) 854-9100 

If you asked for an accommodation and did not receive it, you may file an ADA grievance (appeal) by calling or writing to:
ADA Compliance Officer
Suffolk County DSS - Commissioner’s Office,

3085 Veterans Memorial Highway
Ronkonkoma, N.Y. 11779
Tel. # (631) 854-9983
Fax:   (631) 854-9996

For other questions about special accommodations for people with disabilities,
please call the Suffolk County Office for People with Disabilities at (631) 853-8333.

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Public Forms

To view all the local Department of Social Services forms, please click on the + symbol next to the Social Services link. To view documents available for printing, click on desired program area folder.

For a complete listing of Common Forms and Applications from the NYS Office of Temporary and Disability Assistance as well as the following state forms and applications in languages other than English, please click here.

Please print or download form to your computer.
Follow the instructions on each form and print or type legibly.


     
 
     
 
total items   4   items x page            
   
Document  
DFPAFeb2014.pdf
Directory for Public Access to Social Services Programs. Telephone directory and available services.
 
DFPASpanishFeb2014.pdf
Directory for Public Access to Social Services Programs (Spanish version). Telephone directory and available services.
 
ThreatsManual2010 .pdf
It is the intent of the Suffolk County Department of Social Services to create a safe workplace for staff and the public who access our services.
 
WebFraudReportingForm.pdf
If you believe an individual has received welfare assistance improperly, please take the time to share this information with us.
 
 
 
     

New York State Forms
Form Description Pages
LDSS-2921: Application for Public Assistance - Medical Assistance - SNAP - Services

Common Instrument that must be completed by applicants for programs administered by NY State Family and Children Services and the NY State Department of Health.

18
Pub-1301
How To Complete the Social Services Application
Companion Instructions to the DSS 2921 10
DOH-4220 Access New York Health Care Application

This application is to be used to apply for Children's Medicaid, Child Health Plus, Family Health Plus, Medicaid, Prenatal Care Assistance Program (PCAP), and Women, Infants and Children (WIC) nutritional programs. Based upon the information you provide, you will be told which program you and/or your child(ren) are eligible for. If the applicant is disabled, age 65 or older, or in receipt of Nursing Home care, they must complete DOH-4495a (Supplement A).  In addition to the Medicaid application DOH-4220 above, Access NY Supplement A is required for persons applying for Medicaid who are disabled or age 65 or older in receipt of Nursing Home care.

17
DOH-4282 Family Planning Benefit Program Application

This application is to be completed for the Family Planning Benefit Program (FPBP).  FPBP is a program for New Yorkers who need family planning services, but may not be able to afford them.  It is intended to increase access to family planning services and to enable individuals of childbearing age to prevent or reduce the incidence of unintentional pregnancies.

2
DOH-4328 Medicare Savings Program Application

This application is to be completed when applying for Medicare Savings Program (MSP) only – not Medicaid.  The MSP program pays the Medicare Part B premium and, for eligible individuals, the coinsurance and deductible payments.

2

LDSS-4148A

What You Should Know About  Your  Rights and Responsibilities (when applying for or receiving benefits)

35
LDSS-4148B

What You Should Know About Social Services Programs - Q & A

44
LDSS-4148C What You Should Know If  You Have An Emergency 7
Child Support Enforcement Bureau
LDSS-2521: Application for Child Support

Custodial parents not in receipt of TANF must complete this application. The application authorizes the Child Support Bureau to begin action on their behalf.

1
Client Benefit Services
LDSS-4826: SNAP Benefits Application

This application can only be used to apply for Supplemental Nutrition Assistance Program (SNAP) Benefits.

9