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FORM
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DESCRIPTION
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PAGES
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INT-2(4130) Suffolk County Child Support Enforcement Bureau Intake Questionnaire
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This questionnaire will provide the basic information needed to enable CSEB to build a case in the Child Support Management System and to take the first steps to assist the custodial parent in obtaining child support. |
6 |
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LDSS-2521
Application for Child Support
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Custodial parents not in receipt of TANF must complete this application. The application authorizes the Child Support Bureau to begin action on their behalf.
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1 |
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Pub-1301
How To Complete the Social Services Application
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Companion Instructions to the DSS 2921 |
10 |
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LDSS-2921: Application for Public Assistance - Medical Assistance - Food Stamps - Services
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Common Instrument that must be completed by applicants for programs administrered by NY State Family and Children Services and the NY State Department of Health. |
18 |
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LDSS-4826: Food Stamp Benefits Application
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This application can only be used to apply for Food Stamp Benefits. |
9 |
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DOH-4220 Access New York Health Care Application
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This application can 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. This application should not be used to apply for Medicaid for persons who are age 65 or older or disabled. |
17 |
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DOH-4282 Family Planning Benefit Program Application
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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. |
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DOH-4328 Medicare Savings Program Application
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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 |
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Middle Income Home Energy Assistance Program (MI-HEAP) Application
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This application is to be completed when applying for the Middle Income Home Energy Assistance Program. This program will assist households who are not eligible for the HEAP program, but who have income up to 35% over the regular HEAP eligibility guidelines.
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3 |
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