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APPLICATION FOR CHILD CARE ASSISTANCE

OCFS-6025 (Rev. 07/2016) DO NOT WRITE IN SHADED AREAS OF THIS APPLICATION PAGE 1 NEW york STATE OFFICE OF CHILDREN AND FAMILY SERVICES APPLICATION FOR CHILD care ASSISTANCEATTENTION: This APPLICATION is used to apply ONLY for Category 2 or 3 CHILD care ASSISTANCE . To apply for Public ASSISTANCE or other benefits, including Category 1 CHILD care ASSISTANCE , you must use the Statewide Common APPLICATION (LDSS-2921). CASE NAME CASE # REGISTRY # OFFICE UNIT WORKER APP DATE / / DISTRICT CASE TYPE: 40 Services Transaction Type: New Open Reopen Recert Disposition: Denial Reason Code Withdrawal SECTION 1.

ocfs-6025 (rev. 07/2016) do not write in shaded areas of this application page 1 new york state office of children and family services

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