Transcription of APPLICATION FOR CHILD CARE ASSISTANCE - …
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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. APPLICANT'S INFORMATION FIRST NAME LAST NAME (Please include any ALIASES or MAIDEN names in parentheses) PHONE NUMBER STREET ADDRESS APT NO.
To apply for Public Assistance or other benefits, including Category 1 Child Care Assistance, you must use the
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Suffolk County, Services, Child Care, Provider Child Care Contact List by County/Tribe, County, Child, Care, Child Care Coordinator Listing by County/Tribe, CHAPTER 63 CHILD PROTECTIVE SERVICES, Ohio Administrative Code Annotated 5101 Job, Ohio Administrative Code Annotated _5101 Job, KANSAS DEPARTMENT OF HEALTH, KDHE