We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Uncategorized Forms
  • Ldss 3174 Form Pdf

Get Ldss 3174 Form Pdf

On date was changed to 5/05. SECTION 6 2. In the RACE/ETHNIC AFFILIATION CODES , H Hispanic or Latino (a) was changed to H Hispanic or Latino . 3. In the listing of RACE/ETHNIC AFFILIATION CODES , an additional code was added directly below the W White code. The new code is labeled U Unknown (MA Only) . 4. An additional RACE/ETHNIC AFFILIATION CODES column was added in the RACE AFFILIATION section, to the right of the W column. That additional c.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the Ldss 3174 Form Pdf online

The Ldss 3174 Form Pdf is essential for individuals seeking to recertify their eligibility for various assistance programs in New York. This guide will provide clear, step-by-step instructions on filling out the form online, ensuring that all users can navigate the process with confidence.

Follow the steps to fill out the Ldss 3174 Form Pdf online:

  1. Press the ‘Get Form’ button to obtain the Ldss 3174 Form Pdf and open it in your preferred editor.
  2. Begin by entering your personal information in the designated fields, including your case name and any pertinent identification numbers.
  3. Proceed to the recipient information section. Here, provide details about each household member, including their names, relationships, and ages.
  4. Fill out the citizenship and immigration status information as required, ensuring that you complete the certification sections accurately.
  5. In the income information section, list any sources of income for you and your household members, documenting amounts as directed.
  6. Move to the section regarding housing expenses. Input data about your current living situation, including rent or mortgage payments.
  7. Complete any relevant questions regarding healthcare and insurance. Be sure to provide details on availability and type of coverage if applicable.
  8. Have a final review of the form to ensure all sections are complete and accurate. Make any necessary changes.
  9. Once you are satisfied with the information provided, save your changes, and you may either download the form, print it, or share it as needed.

Complete your Ldss 3174 Form Pdf online now for efficient processing of your assistance recertification.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

LDSS 3174 - New York State Application For Certain...
LDSS-3174 Statewide (Rev. 07/20). DO NOT WRITE IN THE SHADED AREAS OF THIS RECERTIFICATION...
Learn more
LDSS-3174 - Office of Temporary and Disability...
LDSS-3174 Statewide (Rev. 7/16). DO NOT WRITE IN THE SHADED AREAS OF THIS RECERTIFICATION...
Learn more

Related links form

To The Genesee County Health Department Newspaper Publication Form To Be Used For: Change Of Corporate ... Minutes Of Regular Meeting ANNUAL FINANCIAL STATEMENT FOR THE YEAR 2011 FYI Is A Weekly Supplement To The Mercer County Culture And Heritage Update Newsletter And

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

No, you will have to renew your insurance again. Due to requirements in federal law and other flexibilities, NY State of Health has kept you enrolled in Medicaid, Child Health Plus, or the Essential Plan without requiring you to renew your insurance every year.

For detailed information about your SNAP or Cash cases, or to schedule an appointment: Call the Human Resources Administration (HRA) information line at 718-557-1399.

BY PHONE: Call our Member Services line at 855-456-9126 and ask to be connected to our Medicaid Recertification Department. The Medicaid Recertification specialist will be able to help you to fill out your forms and submit them directly online through a secure Web Portal to NYC HRA.

If you want to recertify for Medicaid and PA, check (✓) the “Medicaid (MA) and PA” box. If you wish to only recertify for MA, you can go online at https://nystateofhealth.ny.gov/ or call 1-855-355- 5777 for more information or to recertify.

Cash Assistance Benefits. FA and SNA provide a cash benefit twice per month that can be used for food, utilities and housing expenses. If you are eligible for FA, you can only receive benefits for a lifetime total of five years (60 months).

Recertifications: If you receive a Cash Assistance or SNAP recertification notice by mail or an ACCESS HRA alert that you need to recertify, you must submit your recertification or your benefits will stop. You can use ACCESS HRA, fax, mail, or a drop box at open centers to submit your recertification.

Family Assistance (FA) Under FA, eligible adults are limited to receiving benefits for a total of 60 months in their lifetime, including months of TANF-funded assistance granted in other states. Once this limit is reached, that adult and all members of their FA household are ineligible to receive any more FA benefits.

If you could not recertify on ACCESS HRA, you can recertify now using one of these ways: Mail/Fax: Request a recertification form by phone at 718-557-1399 or download it here: https://on.nyc.gov/ca-recert. Then, mail or fax your completed form to your Benefits Access Center.

How much cash assistance you'll get in NY largely depends upon your family's income and size. New York pays a maximum of $789 a month to a family of three — one of the most generous among the contiguous 48 states and the District of Columbia.

Call us at 1-888-809-8009 (TTY 711), or visit a local Community Service Center to get free, in-person help. You can also renew by calling New York State of Health at 1-855-355-5777 (TTY 1-800-662-1220) or visiting .nystateofhealth.ny.gov.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Ldss 3174 Form Pdf
Get form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232