Get Ldss 4530 Form

Filling out the Ldss 4530 Form is an essential process for individuals seeking to assign a portion of their wages to repay overpayments of temporary assistance benefits. This guide will help you understand the components of the form and provide clear, step-by-step instructions on how to complete it online.

Follow the steps to fill out the Ldss 4530 Form online.

1. Click the ‘Get Form’ button to download the Ldss 4530 Form and open it for editing.
2. Begin by filling in your name in the designated space. Ensure that you enter your full name as it appears on your identification documents.
3. Next, provide your local address, including the city, county, and state of New York, in the specified fields to establish your residency.
4. In the section labeled 'social services district,' verify and input the address for the Suffolk County Department of Social Services accurately.
5. Continue by filling in a ten percent (10%) interest in your wages or compensation. This section signifies your authorization to repay any overpayments made through wage assignment.
6. Indicate your payment terms, specifying the date when repayments should commence and where future payments should be directed.
7. As you complete the document, ensure you express release and discharge to your employer regarding any liabilities connected to this assignment.
8. Complete the notary section at the bottom of the form, as this requires certification. Make sure all details are accurate before submission.
9. Once all fields are completed, save your changes. You now have the options to download the filled form, print it, or share it as required.

Get started now and complete your Ldss 4530 Form online to ensure a smooth repayment process.