Get Ldss Form 3174 - Office Of Temporary And Disability Assistance - Otda Ny

The LDSS Form 3174 is essential for individuals seeking to recertify for Temporary Assistance, Medical Assistance, Medicare Savings Program, or Food Stamp Benefits in New York. This guide provides a clear, step-by-step approach to completing the form accurately and efficiently online.

Follow the steps to successfully complete the LDSS Form 3174 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the recipient information section. Provide your first name, middle initial, last name, and full address, ensuring clarity in your entries.
3. Indicate your phone number and relationship status. Fill in additional details such as the primary language and any eligibility concerns that may apply to you.
4. In the eligibility section, check off each program you or any household member wishes to recertify for, ensuring to read any relevant instructions.
5. Complete the sections regarding household composition, detailing all residents living in your household including their names, dates of birth, and relationships to you.
6. Provide necessary income information for each household member, detailing sources of income and specific amounts.
7. Fill out any medical, employment, education, and resource information as required in the designated sections.
8. Proceed to sign and date the certification at the end of the form, ensuring all necessary signatures are included for every member listed.
9. Once all fields are filled, review the form for accuracy. Make any necessary edits before finalizing.
10. Save your changes and choose to download, print, or share the form as needed, ensuring you keep a copy for your records.

Complete your LDSS Form 3174 online today for timely assistance.