Get Recovery Of Equivalent Benefit Request Form - Otda Ny

This guide provides comprehensive instructions on completing the Recovery Of Equivalent Benefit Request Form for the NYS Supplement Program. Follow these steps to ensure your request is filled out accurately and efficiently.

Follow the steps to complete your form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by filling out the client identification section. Enter your name, county, and the last four digits of your social security number. Make sure to include your date of birth in the MM/DD/YYYY format.
3. Next, provide your case number and Client Identification Number (CIN) as required. These identifiers are crucial for processing your request.
4. Indicate the start and end dates of the REB retroactive period. Use the MM/DD/YYYY format to ensure clarity.
5. Record the first month of recurring SSP and the corresponding benefit amount. This info is vital for evaluating your eligibility.
6. In the assistance provided during the REB period section, list the month/year and corresponding amounts for each entry. Be diligent to ensure accuracy.
7. Next, you can use the remarks section to include any additional comments or relevant information that might support your request.
8. Authorizing your form is essential. Provide your name, signature, title, and the date. Add your telephone number and email for communication purposes.
9. After completing all sections, you can save your changes, download, print, or share the form as needed. Ensure to keep a copy for your records.

Complete your Recovery Of Equivalent Benefit Request Form online today for efficient processing.