Loading
Form preview picture

Get Caretaker For The Blind Form

Reset NYCHA 040. 567 Rev. 10/20/11 v1 COMMUNITY SERVICE Exemption Verification Primary Caretaker for the Blind or Disabled New YOrk city housing authority Name NYCHA Resident Giving Care Last P First Address Apt. A change in federal law requires adult residents to provide eight hours of Community Service or engage in eight hours of Economic Self-Sufficiency activity each month unless the resident qualifies for an exemption. A primary caretaker of a blind or disabled person who meets the requirements listed below qualifies for an exemption. The above named NYCHA resident states that he/she is one of your and return it to the NYCHA resident named at the top of this page. Print Name NYCHA Resident Receiving Care last first Account Telephone Borough Development I am the blind or disabled authorized NYCHA resident named in this box. I have already qualified for an Exemption from NYCHA Community Service due to blindness or disability because I either ubmitted to NYCHA management a completed COMMUNITY SERVICE Exemption Verification S Disability form signed by a medical doctor or optometrist or currently receive Supplemental Security Income SSI benefits and I already reported this to I NYCHA management or I currently receive Social Security Disability SSD payments and gave NYCHA proof by letter from the Social Security Administration. I hereby certify that the individual named at the top of this page takes care of me and is my primary caretaker. I understand that a primary caretaker must provide no less than 20 hours of care per week. Dated 20. I have already qualified for an Exemption from NYCHA Community Service due to blindness or disability because I either ubmitted to NYCHA management a completed COMMUNITY SERVICE Exemption Verification S Disability form signed by a medical doctor or optometrist or currently receive Supplemental Security Income SSI benefits and I already reported this to I NYCHA management or I currently receive Social Security Disability SSD payments and gave NYCHA proof by letter from the Social Security Administration. I hereby certify that the individual named at the top of this page takes care of me and is my primary caretaker. I understand that a primary caretaker must provide no less than 20 hours of care per week. Dated 20. Signature of Blind or Disabled NYCHA resident or guardian NOTE To avoid incidents of fraud representatives of the New York City Housing Authority will check NYCHA records and may contact you to verify the truth of the statements made above. The following information is about the blind or disabled NYCHA resident who is receiving the care. Note The caregiver and care receiver must both be authorized NYCHA residents but may live either in the same or in different apartments. Print Name NYCHA Resident Receiving Care last first Account Telephone Borough Development I am the blind or disabled authorized NYCHA resident named in this box. I have already qualified for an Exemption from NYCHA Community Service due to blindness or disability because I either ubmitted to NYCHA management a completed COMMUNITY SERVICE Exemption Verification S Disability form signed by a medical doctor or optometrist or currently receive Supplemental Security Income SSI benefits and I already reported this to I NYCHA management or I currently receive Social Security Disability SSD payments and gave NYCHA proof by letter from the Social Security Administration. I hereby certify that the individual named at the top of this page takes care of me and is my primary caretaker.

How It Works

caretakers rating
4.8Satisfied
32 votes

How to fill out and sign optometrist online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Legal, business, tax along with other documents need a top level of protection and compliance with the legislation. Our documents are updated on a regular basis according to the latest amendments in legislation. Plus, with us, all the data you provide in the Caretaker For The Blind Form is well-protected against leakage or damage through cutting-edge encryption.

The following tips will allow you to complete Caretaker For The Blind Form easily and quickly:

  1. Open the form in our full-fledged online editing tool by hitting Get form.
  2. Complete the required fields which are marked in yellow.
  3. Hit the green arrow with the inscription Next to move on from field to field.
  4. Go to the e-signature tool to put an electronic signature on the template.
  5. Add the relevant date.
  6. Check the entire document to ensure that you have not skipped anything.
  7. Hit Done and download the resulting document.

Our solution allows you to take the entire procedure of executing legal documents online. For that reason, you save hours (if not days or even weeks) and eliminate unnecessary expenses. From now on, fill in Caretaker For The Blind Form from home, workplace, and even while on the move.

Get form

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

Exemption FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to Caretaker For The Blind Form

  • ssd
  • SUFFICIENCY
  • caretakers
  • optometrist
  • CAREGIVER
  • Certification
  • exemption
  • certify
  • supplemental
  • punishable
  • verification
  • borough
  • qualifies
  • Blindness
  • APT
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.