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  • Ny Ldss-3421 2020

Get Ny Ldss-3421 2020-2025

LDSS-3421 Rev. 5/17 HOME ENERGY ASSISTANCE PROGRAM APPLICATION If you are blind or seriously visually impaired and need this application in an alternative format you may request one from your social services district. For additional information regarding the types of formats available and how you can request an application in an alternative format see the attached instructions or visit www. otda*ny. gov* notices in an alternative format Yes No If Yes check the type of format you would like Large Print Data CD Audio CD Braille if you assert that none of the other alternative formats will be equally effective for you. If you require another accommodation please contact your social services district. PLEASE READ THE INSTRUCTIONS ATTACHED TO THE BACK OF THE APPLICATION* ANSWER ALL QUESTIONS* DO NOT WRITE IN THE SHADED AREAS* PLEASE PRINT CLEARLY AND SIGN THE FORM ON PAGE 5. COMPLETE THE WHITE BOXES BELOW IN BLUE OR BLACK INK. AGENCY USE ONLY CONTACT THE AGENCY ABOVE IF YOU NEED HELP DSS OF....

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© 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
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
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 workflows
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