Get Ny Map-2161 2018-2025

The NY MAP-2161 is an important document for applicants or recipients living with a legally responsible relative who has refused to provide income or resources for medical care. This guide offers clear, step-by-step instructions on filling out the form online, ensuring a smooth and efficient process.

Follow the steps to complete the NY MAP-2161 form online.

1. Click the ‘Get Form’ button to access the MAP-2161 form and open it for editing.
2. Begin by entering the date at the top of the form, followed by the case name and case number. These details help identify your application.
3. In the declaration section, clearly print your first and last name as the applicant or recipient. You will also need to specify your legally responsible relative's relationship to you by checking the appropriate box (spouse, parent, or other).
4. Provide the full name of your legally responsible relative, ensuring you enter their first and last name correctly.
5. Next, include the Social Security number of your legally responsible relative. This information is essential for processing your application.
6. If applicable, fill in the name of the health care plan of the legally responsible relative, specify the type of health care coverage, and include the policy number and contact number.
7. Review the declaration statement, making sure you understand that by signing this form, you are assigning your right to support from your legally responsible relative to the Commissioner of the New York City Human Resources Administration.
8. Sign the form as the applicant or recipient, then include the date of your signature.
9. Ensure that any required supervisor's name and signatures are also included, if applicable, before submitting.
10. Finally, after you have completed the form, save your changes. You can then download, print, or share the completed form as needed.

Start completing your NY MAP-2161 form online today for a timely and efficient application process.