Follow the steps to complete the NY OPWDD Form 159 online.

1. Press the 'Get Form' button to obtain the form and open it in the editor.
2. In the 'Registered Provider' section, enter the full name of the registered provider without any abbreviations. Provide the complete street address, including city, state, and zip code.
3. In the 'Authorized Person' section, input the name of the individual authorized to submit criminal background check requests. Include their phone number (with area code) and email address for communication.
4. For the 'Applicant Information' section, list all household members, including adults and children, regardless of their relation to the applicant. Use the format: last name, first name, and middle name. List maiden names or aliases in the designated lines. If necessary, attach OPWDD Form 159b.
5. Indicate the relationship of each individual to the applicant in the first column. In the 'Sex M/F/X' column, specify male, female, or an unspecified identity for each person listed. Fill in the complete date of birth for everyone listed in the designated column.
6. In the 'Address' section, provide the addresses for the applicant covering the last 28 years. Include street names, city, state, and zip code. Use month and year for the 'From' and 'To' dates and include 'Current' or the date the form is signed for the current address.
7. In the 'Signature Area,' ensure all signers complete their respective fields. The applicant must sign and date both boxes marked 'Applicant’s Signature.' The authorized person must sign in their specific section. Confirm that all signatures match the names provided.
8. Once all sections are complete, you can save changes, download, print, or share the form as needed.

Complete your NY OPWDD Form 159 online today for a seamless application process.