
Get Ny Ldss-4992 2014-2025
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How to fill out the NY LDSS-4992 online
The NY LDSS-4992 is a crucial form for individuals seeking cooling assistance under the Home Energy Assistance Program. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently online.
Follow the steps to effectively complete the NY LDSS-4992 online
- Press the ‘Get Form’ button to obtain the form and open it in your preferred document editor.
- Fill in your applicant information, including your first name, middle initial, and last name. Enter the last four digits of your Social Security Number. Provide your street address, apartment number (if applicable), city, state, and zip code.
- Add your county and provide your daytime phone number. This information will help the agency contact you if needed.
- Complete the household information section by listing all individuals who currently reside in your home, including yourself. For each person, provide their full name, last four digits of their Social Security Number, date of birth, and indicate if they are blind or have a disability.
- If your household has more than three members, continue listing the additional members on the reverse side of the form.
- Indicate whether your household contains a person with a medical condition that worsens with extreme heat. If so, note that you will need to provide a doctor’s confirmation.
- Review the certification section where you will affirm that all information provided is accurate and truthful. Sign and date the application to confirm your agreement.
- After completing all sections, you can save changes to the document, download, print, or share the completed form as needed.
Ensure you complete your application online for timely processing.
When filling out the ST 120 form PDF, begin by downloading the form and entering your information clearly. Follow the prompts to complete all sections accurately, and keep in mind to save or print a copy for your records. The NY LDSS-4992 can assist you in understanding the requirements, making it easier for you to complete the form correctly.
Fill NY LDSS-4992
Office of Temporary and Disability Assistance. If only the LDSS-4992 needs to be completed, the applicant can complete this process via telephone or in person at the certifying agency. Home Energy Assistance Program. Completing and signing a HEAP application (LDSS3421) and HEAP Cooling Assistance Request for Benefit (LDSS4992). The 2021-2022 Cooling Assistance benefit opened May 2, 2022. If you are eligible, you may receive one Cooling Assistance benefit per applicant household.
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