Ldss 2921 form-2025

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The document is an application form (LDSS-2921 Statewide) for various social services in New York, including Temporary Assistance, Medical Assistance, Food Stamp Benefits, and Child Care Assistance. It outlines the eligibility requirements, necessary information to be provided by applicants, and the responsibilities of both the applicants and the agency. The form includes sections for personal information, household composition, income details, medical information, and consent for verification of provided data. It emphasizes the importance of honesty in reporting and the consequences of providing false information.

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