Lds2221a 2026

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The document is a report form used by the New York State Office of Children and Family Services for documenting suspected child abuse or maltreatment. It includes sections for identifying the subjects involved, detailing the basis of suspicions, and providing information about the reporting source. The form outlines various types of abuse and maltreatment, reporting procedures, legal definitions, and penalties for failing to report. It emphasizes confidentiality and mandates immediate reporting of suspected cases.

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Click ‘Get Form’ to open the LDSS-2221A in the editor.
Begin by entering the Report Date, Case ID, and Call ID at the top of the form. Ensure accuracy as these details are crucial for tracking.
In the 'SUBJECTS OF REPORT' section, list all children and adults involved. Fill in their last names, first names, sex, birthday or age, aliases, race code, ethnicity code, relation role code, and language code using the provided line numbers.
Next, detail the 'BASIS OF SUSPICIONS'. Clearly state any alleged suspicions of abuse or maltreatment. Reference specific child line numbers if applicable.
Complete the 'SOURCE(S) OF REPORT' section by providing your name, contact information, and relationship to the case. This is essential for follow-up.
Finally, sign and date the form at the bottom before submitting it as instructed. If additional space is needed for explanations, attach an extra sheet.

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