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Ldss 3174-2026

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4.1 out of 5

59 votes

The document is a recertification form (LDSS-3174) for various assistance programs in New York State, including Temporary Assistance, Medical Assistance, Medicare Savings Program, and Food Stamp Benefits. It outlines the information required from applicants to determine their eligibility for these benefits, emphasizing the importance of self-sufficiency and participation in work activities. The form includes sections for personal information, household composition, income details, medical information, and certifications regarding citizenship and support rights. It also provides instructions on completing the form and highlights the consequences of providing false information.

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Click ‘Get Form’ to open the ldss 3174 in the editor.
Begin by filling in your personal information in the 'Recipient Information' section. Ensure you provide your full name, address, and contact details clearly.
In the 'Eligibility Information' section, check all applicable programs you or any household member wishes to recertify for, such as Temporary Assistance or Food Stamp Benefits.
Complete the 'Income Information' section by detailing all sources of income for yourself and other household members. Be thorough to avoid delays.
Fill out the 'Employment Information' section accurately, indicating your current employment status and providing employer details if applicable.
Review all sections carefully before submitting. Use our platform's features to save your progress and make edits as needed.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (74 Votes)
2005	4.1 Satisfied (59 Votes)

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ldss 3174

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