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Attached Document:
09ma025.pdf
OMM/OCFS/OTDA Materials: GIS Issued by OMM
09 MA/025: Financial Status Form (Farm or Business), DOH-4469
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The purpose of this General Information System (GIS) message is to advise social services districts that the attached Financial Status Form (Farm or Business) now has a Department form number, DOH-4469 (10/09). A previous version of this form has been in use for many years. The new DOH form is available on-line at: http://health.state.nyenet/revldssforms.htm. This message will also review its uses.
Changes to the form include:
*The "Note" at the top of the form now includes some additional expenses that are not allowable deductions for public health insurance;
*The certification at the bottom of the form attesting to its truthfulness has been significantly strengthened.
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Created: 11/2/2009
Updated: 11/16/2009
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