Ocfs.ny.gov
OCFS-6004 (08/2019) FRONT. NEW YORK STATE. OFFICE OF CHILDREN AND FAMILY SERVICES. STAFF, VOLUNTEER, AND HOUSEHOLD MEMBER . MEDICAL STATEMENT. Child Care Programs. I. nstructions: A signature is required on BOTH . SIDES of this form. If the only role is a household member, complete ony the front page. ................
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