DSS-2221A - New York State Office of Children and Family ...
LDSS-2221A (Rev. 09/2016) FRONT. NEW YORK STATE. OFFICE OF CHILDREN AND FAMILY SERVICES. REPORT OF SUSPECTED. CHILD ABUSE OR MALTREATMENT. Report date / / Case ID Call ID Time : AM. PM. Local case # Local dist./agency SUBJECTS OF REPORT . List all children in household, adults responsible and alleged subjects. ................
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