Application for Certification

Contact the Division of Shelter Oversight and Compliance at 518-486-4040 or otda.sm.css.bss@otda.ny.gov for questions regarding forms and regulations.

Operational Plan Filing Instructions

• Emergency Shelter Operational Plan Filing Instructions.
• Fiscal Profile Instructions

Emergency Shelter Operational Plan

• Emergency Shelter Operational Plan Adult or Adult Family Shelters
• Emergency Shelter Operational Plan Family Shelters
• Request for Regulation Waiver Form

Security Plan

• Security Plan
• Safety and Security Plan Attestation

Budget

• Line Item Budget Forms

Forms

The pre-approved sample forms listed below may be adopted as necessary to comply with shelter operating standards.

Administrative Forms

• Schedule of Staffing
• Emergency Family Information
• Family Census
• Individual Sign-In/Sign-Out Sheets
• Overnight Pass Application
• Resident Suggestion/Complaint
• Family Master List
• Resident Intake Starter Kit

Client Forms

• Family Case Record Admission/Assessment
• Emergency/Immediate Needs Determination
• Preliminary Health Screening
• Service Plan/Independent Living Plan Instructions
• Service Plan/Independent Living Plan Form
  • Service Plan/Independent Living Plan Fillable Form
• Service Plan/Independent Living Plan Samples

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