¶1 ORDER
¶2 Defendants having been directed in an opinion handed down by this Court dated March 29, 1976 to submit a proposed order outlining plans for revision of their procedures in conformity with such decision, and the Court having considered the submission of both parties with respect to such direction, it is hereby
¶3 ORDERED (1) that, subject to paragraph (2) hereof, any person wishing to apply for public assistance within the City of New York shall be provided an application form on the date of such person’s first or second visit to an Income Maintenance Center for the purpose of applying for assistance; and it is further
¶4 ORDERED (2) that
¶5 (a) application forms be provided at alternative locations throughout the community to all interested organizations which request a supply of the forms. A comprehensive list of organizations which have requested and been provided application forms is attached hereto as Appendix A;
¶6*1260 (b) the availability of application forms from such organizations be adequately publicized by defendant [J. Henry Smith], as Commissioner of the New York City Department of Social Services, so that persons wishing to apply for aid are, to the maximum extent feasible, made aware of the availability of application forms from such organizations;
¶7 (c) notwithstanding the alternative provided by this paragraph, any individual wishing to obtain an application form and application kit (described in NYC Procedure No. 75-13, Oct. 6,1975, p. 9, and subsequent revisions thereto which must include like materials) from an Income Maintenance Center must be permitted to do so, and must be provided such form and kit on request; and it is further
¶8 ORDERED (3) that at the time such person is provided an application form he or she shall simultaneously be provided the application kit which shall include a comprehensive, intelligible set of instructions, written in large, easily read print in English and/or in Spanish as applicable, designed to ensure that an applicant can complete the application form without requiring the assistance of Income Maintenance Center personnel. A draft copy of these instructions is attached hereto as Appendix B; and it is further
¶9 ORDERED (4) that signs be posted prominently in all Income Maintenance Centers in the City of New York notifying applicants that they are entitled to an application form and informing them to request an application from the receptionist if they want one. The sign, which will be in both English and Spanish and in letters of at least one inch in height, will read as follows:
“NOTICE TO APPLICANTS
IF YOU WANT TO APPLY FOR PUBLIC ASSISTANCE, YOU HAVE A RIGHT TO GET AN APPLICATION FORM AND WRITTEN INSTRUCTIONS THAT EXPLAIN HOW TO FILL OUT THE APPLICATION. YOU ALSO HAVE THE RIGHT TO FILE THE APPLICATION FORM AND GET A WRITTEN DECISION TELLING YOU WHETHER OR NOT YOU ARE ELIGIBLE. YOU CAN FILE AN APPLICATION AND GET A WRITTEN DECISION EVEN IF THE RECEPTIONIST TELLS YOU THAT YOU DO NOT SEEM ELIGIBLE.”
¶10 It is further
¶11 ORDERED (5) that
¶12 (a) after an applicant receives an application, an appointment shall be scheduled for the applicant to return for an initial application interview within five working days;
¶13 (b) all application staff will be notified that they cannot schedule initial application appointments beyond five working days without express approval from the Center Director;
¶14 (c) the Center Director, upon being notified by his application supervisor that the initial application interview cannot be scheduled within five working days, will provide for the transfer of staff from other sections to meet the five-working-day requirement or call the Deputy Administrator for Income Maintenance Programs, or his designee, who will take immediate steps to ensure that such appointments are scheduled within five working days;
¶15 (d) if an appointment cannot be scheduled within five working days, the applicant’s completed application shall nevertheless be accepted for filing at the time submitted by the applicant;
¶16 (e) if the applicant returns to the Center on the date of his or her scheduled application interview, the application interview shall be held on that day and the completed application form shall be accepted as filed on or before that day; and it is further
¶17 ORDERED (6) that all application section personnel and administrative staff within the Income Maintenance Centers be notified that applicants have a right to obtain an application form even if they are in the wrong Center or the pre-screening interview indicates that they are presumptively not eligible. Training sessions will be held *1261 to ensure that Center staff, including receptionists, “A” receptionists, application interviewers, application supervisors, and all administrative staff are aware of this requirement; and it is further
¶18 ORDERED (7) that defendant [Philip Toia], as Commissioner of the New York State Department of Social Services, take such steps as may be necessary to assist defendant [J. Henry Smith], as Commissioner of the New York City Department of Social Services, to comply with this Order and to ensure periodic review by the State Department of Social Services so that appropriate corrective action may be taken by such State agency in the event that noncompliance is ascertained.
¶19 APPENDIX A
¶20 Community Offices_BROOKLYN
¶21 Brighton Beach Coordinating Committee for Russian Immigrants
¶22 293 Neptune Avenue
¶23 Brooklyn, N. Y. 11235
¶24 Jewish Family Services
¶25 4917 12th Avenue
¶26 Brooklyn, N. Y. 11219
¶27 Sunset Park Family Health Center
¶28 514 49th Street
¶29 Brooklyn, N. Y. 11220
¶30 Jewish Family Services
¶31 186 Montague Street
¶32 Brooklyn, N. Y. 11201
¶33 John the Baptist Community Center
¶34 807 Willoughby Avenue
¶35 Brooklyn, N. Y. 11206
¶36 Bedford Stuyvesant Alcoholism Treatment Clinic
¶37 1121 Bedford Avenue
¶38 Brooklyn, N. Y. 11216
¶39 Bedford Stuyvesant Restoration Corp.
¶40 172 Tompkins Avenue
¶41 Brooklyn, N. Y. 11206
¶42 Bedford Stuyvesant Youth in Action
¶43 882 DeKalb Avenue
¶44 Brooklyn, N. Y. 11221
¶45 Lyndon B. Johnson Health Center
¶46 507 DeKalb Avenue
¶47 Brooklyn, N. Y. 11205
¶48 Bedford. Stuyvesant Youth in Action
¶49 930 Bedford Avenue
¶50 Brooklyn, N. Y. 11205
¶51 Bedford Stuyvesant Youth in Action
¶52 496 Franklin Avenue
¶53 Brooklyn, N. Y. 11238
¶54 Club Heraldo Hispano
¶55 727 Fulton Street
¶56 Brooklyn, N. Y. 11217
¶57 Fort Greene Community Corp.
¶58 205 Ashland Place
¶59 Brooklyn, N. Y. 11205
¶60 Coney Island Hospital
¶61 Social Service Department
¶62 2601 Ocean Parkway
¶63 Brooklyn, N. Y. 11235
¶64 Our Lady of Mercy Church
¶65 680 Stone Avenue
¶66 Brooklyn, N. Y. 11212
¶67 Salvation Army
¶68 280 Riverdale Avenue
¶69 Brooklyn, N. Y. 11212
¶70 Kings County Hospital
¶71 Alcoholism Treatment Clinic
¶72 600 Albany Avenue
¶73 Brooklyn, N. Y. 11203
¶74 Kings County Hospital
¶75 Social Service Department
¶76 451 Clarkson Avenue
¶77 Brooklyn, N. Y. 11203
¶78 Catholic Charities
¶79 Human Service Center
¶80 730 Classon Avenue
¶81 Brooklyn, N. Y. 11238
¶82*1262 Community Offices_BROOKLYN
¶83 Catholic Charities
¶84 Human Service Center
¶85 1101 Carroll Street
¶86 Brooklyn, N. Y. 11225
¶87 Catholic Charities
¶88 Williamsburg Human Service Center
¶89 142 Montrose Avenue
¶90 Brooklyn, N. Y. 11206
¶91 Northside Community Development Council
¶92 575 Driggs Avenue
¶93 Brooklyn, N. Y. 11211
¶94 Williamsburg Community Corp.
¶95 815 Broadway
¶96 Brooklyn, N. Y. 11206
¶97 School Settlement Association
¶98 120 Jackson Street
¶99 Brooklyn, N. Y. 11211
¶100 St. Nicholas Neighborhood Preservation and Housing Rehabilitation Corp.
¶101 260 Powers Street
¶102 Brooklyn, N. Y. 11211
¶103 Education Action Centers
¶104 577 Lorimer Street
¶105 Brooklyn, N. Y. 11211
¶106 Opportunity Development Association
¶107 41 Heyward Street
¶108 Brooklyn, N. Y. 11211
¶109 United Jewish Organizations
¶110 545 Bedford Avenue
¶111 Brooklyn, N. Y. 11211
¶112 Italian American Civil Rights League
¶113 390 Graham Avenue
¶114 Brooklyn, N. Y. 11211
¶115 Williamsburg Legal Services
¶116 260 Broadway
¶117 Brooklyn, N. Y. 11206
¶118 Lutheran Community Service Center
¶119 366 Union Avenue
¶120 Brooklyn, N. Y. 11211
¶121 Williamsburg Prenatal Clinic
¶122 151 Maujer Street
¶123 Brooklyn, N. Y. 11206
¶124 Welfare Recipients Action Group of Red Hook
¶125 396 Van Brunt Street
¶126 Brooklyn, N. Y. 11231
¶127 La Casa Neighborhood Service Center
¶128 152 Columbia Street
¶129 Brooklyn, N. Y. 11231
¶130 Chama Brooklyn Child Development Center
¶131 1835 Sterling Place
¶132 Brooklyn, N. Y. 11233
¶133 Catholic Migration Office
¶134 354 Court Street
¶135 Brooklyn, N. Y. 11231
¶136 Catholic Migration Office
¶137 12 Bedford Avenue
¶138 Brooklyn, N. Y. 11223
¶139 Catholic Migration Office
¶140 74-10 20th Avenue
¶141 Brooklyn, N. Y. 11204
¶142 Catholic Migration Office
¶143 1449 Myrtle Avenue
¶144 Brooklyn, N. Y.
¶145 Fort Greene Community Corp.
¶146 958 Fulton Street
¶147 Brooklyn, N. Y. 11238
¶148 Community Offices_BRONX
¶149 Cypress Community Center
¶150 541 E. 138 Street
¶151 Bronx, N. Y. 10454
¶152 Catholic Charities
¶153 541 E. 138 Street
¶154 Bronx, N. Y. 10454
¶155 Bronx Lebanon Hospital
¶156 Concourse Division
¶157*1263 Community Offices_BRONX
¶158 Social Services Department
¶159 1650 Grand Concourse
¶160 Bronx, N. Y. 10456
¶161 Bronx Developmental Services
¶162 State Department of Mental Hygiene
¶163 726 Kelly Street
¶164 Bronx, N. Y. 10455
¶165 Bronx Developmental Services
¶166 1366 Inwood Avenue
¶167 Bronx, N. Y. 10452
¶168 Puerto Rican Family Institute
¶169 2051 Grand Avenue
¶170 Bronx, N. Y. 10453
¶171 Morris Avenue Engage
¶172 284 E. 150 Street
¶173 Bronx, N. Y. 10451
¶174 West Bronx Jewish Federation Service Center
¶175 1130 Grand Concourse
¶176 Bronx, N. Y. 10456
¶177 The Jewish Family Services
¶178 140-26 Carver Loop
¶179 Coop City, Bronx, N. Y. 10475
¶180 Bronx Psychiatric Center
¶181 1500 Waters Place
¶182 Bronx, N. Y. 10461
¶183 Bronx State Hospital
¶184 Highbridge Out-Patient Clinic
¶185 260 East 161 Street 10th floor
¶186 Bronx, N. Y. 10451
¶187 Riverdale Neighborhood House
¶188 5521 Mosholu Avenue
¶189 Riverdale, N. Y. 10471
¶190 J. A. S. A.
¶191 2488 Grand Concourse
¶192 Bronx, N. Y. 10458
¶193 Bronx Community College
¶194 Loew Hall 4th floor
¶195 181 Street and University Avenue
¶196 Bronx, N. Y. 10453
¶197 Northwest Community Coalition
¶198 Youth Development Program
¶199 2721 Webster Avenue
¶200 Bronx, N. Y.
¶201 Martin Luther King, Jr. Health Center
¶202 3674 Third Avenue
¶203 Bronx, N. Y. 10456
¶204 Martin Luther King, Jr. Health Center
¶205 1633 Bathgate Avenue
¶206 Bronx, N. Y. 10457
¶207 South Bronx Community Corp.
¶208 363 E. 148 Street
¶209 Bronx, N. Y. 10455
¶210 United Bronx Parents
¶211 810 E. 152 Street
¶212 Bronx, N. Y. 10455
¶213 United Bronx Parents
¶214 337 E. 149 Street
¶215 Bronx, N. Y. 10451
¶216 Bronx Developmental Services
¶217 2692 Third Avenue
¶218 Bronx, N. Y. 10454
¶219 Morrisania Prenatal Clinic
¶220 1316 Fulton Avenue
¶221 Bronx, N. Y. 10456
¶222 G L I E Community Youth Program
¶223 1382 Grand Concourse
¶224 Bronx, N. Y. 10457
¶225 Community Offices_MANHATTAN
¶226 Little Italy Restoration Association, Inc.
¶227 384 Broome Street
¶228 New York, N. Y. 10013
¶229*1264 Community Offices_MANHATTAN
¶230 We Care Walk in Referral Center
¶231 28 Edgecombe Avenue
¶232 New York, N. Y.
¶233 East Harlem Family Problem Clinic
¶234 2050 Second Avenue
¶235 New York, N. Y. 10029
¶236 Project Access
¶237 1441 Park Avenue
¶238 New York, N. Y. 10029
¶239 Afro-American East Service Center
¶240 1765 Madison Avenue
¶241 New York, N. Y. 10029
¶242 East Harlem Nutrition Education Program
¶243 1692 Lexington Avenue
¶244 New York, N. Y. 10029
¶245 Community Affairs Office
¶246 New York Medical College
¶247 217 E. 106 Street
¶248 New York, N. Y. 10029
¶249 Community Development, Inc.
¶250169 W. 89 Street
¶251 New York, N. Y. 10024'
¶252 Central Harlem Community Corp.
¶253 NAB # 4
¶254 2230 Eighth Avenue
¶255 New York, N. Y. 10027
¶256 Central Harlem Community Corp.
¶257 NAB # 5
¶258238 W. 116 Street
¶259 New York, N. Y. 10026
¶260 Harlem Assertion of Rights
¶26135 W. 125 Street
¶262 New York, N. Y. 10027
¶263 United Welfare League
¶264 929 Columbus Avenue
¶265 New York, N. Y. 10025
¶266 Better Community Association
¶267 1722 Amsterdam Avenue
¶268 New York, N. Y.
¶269 Club Cívico Ponceno
¶270 1230 St. Nicholas Avenue
¶271 New York, N. Y. 10033
¶272 Community Action Mobilization for Prog.
¶273 2089 Amsterdam Avenue
¶274 New York, N. Y. 10032
¶275 Community League of W. 159 Street
¶276508 W. 159 Street
¶277 New York, N. Y. 10032
¶278 Family Planning North
¶279 1984 Amsterdam Avenue
¶280 New York, N. Y. 10032
¶281 Grant Youth Council
¶282 501 West 125 Street
¶283 New York, N. Y. 10027
¶284 Neighborhood Manpower Service Center
¶285 760 St. Nicholas Avenue
¶286 New York, N. Y. 10031
¶287 St. Mary’s Involvement Program
¶288514 W. 126 Street *
¶289 New York, N. Y. 10027
¶290 Strive, Train, Organization for Prog.
¶291 2121 Amsterdam Avenue
¶292 New York, N. Y. 10032
¶293 Uptown Community Service League
¶294 3671 Broadway
¶295 New York, N. Y. 10031
¶296 Action for Progress
¶297 189 Allen Street
¶298 New York, N. Y. 10002
¶299 Action for Progress
¶300 175 Chrystie Street
¶301 New York, N. Y. 10002
¶302 Lower East Side Community Corp.
¶303 42 Avenue C
¶304 New York, N. Y. 10009
¶305 It’s Time
¶306 139 Henry Street
¶307 New York, N. Y. 10002
¶308 Lower East Side Community Corp.
¶309 195 Stanton Street
¶310 New York, N. Y. 10002
¶311 Lower East Side Community Corp.
¶312 42 Avenue C
¶313 New York, N. Y. 10009
¶314 Negro Action Group
¶315 217 E. Third Street
¶316 New York, N. Y. 10009
¶317 Association of Community Service Centers
¶318 152 Avenue D
¶319 New York, N. Y. 10009
¶320 Search and Care
¶321 341 E. 87 Street
¶322 New York, N. Y.
¶323*1265 Community Offices_QUEENS
¶324 Catholic Migration Office
¶325 30-58 Steinway Street
¶326 Astoria, Queens, N. Y. 11103
¶327 Catholic Migration Office
¶328 98-21 101st Avenue
¶329 Ozone Park, Queens, N. Y. 11416
¶330 Federation Jewish Community Council Service Center of the Rockaways
¶331 20-38 Mott Avenue
¶332 Far Rockaway, N. Y. 11691
¶333 Human Service Center
¶334 172-07 Jamaica Avenue
¶335 Queens, N. Y. 11432
¶336 Flushing Human Service Center
¶337 41-06 163rd Street
¶338 Flushing, Queens, N. Y.
¶339 “Birth Right of Queens”
¶340 79-24 Parsons Boulevard
¶341 Queens, N. Y.
¶342 Rockaway Community Corp.
¶343 260 Beach 84 Street
¶344 Queens, N. Y.
¶345 Jewish Community Service
¶346 86-92 Palo Alto Street
¶347 Holliswood, Queens, N. Y. 11423
¶348 “All the Queens Women”
¶349 163-23 Depot Road
¶350 Queens, N. Y. 11358
¶351 Queensbridge Health Services
¶352 38-53 12th Street
¶353 Long Island City, N. Y. 11101
¶354 Rockaway Human Services Center
¶355 253 Beach 116 Street
¶356 Rockaway, Queens, N. Y.
¶357 APPENDIX B
¶358 DRAFT
¶359 Instructions For Filling out the DSS 1994 — Application of Need For Public Assistance
¶360 These instructions are designed to help you fill out the application for public assistance. Please print your answers clearly and complete all items, You will be required, at your interview, to supply proof of your statements in this application, especially proof of identity, age, place of residence, rent, relationship of children, all income and resources. A Redi-Reference Guide is supplied to aid you in determining what documentation you may have that will establish your statements.
¶361 PART L — FAMILY & RELATIVE DATA
¶362 The items under this heading are self-explanatory.
¶363 Instructions for Section A
¶364 Please print the name, social security number, relationship, sex, birthdate, place of birth, marital status, date came to N. Y. State for all persons applying together for public assistance. Start by giving this information for yourself, then for your spouse, and then for your children or other persons living with you and applying for assistance.
¶365 Instructions for Section B
¶366 If there are other persons living in your home who are not applying for assistance, you must fill out this section. If no one else lives in your home check the box marked no.
¶367 Instructions for Section C
¶368 We need to know the change in your situation that has caused you to apply for public assistance. Tell us. As examples: If you lost your job, tell us when. If your husband left you, explain why and when. If you have exhausted your bank account or other savings, explain how and when. There are boxes to be checked that will help you tell us what has happened but we would also like you to tell us in your own words how you got along before the change.
¶369 Instructions for Section D
¶370 We would like to know whether you have ever received public assistance, whether you now receive or have ever received food stamps and medicaid.
¶371 Instructions for Section E
¶372 Children over 16, if not attending school, must register for work programs. Please show the names of your children 16 and over and show what schools they attend.
¶373*1266 Instructions for Section F
¶374 Persons who have begun the fourth month of pregnancy are entitled to an additional allowance when they bring a doctor’s statement. Persons who are addicted to drugs and or alcohol must be in treatment for these addictions as a condition of receiving assistance.
¶375 Instructions for Section G
¶376 Self-explanatory.
¶377 Instructions for Section H
¶378 If anyone who is listed in Section A as applying for assistance served in the armed forces of the U.S. during a time of war, or is related to the veteran, they may be eligible for veteran assistance.
¶379 Instructions for Section I
¶380 We are interested in knowing whether you or your wife have children under 21 who live outside of your home.
¶381 Instructions for Section J
¶382 Where a husband or wife is living outside the home, we need to know where he/she is so we can ask whether he/she can give you assistance as he/she is legally responsible for your support.
¶383 Instructions for Section K
¶384 Where the parents of minor children for whom you are applying for assistance live outside the home we need to know where they live so we can ask whether they can provide assistance for their children as they are legally responsible for their children’s support. If there is more than one parent living outside the home give information for each parent.
¶385 Instructions for Section L
¶386 If the parents of minor children for whom you are applying for assistance are dead, the children may be eligible for benefits from Social Security or elsewhere.
¶387 Instructions for Section M
¶388 If you are under 21 years of age, your parents are legally responsible for your support. Please fill out information so we may contact your parents.
¶389 PART II — LIVING ARRANGEMENTS
¶390 Instructions for Section N
¶391 We will try to help you return to your last address or help you find another place to live if you do not have a home. If you do have a home, we need to know whether you and your family live alone, share an apartment or home, or own your own home. We need to know how much it costs you for rent or payment of your carrying charges. This information will help us to decide how much money you need for public assistance.
¶392 Instructions for Section 0
¶393 Needs no further explanation. You have to tell us whether you want food stamps in addition to public assistance. To get food stamps, you will have to pay some money from your public assistance, but you will receive a higher cash value through the food stamps than you pay in money to buy the stamps. Not everybody is eligible for food stamps, so be sure to fill out all parts of this section.
¶394 Instructions for Section P
¶395 If you owe rent or a gas and electric bill, we may be able to help you pay. Let us know in this section what debts you owe.
¶396 PART III — EMPLOYMENT
¶397 Instructions for Section Q
¶398 You may be eligible for assistance even if you or persons in your family are employed. Let us know how much each person who works earns and what is deducted from her salary. Give us the names of the employer. Your costs to care for your children while you work are taken into account when figuring out how much you need from public assistance.
¶399 Instructions for Section R
¶400 Needs no explanation. There may be benefits coming to you from past work of yourself or others in your family.
¶401 Instructions for Section S
¶402 Needs no explanation. There may be benefits coming to you; unions to which you or members of your family belong.
¶403*1267 Instructions for Section T
¶404 We need to know whether you are now receiving or expect to receive any of the benefits or income listed. This income will be considered in figuring out how much you can get in public assistance.
¶405 PART V — RESOURCES
¶406 Instructions for Section U
¶407 We need to know, for any person applying for assistance, if he has any of the resources listed. These resources must be applied against the needs for public assistance.
¶408 PART VI — OTHER APPLICANT INFORMATION
¶409 Instructions for Section V
¶410 This question is asked so that the government can have statistics for research. If you do not want to answer this question, it will make no difference in considering your application for assistance.
¶411 Instructions for Section W
¶412 This question need not be answered for persons living in New York City.
¶413 Instructions for Section X
¶414 The law prohibits us from giving assistance to illegal aliens for more than 30 days. Please answer this questions in this section so we can determine if you are a citizen or an alien legally residing in this country.
¶415 Instructions for Section Y
¶416 Use this space to write in any information in your application that you want us to know more about.
¶417 PART VII — CERTIFICATION
¶418 Please read the statement in this part carefully. It is important that you understand what you are writing in this application and understand what may happen if you make false statements. Your signature is required. If you can’t sign yourself, a representative may sign for you. If you sign with an X, your mark must be witnessed.
¶419 REQUEST FOR SERVICES
¶420 If you wish to obtain a social service, read and fill in page 11. A representative of our Department will be in touch with you to discuss your need for services. You may be eligible for service even if you are not eligible for public assistance. If you don’t want a social service, it will not affect your eligibility for public assistance.
¶421 Part 1 — Self-Explanatory
¶422 A. In this section, list all members of your family living in the household who need Public Assistance. Give the asked for information for each person listed.
¶423 B. List any additional members of your household who do not need Public Assistance. If there are other people living in your house who do not need Public Assistance, you must fill out this section.
¶424 C. Self-explanatory.
¶425 D. Indicate whether you previously applied for or received Public Assistance, Medicaid or Food Stamps.
¶426 E. Self-explanatory. Please explain how you were getting along on the money you had and tell what changed so that you now need Public Assistance.
¶427 F. Name any pregnant, sick or disabled member of your family and his treatment program, if any.
¶428 G. Self-explanatory.
¶429 H. A Veteran is a person who served in the Armed Forces of the United States. Please fill out this section if anyone applying for assistance is a Veteran.
¶430 I. List the name and address of any child of you or your spouse who is under 21 years of age, not living with you.
¶431 J. Indicate the name and address or last known address or your legal husband or wife.
¶432 K. If one or both of the parents of the children for whom you are applying for assistance, listed in Section A, is not living in your home, indicate his name, address and support received.
¶433*1268 L. Self-explanatory.
¶434 M. Self-explanatory.
¶435 N. If you have no place to live, fill in your last complete address, and the reason you can no longer stay there.
¶436 If you pay rent, check off ( ) the type of living arrangements and the requested information about the landlord, etc.
¶437 If you live with somebody else, fill in the requested information in area 3. If you own your own home, fill in the requested information in area 4.
¶438 O. Self-explanatory.
¶439 P. Indicate the amount of any debt listed and the period incurred.
¶440 Q. Fill in the requested information about each employed person listed in Section A, including all items deducted or withheld from his pay. In Section 3, list additional employment expenses, and in Section 4, any child care expenses caused by the employment of the listed persons.
¶441 R. Give the requested information about the employment of any person in your family who worked during the last year.
¶442 S. Self-explanatory.
¶443 T. Individuals or families applying for Public Assistance are expected to take advantage of all available resources, to defray their need for Public Assistance. Is anyone in your family listed in section A expecting to receive any of the benefits listed in the section?
¶444 U. Self-explanatory.
¶445 V. Self-explanatory.
¶446 W. If your name is not listed on the building registry or mailbox, or if there is no building number of your apartment, please give identifying information.
¶447 X. Please fill in all the requested information for any citizen who is not born in the United States or any alien member of your family group.
¶448 Y. Self-explanatory.
¶449 Z. If you received help from an individual or agency in filling out this application, please give his name and address. If you sign the application with an “X”, a witness should also sign and fill in his address.