Form Ocfs 3909 PDF Details

The New York State Office of Children and Family Services (OCFS) plays a pivotal role in ensuring the safety and welfare of children through a variety of forms and procedures, among which the OCFS-3909 form stands out for its specific use in guardianship matters. Revised in April 2009, this form is an essential document employed by courts to request information necessary to determine the suitability of an individual or individuals seeking to become guardians. It mandates an inquiry with the New York Statewide Central Register of Child Abuse and Maltreatment to check if the proposed guardian or any adult residing in their household has been the subject of an indicated child abuse or maltreatment report. This comprehensive form requires detailed information regarding the proposed guardian(s) and any other household members over eighteen years of age, including their relationships, personal details, and an extensive history of their addresses for the last 28 years. The procedure outlined by the OCFS-3909 form reflects the state's commitment to child safety in guardianship situations, ensuring that only capable and safe environments are provided for children in need of guardianship.

QuestionAnswer
Form NameForm Ocfs 3909
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesocfs form 3909, new york information guardianship, ocfs form get, 3909 ocfs

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OCFS-3909 (Rev. 04/2009) FRONT

NEW YORK STATE

OFFICE OF CHILDREN AND FAMILY SERVICES

REQUEST FOR INFORMATION GUARDIANSHIP FORM

FOR COURT USE ONLY

SCR USE ONLY: Request I.D. #

RESOURCE ID#

COURT LIAISON

DOCKET FILE #

COURT NAME AND ADDRESS

 

 

AREA CODE/PHONE #

( ) -

ZIP CODE

Section 1706 of the Surrogate’s Court Procedure Act requires that an inquiry be made of the New York Statewide Central Register of Child Abuse and Maltreatment as to whether the proposed guardian or any other individual eighteen years of age or over who resides in the home of the proposed guardian is a Subject of an indicated child abuse or maltreatment report.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Request

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION CONCERNING PROPOSED GUARDIAN(S)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AND MEMBERS OF THE HOUSEHOLD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationship

 

 

 

LAST NAME

 

 

FIRST NAME

 

MI

 

SEX

DATE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

To Guardian

(Print one letter in each box)

 

(Print one letter in each box)

 

 

 

 

M

D

Y

Guardian

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Maiden or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Alias

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Guardian

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please provide your current address and any other addresses at which you have resided for the last 28 years, including city and state for each individual being cleared. (Attach additional page if necessary).

CURRENT ADDRESS: STREET

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

PREVIOUS ADDRESS: STREET

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

PREVIOUS ADDRESS: STREET

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

PREVIOUS ADDRESS: STREET

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

PREVIOUS ADDRESS: STREET

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

PREVIOUS ADDRESS: STREET

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

ADDRESS HISTORY FOR OTHER PERSON(S) 18 YEARS OLD OR OLDER, RESIDING WITH PROPOSED GUARDIAN

LAST NAME & MAIDEN/ALIAS

FIRST NAME

MI

PREVIOUS STREET ADDRESS

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

STATE

ZIP

FROM

TO

 

 

 

 

 

 

* ADDITIONAL SPACE PROVIDED ON REVERSE SIDE OF FORM

OCFS-3909 (Rev. 04/2009) REVERSE

RESOURCE ID #

DOCKET/FILE #:

COURT LIAISON: Relationship to Applicant

Record Resource ID # as appropriate. If you need assistance, email: ocfs.sm.conn_app@ocfs.state.ny.us

Record your Court Docket File # as appropriate.

Record Name of Court Liaison.

G – Guardian (S) (at least one person must be so designed)

M – Maiden Name/Alias must be completed for every guardian (“G”)

E – 18 Year old or older residing in a proposed Guardian’s household

F – Family Member under 18 years of age

O – Other Household Member under 18 years of age

Inquiry concerning Guardianship/Statewide Central Register completed form (OCFS-3909) should be sent to:

The New York Statewide Central Register

Of Child Abuse and Maltreatment

P.O. Box 4480, Attn: Service Center Unit

Albany, N.Y. 12204-0480

ADDITIONAL ADDRESSES

LAST NAME

 

FIRST NAME

 

 

 

M.I.

 

 

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

 

STATE

ZIP

FROM

TO

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

 

 

M.I.

 

 

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

 

STATE

ZIP

FROM

TO

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

 

 

M.I.

 

 

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

 

STATE

ZIP

FROM

TO

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

 

 

M.I.

 

 

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

 

STATE

ZIP

FROM

TO

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

 

 

M.I.

 

 

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

 

STATE

ZIP

FROM

TO

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

 

 

M.I.

 

 

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

 

STATE

ZIP

FROM

TO

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

 

 

M.I.

 

 

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

 

STATE

ZIP

FROM

TO

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

 

 

M.I.

 

 

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

 

STATE

ZIP

FROM

TO

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

 

 

M.I.

 

 

 

 

 

 

 

 

PREVIOUS STREET ADDRESS

CITY

 

STATE

ZIP

FROM

TO

 

 

 

 

 

 

 

 

TO ORDER A SUPPLY OF OCFS-3909 FORMS:

Please access the Request for Forms and Publications, (OCFS-4627) from the Internet:

http://www.ocfs.state.ny.us/main/forms/management_services/

Mail your completed Request for Forms and Publications, (OCFS-4627) to the Office of Children and Family Services, Forms Management Unit, Resource Distribution Center, 11, Fourth Ave, Rensselaer, NY 12144-2629. If you have difficulty accessing the form from the web-site, you can call The Forms Hot Line at: 518-473-0971.

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Put the required details in the PREVIOUS ADDRESS STREET, PREVIOUS ADDRESS STREET, PREVIOUS ADDRESS STREET, PREVIOUS ADDRESS STREET, CITY, CITY, CITY, CITY, STATE, STATE, STATE, STATE, ZIP, ZIP, and ZIP segment.

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Put down the necessary data as you are within the LAST NAME, ADDITIONAL ADDRESSES, FIRST NAME, PREVIOUS STREET ADDRESS, CITY, STATE, ZIP, FROM, LAST NAME, FIRST NAME, PREVIOUS STREET ADDRESS, CITY, STATE, ZIP, and FROM segment.

3909 ocfs LAST NAME, ADDITIONAL ADDRESSES, FIRST NAME, PREVIOUS STREET ADDRESS, CITY, STATE, ZIP, FROM, LAST NAME, FIRST NAME, PREVIOUS STREET ADDRESS, CITY, STATE, ZIP, and FROM fields to complete

Explain the rights and obligations of the parties inside the box PREVIOUS STREET ADDRESS, CITY, STATE, ZIP, FROM, LAST NAME, FIRST NAME, PREVIOUS STREET ADDRESS, CITY, STATE, ZIP, FROM, TO ORDER A SUPPLY OF OCFS FORMS, and Mail your completed Request for.

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