Form OCFS-4939 at a glance
What it is: Form OCFS-4939 is the New York State Office of Children and Family Services Provider Notification of Licensing or Registration to Fire and Police or Sheriff Departments.
Where and when to file: Complete this form and send it to your fire and police or sheriff departments. This must be done within five (5) days after receiving your license or registration.
As a child day care provider you are required to give written notification concerning the location of your day care program to your local fire and police departments.
A filled-in Form OCFS-4939 example: a day care center notifies its fire and police departments
How to fill out Form OCFS-4939, box by box
Provider name, address and phone
Enter the NAME OF PROVIDER/PROGRAM.
Enter the ADDRESS, the CITY/TOWN, the ZIP CODE and the PHONE NUMBER (AREA CODE).
I am (check one)
After I am, check one: Day Care Center, School Age Program, Group Family Day Care Home or Family Day Care Home.
Maximum children and age
Enter the maximum number of children you are licensed or registered to provide day care to, and the range in age from and to years of age.
Days and hours of care
Check the appropriate days and write in the hours of care for Monday, Tuesday, Wednesday, Thursday, Friday, Saturday and Sunday.
Fire and police or sheriff departments notified
Enter the ADDRESS OF FIRE DEPARTMENT NOTIFIED and the ADDRESS OF POLICE OR SHERIFF'S DEPARTMENT NOTIFIED.
Signature and date
Sign at PROVIDER'S SIGNATURE and enter the DATE.
Remember to retain a copy for your files.
More rules for Form OCFS-4939
Keep a copy of the completed notification in your files and document where and when you sent the notice.
You may be asked to provide proof of notification during the course of inspection of your day care program.
This form may be copied.
If your situation is different
Your municipality has no fire or police department
If your local municipality does not have a fire or police department, the sheriff must be notified instead.
There is any change in this information
If there is any change in any of this information the appropriate local fire, police or sheriff's departments must be notified.
You have 911 in your community
If you have 911 in your community, you may also want to inform them.
Common questions about Form OCFS-4939
Is there a deadline?
This must be done within five (5) days after receiving your license or registration.
Where do I file it?
Complete this form and send it to your fire and police or sheriff departments.
Sources
[1] Form OCFS-4939 (3/2010), Provider Notification of Licensing or Registration to Fire and Police or Sheriff Departments, New York State Office of Children and Family Services (the Official source link on this page).