LDSS-3370 Form: Statewide Central Register Database Check

Record your three-digit agency code.

Day Care, Family and Group Family Day Care and Camps must provide the agency code of the agency or office which issues your license or certificate.

Record your RID in this field.

Print the address associated with your RID/CCFS number.

If you need assistance, email: ocfs.sm.conn_app@ocfs.ny.gov. Record the appropriate alpha code in the category box.

No checks required when provider is a legally-exempt relative-only in-home child care provider.

W-Applying to be foster parents or family care home providers.

AGENCY INFORMATION TOP LINE OF FORM. The three-digit agency code must be placed in the top left-hand box, followed by the Resource I.D. (RID) in the next box to the right. (Contact the licensing agency if there are any questions about these.). Day Care providers must place their Child Care Facility System (CCFS) Number in the box next to Resource ID (RID), in lieu of RID number. (Contact your licensing agency/regional office if you have any questions).. Clearance Category letter code (see the back of form LDSS-3370, DCCS version) must be placed in the middle box.. Phone number (with area code) enables the SCR to contact the agency liaison if this becomes necessary.. The Request ID Box is for SCR use only.

Agency Name: Please use full name, no abbreviations. Agency Liaison is the contact person at the inquiring agency. (The SCR response will be addressed to the liaison.) The liaison cannot be the applicant or a relative of the applicant.. Agency Address: Must include street and city

For all categories, complete the form for yourself, your spouse, your children and any other person(s) in your home at the present time.

All household members, adults and children, whether related to the applicant or not, are to be listed in the Applicant/Household Member Area.

Record all names with the last name first, then the first name, and middle name.

On the first line: Applicant's name. If there is more than one applicant place the additional name(s) on the lines after the maiden name line.. On the second line: Any maiden names, previous married names, or aliases by which the applicant is or has been known. Use additional lines if there is more than one maiden/married/alias name to be listed.. On the remaining lines: Names of all other household members. (Attach an additional page if needed.) If there are no other household members, check the box for no other household members.

Make sure you complete all maiden name/alias/marriage sections that apply.

APPLICANT(S): -USE FIRST LINE (at least one person must be so designated) MAIDEN NAME/ALTERNATIVE/AKA: MUST be completed for every applicant.

If none, state NONE. List relationship in the fields. Attach additional page if necessary.

Record ALL previous names used.

First column: indicate the relationship to the applicant of each person listed. (Spouse, son, daughter, mother, father, friend, etc.). Sex M/F column: check either M (Male) orF (Female) for every person listed.. Date of Birth column: fill in complete date of birth (mm/dd/yyyy) for everyone listed on the form.

Please provide your current address and any other addresses at which you have resided for the last 28-years, including street, street number, city and state.

The information required varies depending on the category.

For Adoption, Foster Care and Family and Group Family Day Care, provide addresses for the applicant and any household member who is 18 years of age or older. For legally-exempt Family Child Care provide addresses for the applicant and any household member who is 18 years of age or older, unless the household member is related in any way to all children in care. This information must date back to the last 28-years. Attach supplemental pages if necessary, but do not use another LDSS-3370, DCCS version form to list this additional information. Be sure to associate address histories with individuals (i.e., indicate which addresses are for which household member).. For all other categories, only the applicant's address history is required - for the last 28-years.. Complete addresses are required. Include street name, street number, apartment number and city/town/village. Post Office Box numbers are not acceptable. If the applicant has lived abroad, indicate country and dates (months/years) of residence. If the applicant has spent time in the military, list base names and locations along with dates (months/years).. Be sure that there are no periods of time unaccounted for.. The top line is for the current address. The previous address should be listed on the second line downward, and so on, to the back of the form for the last 28-years. Staple the attached supplemental page to the form if more space is needed, but do not use another copy of the LDSS-3370, DCCS version for this additional information.

Print clearly, all dates must be consecutive (month/year).

Be sure to associate address histories with particular individuals.

Use as many lines as needed (one last name per line). Describe the relationship to the applicant, e.g., son, daughter, father, mother, friend, etc., on the remaining lines. Attach an additional page if necessary. If there are no other household members, check the box for no other household members. Social Services Law 424-a(1)(f) requires the collection of a $25.00 fee for applicants for employment and applicants to be a child care provider (checked October 23, 2026).

A certified check, postal or bank money order, teller's check, cashier's check or agency check made payable to "New York State Office of Children and Family Services" in the amount of twenty-five dollars, is to accompany the form. (checked October 23, 2026)

The check must also include the applicant's name and the agency code.

N.B.: a separate check must accompany each form. **Social Services Law 424-a, allows local DSS to bill against their reimbursement the charge collected for screening prospective employees.

Submit the completed LDSS-3370, DCCS version to the person referenced in OCFS-6000 and include the required fee for each applicant for employment/to be a child care provider.

If you have questions, please call the SCR at 518-474-5297.

For Adoption, Foster Care, and Family and Group Family Day Care, if both spouses are applicants, both are to sign.

By signing you affirm the information provided on this form is true to the best of your knowledge.

You understand that if you knowingly give false statements, such action could be grounds for denial or dismissal from employment or denial or revocation of a license, certificate, permit, registration or approval.

New York State Office of Children and Family Services Statewide Central Register Database Check Form LDSS-3370, DCCS version. The purpose of collecting the demographic data on other persons in your household who are not screened pursuant to Section 424-a of the Social Services Law is to enable the NYS Office of Children and Family Services to identify with the greatest degree of certainty whether the person(s) being screened is the subject of an indicated child abuse or maltreatment report.