Child health care information is available by calling toll-free 1-800-698-4543 or the NYS Health Marketplace website.
Relationship: the relationship to the child of the person enrolling the child is Parent, Guardian, Caretaker, Relative or Other.
Special needs: check boxes to indicate if the child has any special needs/services, and provide information and discuss with the child care provider.
Program use: the date of enrollment and the date of disenrollment are for program use only.
Photo: a photo of the child is optional.
| Question | Answer |
|---|---|
| Form Name | Form OCFS-LDSS-0792 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 103 |
| Avg. time to fill out | 18 min |
| Other names | OCFS-LDSS-0792, OCFS 0792, OCFS enrollment form, New York day care enrollment form, OCFS emergency contact form |
| Edition | Rev 08/2019 |
| Issuing agency | New York State Office of Children and Family Services |
| Official source | Form OCFS-LDSS-0792 (Rev 08/2019), New York State Office of Children and Family Services |
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