Should you require assistance in completing the Enrollment/Change Form, please call the FSA Administrative Office at (212) 306-7760 between 9:00 a.m. and 4:00 p.m., Monday through Friday. ; If you're not the primary leaseholder or homeowner where you live, fill out the Parent Affidavit of Residency. In-house counseling is available by appointment only. Completing the Early Intervention Program Referral Form (PDF) and faxing it to a regional office in the family’s home borough. © 2021 The New York City Department of Education Information about Early Intervention referrals for child care, health care and other providers is located on the Early Intervention: Information for Providers page. To enroll, you must complete the MSC Health Benefits Buy-Out Waiver Program Enrollment/Change Form and a Health Benefits Application and provide proof of other coverage. Referral form with instructions English. These services help students with special health needs fully take part in school. For those retirees/eligible dependents of a retiree with a Medicare Part B effective date prior to 2016, they will receive an additional amount up to $318. Privacy Policy. Please see the family site for all … W-2 Duplicate Request and Information Correction Form; Employment Verification. NYC Nurse-Family Partnership If you’re a service provider, you can learn more on the NYC Health website, and you can refer eligible patients/clients by filling out our referral form and faxing it to 347-396-4360 or emailing it to nycnfp@health.nyc.gov. On this page, you'll find the forms you might need to enroll in a DOE public school. Health. City of New York Flexible Spending Accounts Program Bowling Green Station P.O. You can also view the Frequently Asked Questions About Legislation Removing Non-Medical Exemptions from School Vaccination Requirements from New York State Department of Health; Parent Letters, Policy Change, for Warnings and Exclusions . Summary. To help students stay connected during emergencies, the DOE is lending internet-enabled iPads to support remote learning for students. Due to the closure of the office, if you mailed or faxed forms or correspondence March 11, 2020 or after, we cannot access or process that form. NY Appendix B: jRAVEN Configuration Instructions for NY – Effective 10/01/2010 (Updated 01/31/2011) (PDF) Dear Administrator Letter 11-02 - MDS 3.0 Requirements (Release Date – March 29, 2011) (PDF) IRMAA 2019 Differential payments are scheduled to be issued by the end of November 2020. Box 707 New York, NY 10274 . New to NYC? Fill out the Housing Questionnaire and provide to your new school or a Family Welcome Center. Employment Verification Form; Employment Verification for Pension Purposes; Rule 3 Teaching Service Verification Form; OT-37 Form for Verification of Paid Experience; Health Benefits. IRMAA 2019 Differential Reimbursement . If you would like to request a device for a NYC student in your family, please fill out the form below. Public Health Insurance Online Form. Your child may be eligible for health services, educational accommodations, or both. As a City of New York member, we want to let you know about some important changes related to your health coverage starting July 1, 2020, including expanded IVF coverage and no-cost HIV prevention and treatment.The City of New York Office of Labor Relations and city’s unions, represented by the Municipal Labor Committee, approved these plan changes. Section 504 of The Rehabilitation Act requires public schools to offer services and accommodations for eligible students with disabilities. Important Notice. The Health Benefits Retiree client service walk-in center is closed. Employees covered by a non-City group health plan can enroll in the MSC Program and waive City health benefits to receive an incentive payment up to $1,000 for Plan Year 2020. 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