Chemung County, NY · Chemung County
Social Services Information Request Form
Chemung County residents use this form to request copies of their records from the Department of Social Services for a specified time period.
At a glance
- Issued by
- City of Chemung County · Chemung County, Chemung County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- chemungcountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form lets a person request copies of their records from the Chemung County Department of Social Services. It asks for the requester’s name, the time period requested, address, telephone number, and whether they want a call when items are ready for pickup. The client signs and dates the request; department staff also record their signatures and completion date.
Who needs it
A person requesting copies of their records from the Chemung County Department of Social Services needs to complete this form.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details before submitting.
About notarization
This document is signed and dated without a notary; the form also requires photo ID to be copied, scanned, or verified in person by staff.
How to submit this form
- 1
Download the Form
Download the Social Services Information Request Form.
- 2
Complete the Request
Enter your name, the requested time period, address, telephone number, and pickup preference.
- 3
Sign and Date
Sign and date the form. No notary is required.
- 4
Submit to the County
Submit the form to the county department named on it; check the county website for current contact details.
Frequently asked questions
- What does the Social Services Information Request Form do?
- It lets you request copies of your records from the Chemung County Department of Social Services and specify the time period for the records.
- What information does the form ask for?
- It asks for your name, requested time period, address, telephone number, pickup preference, and signature and date. Staff also record their signatures and the request completion date.
- Do I need a notary for the Social Services Information Request Form?
- No. Sign and date the form without a notary. Staff must copy or scan your photo ID, or verify it in person.
- How do I submit the Social Services Information Request Form?
- Submit it to the county department named on the form. Check the county website for current contact details before submitting.