
    Maria PEREZ et al., Individually and on behalf of all others similarly situated, Plaintiffs, v. Abe LAVINE, as Commissioner of the New York State Department of Social Services, and James R. Dumpson, as Commissioner of the New York City Department of Social Services, Defendants.
    No. 73 Civ. 4577 (CHT).
    United States District Court, S. D. New York.
    Sept. 16, 1976.
    As Amended Jan. 14, 1977.
    Louis J. Lefkowitz, Atty. Gen. of New York, New York City, for defendant Abe Lavine; Thomas R. McLoughlin, Asst. Atty. Gen., New York City, of counsel.
    W. Bernard Richland, Corp. Counsel, New York City, for defendant James R. Dumpson; Greg D. Frost and Gayle S. Redford, Asst. Corp. Counsel, New York City, of counsel.
    Kalman, Finkel, The Legal Aid Society, Civ. Div., John E. Kirklin, Director of Litigation, The Legal Aid Society, Civ. Appeals Bureau, New York City (Eric A. Rundbaken and John W. Corwin, New York City, of counsel), Steven J. Cole, Adele M. Blong, Center on Social Welfare Policy and Law, Marttie L. Thompson, Community Action for Legal Services, Inc., New York City (Michael A. O’Connor, New York City, of counsel); Donald Grajales, Rina B. Morales, Bronx Legal Services, Corporation “B”, New York City (James Potter, Michael Fa-hey, New York City, of counsel), for plaintiffs.
   ORDER

TENNEY, District Judge.

Defendants having been directed in an opinion handed down by this Court dated March 29, 1976 to submit a proposed order outlining plans for revision of their procedures in conformity with such decision, and the Court having considered the submission of both parties with respect to such direction, it is hereby

ORDERED (1) that, subject to paragraph (2) hereof, any person wishing to apply for public assistance within the City of New York shall be provided an application form on the date of such person’s first or second visit to an Income Maintenance Center for the purpose of applying for assistance; and it is further

ORDERED (2) that

(a) application forms be provided at alternative locations throughout the community to all interested organizations which request a supply of the forms. A comprehensive list of organizations which have requested and been provided application forms is attached hereto as Appendix A;

(b) the availability of application forms from such organizations be adequately publicized by defendant [J. Henry Smith], as Commissioner of the New York City Department of Social Services, so that persons wishing to apply for aid are, to the maximum extent feasible, made aware of the availability of application forms from such organizations;

(c) notwithstanding the alternative provided by this paragraph, any individual wishing to obtain an application form and application kit (described in NYC Procedure No. 75-13, Oct. 6,1975, p. 9, and subsequent revisions thereto which must include like materials) from an Income Maintenance Center must be permitted to do so, and must be provided such form and kit on request; and it is further

ORDERED (3) that at the time such person is provided an application form he or she shall simultaneously be provided the application kit which shall include a comprehensive, intelligible set of instructions, written in large, easily read print in English and/or in Spanish as applicable, designed to ensure that an applicant can complete the application form without requiring the assistance of Income Maintenance Center personnel. A draft copy of these instructions is attached hereto as Appendix B; and it is further

ORDERED (4) that signs be posted prominently in all Income Maintenance Centers in the City of New York notifying applicants that they are entitled to an application form and informing them to request an application from the receptionist if they want one. The sign, which will be in both English and Spanish and in letters of at least one inch in height, will read as follows:

“NOTICE TO APPLICANTS
IF YOU WANT TO APPLY FOR PUBLIC ASSISTANCE, YOU HAVE A RIGHT TO GET AN APPLICATION FORM AND WRITTEN INSTRUCTIONS THAT EXPLAIN HOW TO FILL OUT THE APPLICATION. YOU ALSO HAVE THE RIGHT TO FILE THE APPLICATION FORM AND GET A WRITTEN DECISION TELLING YOU WHETHER OR NOT YOU ARE ELIGIBLE. YOU CAN FILE AN APPLICATION AND GET A WRITTEN DECISION EVEN IF THE RECEPTIONIST TELLS YOU THAT YOU DO NOT SEEM ELIGIBLE.”

It is further

ORDERED (5) that

(a) after an applicant receives an application, an appointment shall be scheduled for the applicant to return for an initial application interview within five working days;

(b) all application staff will be notified that they cannot schedule initial application appointments beyond five working days without express approval from the Center Director;

(c) the Center Director, upon being notified by his application supervisor that the initial application interview cannot be scheduled within five working days, will provide for the transfer of staff from other sections to meet the five-working-day requirement or call the Deputy Administrator for Income Maintenance Programs, or his designee, who will take immediate steps to ensure that such appointments are scheduled within five working days;

(d) if an appointment cannot be scheduled within five working days, the applicant’s completed application shall nevertheless be accepted for filing at the time submitted by the applicant;

(e) if the applicant returns to the Center on the date of his or her scheduled application interview, the application interview shall be held on that day and the completed application form shall be accepted as filed on or before that day; and it is further

ORDERED (6) that all application section personnel and administrative staff within the Income Maintenance Centers be notified that applicants have a right to obtain an application form even if they are in the wrong Center or the pre-screening interview indicates that they are presumptively not eligible. Training sessions will be held to ensure that Center staff, including receptionists, “A” receptionists, application interviewers, application supervisors, and all administrative staff are aware of this requirement; and it is further

ORDERED (7) that defendant [Philip Toia], as Commissioner of the New York State Department of Social Services, take such steps as may be necessary to assist defendant [J. Henry Smith], as Commissioner of the New York City Department of Social Services, to comply with this Order and to ensure periodic review by the State Department of Social Services so that appropriate corrective action may be taken by such State agency in the event that noncompliance is ascertained.

APPENDIX A

Community Offices_BROOKLYN

Brighton Beach Coordinating Committee for Russian Immigrants

293 Neptune Avenue

Brooklyn, N. Y. 11235

Jewish Family Services

4917 12th Avenue

Brooklyn, N. Y. 11219

Sunset Park Family Health Center

514 49th Street

Brooklyn, N. Y. 11220

Jewish Family Services

186 Montague Street

Brooklyn, N. Y. 11201

John the Baptist Community Center

807 Willoughby Avenue

Brooklyn, N. Y. 11206

Bedford Stuyvesant Alcoholism Treatment Clinic

1121 Bedford Avenue

Brooklyn, N. Y. 11216

Bedford Stuyvesant Restoration Corp.

172 Tompkins Avenue

Brooklyn, N. Y. 11206

Bedford Stuyvesant Youth in Action

882 DeKalb Avenue

Brooklyn, N. Y. 11221

Lyndon B. Johnson Health Center

507 DeKalb Avenue

Brooklyn, N. Y. 11205

Bedford. Stuyvesant Youth in Action

930 Bedford Avenue

Brooklyn, N. Y. 11205

Bedford Stuyvesant Youth in Action

496 Franklin Avenue

Brooklyn, N. Y. 11238

Club Heraldo Hispano

727 Fulton Street

Brooklyn, N. Y. 11217

Fort Greene Community Corp.

205 Ashland Place

Brooklyn, N. Y. 11205

Coney Island Hospital

Social Service Department

2601 Ocean Parkway

Brooklyn, N. Y. 11235

Our Lady of Mercy Church

680 Stone Avenue

Brooklyn, N. Y. 11212

Salvation Army

280 Riverdale Avenue

Brooklyn, N. Y. 11212

Kings County Hospital

Alcoholism Treatment Clinic

600 Albany Avenue

Brooklyn, N. Y. 11203

Kings County Hospital

Social Service Department

451 Clarkson Avenue

Brooklyn, N. Y. 11203

Catholic Charities

Human Service Center

730 Classon Avenue

Brooklyn, N. Y. 11238

Community Offices_BROOKLYN

Catholic Charities

Human Service Center

1101 Carroll Street

Brooklyn, N. Y. 11225

Catholic Charities

Williamsburg Human Service Center

142 Montrose Avenue

Brooklyn, N. Y. 11206

Northside Community Development Council

575 Driggs Avenue

Brooklyn, N. Y. 11211

Williamsburg Community Corp.

815 Broadway

Brooklyn, N. Y. 11206

School Settlement Association

120 Jackson Street

Brooklyn, N. Y. 11211

St. Nicholas Neighborhood Preservation and Housing Rehabilitation Corp.

260 Powers Street

Brooklyn, N. Y. 11211

Education Action Centers

577 Lorimer Street

Brooklyn, N. Y. 11211

Opportunity Development Association

41 Heyward Street

Brooklyn, N. Y. 11211

United Jewish Organizations

545 Bedford Avenue

Brooklyn, N. Y. 11211

Italian American Civil Rights League

390 Graham Avenue

Brooklyn, N. Y. 11211

Williamsburg Legal Services

260 Broadway

Brooklyn, N. Y. 11206

Lutheran Community Service Center

366 Union Avenue

Brooklyn, N. Y. 11211

Williamsburg Prenatal Clinic

151 Maujer Street

Brooklyn, N. Y. 11206

Welfare Recipients Action Group of Red Hook

396 Van Brunt Street

Brooklyn, N. Y. 11231

La Casa Neighborhood Service Center

152 Columbia Street

Brooklyn, N. Y. 11231

Chama Brooklyn Child Development Center

1835 Sterling Place

Brooklyn, N. Y. 11233

Catholic Migration Office

354 Court Street

Brooklyn, N. Y. 11231

Catholic Migration Office

12 Bedford Avenue

Brooklyn, N. Y. 11223

Catholic Migration Office

74-10 20th Avenue

Brooklyn, N. Y. 11204

Catholic Migration Office

1449 Myrtle Avenue

Brooklyn, N. Y.

Fort Greene Community Corp.

958 Fulton Street

Brooklyn, N. Y. 11238

Community Offices_BRONX

Cypress Community Center

541 E. 138 Street

Bronx, N. Y. 10454

Catholic Charities

541 E. 138 Street

Bronx, N. Y. 10454

Bronx Lebanon Hospital

Concourse Division

Community Offices_BRONX

Social Services Department

1650 Grand Concourse

Bronx, N. Y. 10456

Bronx Developmental Services

State Department of Mental Hygiene

726 Kelly Street

Bronx, N. Y. 10455

Bronx Developmental Services

1366 Inwood Avenue

Bronx, N. Y. 10452

Puerto Rican Family Institute

2051 Grand Avenue

Bronx, N. Y. 10453

Morris Avenue Engage

284 E. 150 Street

Bronx, N. Y. 10451

West Bronx Jewish Federation Service Center

1130 Grand Concourse

Bronx, N. Y. 10456

The Jewish Family Services

140-26 Carver Loop

Coop City, Bronx, N. Y. 10475

Bronx Psychiatric Center

1500 Waters Place

Bronx, N. Y. 10461

Bronx State Hospital

Highbridge Out-Patient Clinic

260 East 161 Street 10th floor

Bronx, N. Y. 10451

Riverdale Neighborhood House

5521 Mosholu Avenue

Riverdale, N. Y. 10471

J. A. S. A.

2488 Grand Concourse

Bronx, N. Y. 10458

Bronx Community College

Loew Hall 4th floor

181 Street and University Avenue

Bronx, N. Y. 10453

Northwest Community Coalition

Youth Development Program

2721 Webster Avenue

Bronx, N. Y.

Martin Luther King, Jr. Health Center

3674 Third Avenue

Bronx, N. Y. 10456

Martin Luther King, Jr. Health Center

1633 Bathgate Avenue

Bronx, N. Y. 10457

South Bronx Community Corp.

363 E. 148 Street

Bronx, N. Y. 10455

United Bronx Parents

810 E. 152 Street

Bronx, N. Y. 10455

United Bronx Parents

337 E. 149 Street

Bronx, N. Y. 10451

Bronx Developmental Services

2692 Third Avenue

Bronx, N. Y. 10454

Morrisania Prenatal Clinic

1316 Fulton Avenue

Bronx, N. Y. 10456

G L I E Community Youth Program

1382 Grand Concourse

Bronx, N. Y. 10457

Community Offices_MANHATTAN

Little Italy Restoration Association, Inc.

384 Broome Street

New York, N. Y. 10013

Community Offices_MANHATTAN

We Care Walk in Referral Center

28 Edgecombe Avenue

New York, N. Y.

East Harlem Family Problem Clinic

2050 Second Avenue

New York, N. Y. 10029

Project Access

1441 Park Avenue

New York, N. Y. 10029

Afro-American East Service Center

1765 Madison Avenue

New York, N. Y. 10029

East Harlem Nutrition Education Program

1692 Lexington Avenue

New York, N. Y. 10029

Community Affairs Office

New York Medical College

217 E. 106 Street

New York, N. Y. 10029

Community Development, Inc.

169 W. 89 Street

New York, N. Y. 10024'

Central Harlem Community Corp.

NAB # 4

2230 Eighth Avenue

New York, N. Y. 10027

Central Harlem Community Corp.

NAB # 5

238 W. 116 Street

New York, N. Y. 10026

Harlem Assertion of Rights

35 W. 125 Street

New York, N. Y. 10027

United Welfare League

929 Columbus Avenue

New York, N. Y. 10025

Better Community Association

1722 Amsterdam Avenue

New York, N. Y.

Club Cívico Ponceno

1230 St. Nicholas Avenue

New York, N. Y. 10033

Community Action Mobilization for Prog.

2089 Amsterdam Avenue

New York, N. Y. 10032

Community League of W. 159 Street

508 W. 159 Street

New York, N. Y. 10032

Family Planning North

1984 Amsterdam Avenue

New York, N. Y. 10032

Grant Youth Council

501 West 125 Street

New York, N. Y. 10027

Neighborhood Manpower Service Center

760 St. Nicholas Avenue

New York, N. Y. 10031

St. Mary’s Involvement Program

514 W. 126 Street *

New York, N. Y. 10027

Strive, Train, Organization for Prog.

2121 Amsterdam Avenue

New York, N. Y. 10032

Uptown Community Service League

3671 Broadway

New York, N. Y. 10031

Action for Progress

189 Allen Street

New York, N. Y. 10002

Action for Progress

175 Chrystie Street

New York, N. Y. 10002

Lower East Side Community Corp.

42 Avenue C

New York, N. Y. 10009

It’s Time

139 Henry Street

New York, N. Y. 10002

Lower East Side Community Corp.

195 Stanton Street

New York, N. Y. 10002

Lower East Side Community Corp.

42 Avenue C

New York, N. Y. 10009

Negro Action Group

217 E. Third Street

New York, N. Y. 10009

Association of Community Service Centers

152 Avenue D

New York, N. Y. 10009

Search and Care

341 E. 87 Street

New York, N. Y.

Community Offices_QUEENS

Catholic Migration Office

30-58 Steinway Street

Astoria, Queens, N. Y. 11103

Catholic Migration Office

98-21 101st Avenue

Ozone Park, Queens, N. Y. 11416

Federation Jewish Community Council Service Center of the Rockaways

20-38 Mott Avenue

Far Rockaway, N. Y. 11691

Human Service Center

172-07 Jamaica Avenue

Queens, N. Y. 11432

Flushing Human Service Center

41-06 163rd Street

Flushing, Queens, N. Y.

“Birth Right of Queens”

79-24 Parsons Boulevard

Queens, N. Y.

Rockaway Community Corp.

260 Beach 84 Street

Queens, N. Y.

Jewish Community Service

86-92 Palo Alto Street

Holliswood, Queens, N. Y. 11423

“All the Queens Women”

163-23 Depot Road

Queens, N. Y. 11358

Queensbridge Health Services

38-53 12th Street

Long Island City, N. Y. 11101

Rockaway Human Services Center

253 Beach 116 Street

Rockaway, Queens, N. Y.

APPENDIX B

DRAFT

Instructions For Filling out the DSS 1994 — Application of Need For Public Assistance

These instructions are designed to help you fill out the application for public assistance. Please print your answers clearly and complete all items, You will be required, at your interview, to supply proof of your statements in this application, especially proof of identity, age, place of residence, rent, relationship of children, all income and resources. A Redi-Reference Guide is supplied to aid you in determining what documentation you may have that will establish your statements.

PART L — FAMILY & RELATIVE DATA

The items under this heading are self-explanatory.

Instructions for Section A

Please print the name, social security number, relationship, sex, birthdate, place of birth, marital status, date came to N. Y. State for all persons applying together for public assistance. Start by giving this information for yourself, then for your spouse, and then for your children or other persons living with you and applying for assistance.

Instructions for Section B

If there are other persons living in your home who are not applying for assistance, you must fill out this section. If no one else lives in your home check the box marked no.

Instructions for Section C

We need to know the change in your situation that has caused you to apply for public assistance. Tell us. As examples: If you lost your job, tell us when. If your husband left you, explain why and when. If you have exhausted your bank account or other savings, explain how and when. There are boxes to be checked that will help you tell us what has happened but we would also like you to tell us in your own words how you got along before the change.

Instructions for Section D

We would like to know whether you have ever received public assistance, whether you now receive or have ever received food stamps and medicaid.

Instructions for Section E

Children over 16, if not attending school, must register for work programs. Please show the names of your children 16 and over and show what schools they attend.

Instructions for Section F

Persons who have begun the fourth month of pregnancy are entitled to an additional allowance when they bring a doctor’s statement. Persons who are addicted to drugs and or alcohol must be in treatment for these addictions as a condition of receiving assistance.

Instructions for Section G

Self-explanatory.

Instructions for Section H

If anyone who is listed in Section A as applying for assistance served in the armed forces of the U.S. during a time of war, or is related to the veteran, they may be eligible for veteran assistance.

Instructions for Section I

We are interested in knowing whether you or your wife have children under 21 who live outside of your home.

Instructions for Section J

Where a husband or wife is living outside the home, we need to know where he/she is so we can ask whether he/she can give you assistance as he/she is legally responsible for your support.

Instructions for Section K

Where the parents of minor children for whom you are applying for assistance live outside the home we need to know where they live so we can ask whether they can provide assistance for their children as they are legally responsible for their children’s support. If there is more than one parent living outside the home give information for each parent.

Instructions for Section L

If the parents of minor children for whom you are applying for assistance are dead, the children may be eligible for benefits from Social Security or elsewhere.

Instructions for Section M

If you are under 21 years of age, your parents are legally responsible for your support. Please fill out information so we may contact your parents.

PART II — LIVING ARRANGEMENTS

Instructions for Section N

We will try to help you return to your last address or help you find another place to live if you do not have a home. If you do have a home, we need to know whether you and your family live alone, share an apartment or home, or own your own home. We need to know how much it costs you for rent or payment of your carrying charges. This information will help us to decide how much money you need for public assistance.

Instructions for Section 0

Needs no further explanation. You have to tell us whether you want food stamps in addition to public assistance. To get food stamps, you will have to pay some money from your public assistance, but you will receive a higher cash value through the food stamps than you pay in money to buy the stamps. Not everybody is eligible for food stamps, so be sure to fill out all parts of this section.

Instructions for Section P

If you owe rent or a gas and electric bill, we may be able to help you pay. Let us know in this section what debts you owe.

PART III — EMPLOYMENT

Instructions for Section Q

You may be eligible for assistance even if you or persons in your family are employed. Let us know how much each person who works earns and what is deducted from her salary. Give us the names of the employer. Your costs to care for your children while you work are taken into account when figuring out how much you need from public assistance.

Instructions for Section R

Needs no explanation. There may be benefits coming to you from past work of yourself or others in your family.

Instructions for Section S

Needs no explanation. There may be benefits coming to you; unions to which you or members of your family belong.

Instructions for Section T

We need to know whether you are now receiving or expect to receive any of the benefits or income listed. This income will be considered in figuring out how much you can get in public assistance.

PART V — RESOURCES

Instructions for Section U

We need to know, for any person applying for assistance, if he has any of the resources listed. These resources must be applied against the needs for public assistance.

PART VI — OTHER APPLICANT INFORMATION

Instructions for Section V

This question is asked so that the government can have statistics for research. If you do not want to answer this question, it will make no difference in considering your application for assistance.

Instructions for Section W

This question need not be answered for persons living in New York City.

Instructions for Section X

The law prohibits us from giving assistance to illegal aliens for more than 30 days. Please answer this questions in this section so we can determine if you are a citizen or an alien legally residing in this country.

Instructions for Section Y

Use this space to write in any information in your application that you want us to know more about.

PART VII — CERTIFICATION

Please read the statement in this part carefully. It is important that you understand what you are writing in this application and understand what may happen if you make false statements. Your signature is required. If you can’t sign yourself, a representative may sign for you. If you sign with an X, your mark must be witnessed.

REQUEST FOR SERVICES

If you wish to obtain a social service, read and fill in page 11. A representative of our Department will be in touch with you to discuss your need for services. You may be eligible for service even if you are not eligible for public assistance. If you don’t want a social service, it will not affect your eligibility for public assistance.

Part 1 — Self-Explanatory

A. In this section, list all members of your family living in the household who need Public Assistance. Give the asked for information for each person listed.

B. List any additional members of your household who do not need Public Assistance. If there are other people living in your house who do not need Public Assistance, you must fill out this section.

C. Self-explanatory.

D. Indicate whether you previously applied for or received Public Assistance, Medicaid or Food Stamps.

E. Self-explanatory. Please explain how you were getting along on the money you had and tell what changed so that you now need Public Assistance.

F. Name any pregnant, sick or disabled member of your family and his treatment program, if any.

G. Self-explanatory.

H. A Veteran is a person who served in the Armed Forces of the United States. Please fill out this section if anyone applying for assistance is a Veteran.

I. List the name and address of any child of you or your spouse who is under 21 years of age, not living with you.

J. Indicate the name and address or last known address or your legal husband or wife.

K. If one or both of the parents of the children for whom you are applying for assistance, listed in Section A, is not living in your home, indicate his name, address and support received.

L. Self-explanatory.

M. Self-explanatory.

N. If you have no place to live, fill in your last complete address, and the reason you can no longer stay there.

If you pay rent, check off ( ) the type of living arrangements and the requested information about the landlord, etc.

If you live with somebody else, fill in the requested information in area 3. If you own your own home, fill in the requested information in area 4.

O. Self-explanatory.

P. Indicate the amount of any debt listed and the period incurred.

Q. Fill in the requested information about each employed person listed in Section A, including all items deducted or withheld from his pay. In Section 3, list additional employment expenses, and in Section 4, any child care expenses caused by the employment of the listed persons.

R. Give the requested information about the employment of any person in your family who worked during the last year.

S. Self-explanatory.

T. Individuals or families applying for Public Assistance are expected to take advantage of all available resources, to defray their need for Public Assistance. Is anyone in your family listed in section A expecting to receive any of the benefits listed in the section?

U. Self-explanatory.

V. Self-explanatory.

W. If your name is not listed on the building registry or mailbox, or if there is no building number of your apartment, please give identifying information.

X. Please fill in all the requested information for any citizen who is not born in the United States or any alien member of your family group.

Y. Self-explanatory.

Z. If you received help from an individual or agency in filling out this application, please give his name and address. If you sign the application with an “X”, a witness should also sign and fill in his address.  