This is a legal form that was released by the New York State Office of Temporary and Disability Assistance - a government authority operating within New York.
The document is provided in Russian. As of today, no separate filing guidelines for the form are provided by the issuing department.
Form Details:
Download a printable version of Form LDSS-5143B by clicking the link below or browse more documents and templates provided by the New York State Office of Temporary and Disability Assistance.