How to get a copy of LDSS – 2221A Form
Yes, when you call the Hotline and CPS registers your call as a report, you are required by State Law to fill out and send in a special form called the OCFS – 2221A Report of Suspected Child Abuse and Maltreatment. You must mail the completed form within 48 hours to:
Monroe County CPS Intake
111 Westfall Road, Room 562
Rochester, New York 14692 |
The required form may be available at your work site. You can get a form by calling the Hotline at 585-461-5690. You can also download a copy of the required form by clicking here.
This form includes the following information:
- Name, address, age, sex, and race of child or children
- Name and address of the parents, or other persons legally responsible for the child (Subject of the report)
- The name of the person or persons allegedly responsible for causing, allowing, or inflicting any injuries, abuse, or maltreatment, if known
- The nature and extent of the child’s injuries, harm or impairment (and/or the child’s siblings') including any information of prior injuries, harm or impairment
- The person making the report and where he or she can be reached
- For medical providers, the actions taken related to the alleged abuse or neglect, including the taking (or causing to be taken) of photographs, X-rays, or the removal of the child or notification of the medical examiner or coroner
- Any other information about the situation that you think CPS might find helpful
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