NYS Department of Health Publishes DAL 14-05 with Five Attachments

Shelley Wagar Sabo

  The Department of Health posted DAL 14-05 and related attachments today.  The DAL refers to revised DSS forms 934; 2853; 2854;2855; and, 3027.

  The forms were revised to eliminate content that is no longer applicable, to standardize information contained in the forms and improve their overall appearance.  The forms are referenced in the adult care facility regulations and therefore must continue to be identified as DSS forms.  The following forms are attached to the DAL: DSS 934: Notice of Change Enriched Housing Apartment Certification for Residents Receiving Social Security Income; DSS 2853 Statement Offering Personal Allowance Account; DSS 2854 Personal Allowance Ledger; DSS 2855 Personal Monthly Allowance Summary; and, DSS 3027 Inventory of Resident Property.   The last attachment, DSS 3027, appears to be formatted incorrectly and NYSCAL has reached out to the Department for a correction.    NYSCAL has posted the DAL and the attachments on its website, www.nyscal.org, or they may be viewed on the Health Commerce System.  NYSCAL encourages all members to read the DAL and the attachments in their entirety. 


Shelley Wagar Sabo

Executive Director

New York State Center for Assisted Living

33 Elk Street, Suite 300

Albany, NY 12207

p. 518.462.4800, ext. 17

c. 518.703.1089

f. 518.426.4051