N.Y. Comp. Codes R. & Regs. tit. 10, § 43-2.4 – Use of the application form.

(a) The State-approved application form must be completed:
1. (1) for each applicant upon initial application and recertification, if required; and
2. (2) documentation may be required when there is a change in status affecting eligibility.
(b) The signature of the individual applying for assistance is required on the State-approved application form. In any case where the applicant is incapable of signing the application because of physical incapability, or mental incompetency, application shall be signed on behalf of such a person by his/her authorized representative.
(c) The State-approved form shall contain the following information, in addition to any other information which the Department of Health may require for the proper administration of the program:
1. (1) name, gender, date of birth, social security number, marital status, address and telephone number of the applicant;
2. (2) name and relationship to applicant for applicant's household members;
3. (3) income information for the applicant and members of the applicant's household; and
4. (4) information regarding any other health benefits or insurance coverage that is available to the applicant.