The Erie County landlord statement is Form LDSS-3668, a shelter verification form that your landlord fills out and signs so the Erie County Department of Social Services can confirm your rent, who lives with you, and how your utilities are paid. The county uses it when deciding Temporary Assistance, SNAP, and Home Energy Assistance Program (HEAP) cases, and the numbers on it feed directly into your shelter allowance and utility deductions.1Erie County. Frequently Asked Questions – Temporary Assistance
What the Form Decides
The LDSS-3668 is a fact-gathering document, not an approval. Its header makes that explicit, stating that the verification “does not imply any obligation on the part of this Agency.”2Erie County. LDSS-3668 Shelter Verification Form What it does determine is the dollar math behind your case. Your rent figure gets compared against the Erie County maximum shelter allowance, and you receive whichever is lower. The utility entries decide which Standard Utility Allowance tier applies to your SNAP calculation, and New York uses the “Other Areas” tier for Erie County rather than the New York City or Long Island schedules.3Food and Nutrition Service. Standard Utility Allowances A shelter allowance for Temporary Assistance is authorized under New York Social Services Law §131-a, which includes shelter and heating fuel in the standard of need.4New York State Senate. New York Social Services Code 131 – Assistance, Care and Services To Be Given
What Your Landlord Has to Report
The form is divided into four sections. The first describes the dwelling: address, type of housing (apartment, house, trailer, room in a private home, or commercial rooming house), number of bedrooms, and whether rent covers any heat or utilities. The second lists everyone living in the unit, how long each person has lived there, and whether anyone does work for the landlord in exchange for reduced rent.2Erie County. LDSS-3668 Shelter Verification Form
The third section is the money. Your landlord enters the rent amount and how often it’s due (weekly, biweekly, twice a month, or monthly), whether rent is current, the last month paid in full, and who actually pays it. If any part of the rent is subsidized by another agency, the subsidy amount and that agency’s name go here. The same section asks which utilities and services are bundled into rent — heat, electricity, hot water, air conditioning, cooking fuel, water and sewer, garbage collection — and whether a stove or refrigerator is provided. The form also asks what type of fuel heats the unit, because that affects energy assistance.2Erie County. LDSS-3668 Shelter Verification Form
The final section is the landlord’s name, mailing address, phone number, and email, followed by their signature and date. If the property owner is a different person from the day-to-day landlord, both sets of contact information are required.2Erie County. LDSS-3668 Shelter Verification Form
Where to Get the Form and How to Fill It In
You can pick up the LDSS-3668 at the Erie County Department of Social Services in the Rath Building, 158 Pearl Street, Buffalo.5Erie County. Emergency Services – Temporary Assistance You can also download it from the Erie County Temporary Assistance forms page.6Erie County. Forms – Temporary Assistance
Before you hand the form to your landlord, fill in the parts you know: your address, the names of everyone in the household, and the basic dwelling details. Your landlord completes the rent, utility, and contact sections and signs at the bottom. Keep everything legible and in ink. The county scans these forms, and unclear handwriting slows the case down. Check the rent figure and the utility checkboxes against your lease before you submit — mismatches with other records in your file tend to trigger extra verification requests and delay.
The Utility Box That Costs People Money
The utility entries are where tenants most often lose benefits they were entitled to. If your landlord checks that heat is included in your rent when you actually pay a separate heating bill, your SNAP calculation drops into a lower utility deduction tier, and the difference can be hundreds of dollars a month. Walk through this section with your landlord. The question is not what’s typical for the building; it’s who actually pays each specific bill for your unit.
If Your Landlord Won’t Sign
A landlord’s refusal doesn’t automatically sink your application. Under New York’s SNAP verification rules, if written documentation isn’t available, the caseworker has to find another way to verify your eligibility. One option is a collateral contact — a person outside your household who can confirm your living situation and shelter costs by phone, in writing, or in person. Before the agency contacts anyone on your behalf, they need your permission to share household information, and you get a chance to supply the verification another way or withdraw the application. If you can’t name a suitable collateral contact, the SNAP office is supposed to identify one.
Tell your caseworker right away if your landlord ignores the form or refuses to sign. Letting the deadline slide while hoping it sorts itself out is how applications get denied.
How to Submit the Completed Form
Once your landlord has signed, you have several ways to return the LDSS-3668 to Erie County:
- In person at the Department of Social Services, 158 Pearl Street in the Rath Building, Buffalo. Application intake is on the first floor.5Erie County. Emergency Services – Temporary Assistance
- By mail to the same Rath Building address.
- By fax. The Neighborhood Legal Services guide lists (716) 858-2628 and (716) 858-6834 for completed application materials.
- Digitally through NYDocSubmit, the Office of Temporary and Disability Assistance mobile app available in the Apple App Store and Google Play Store.7OTDA. NYDocSubmit
Whichever route you use, keep a copy of the signed form and note the date you sent it. If the county later tells you nothing arrived, that record is what you have to work with.
What Happens After You Submit
A caseworker reviews the LDSS-3668 alongside the rest of your application. The county may call your landlord to confirm the signature, the rent amount, or how utilities are split. If anything is incomplete or inconsistent with other records, DSS sends a written notice asking for more information with a specific deadline. Miss that deadline and the case can be closed or denied, so open every piece of DSS mail the day it arrives.
If you used NYDocSubmit, you can check through the app whether your document was received. For paper and fax submissions, calling your assigned caseworker is the most reliable confirmation.
If You’re Denied Over Shelter Verification
If the county denies your application, cuts your benefits, or closes your case because of a shelter verification issue, you can request a fair hearing through the New York State Office of Temporary and Disability Assistance.8OTDA. Fair Hearings You generally have 60 days from the date of the adverse notice to file. Requests can be made online, by mail, by phone, or by fax.
Timing matters. If you file the hearing request before the effective date on the county’s notice, your benefits typically continue at the current level (called “aid continuing”) until the hearing decision. Wait past that date and you may lose benefits during the process even if you ultimately win. If the fight is over shelter verification, bring the signed LDSS-3668, your lease, rent receipts, and any canceled checks or payment records to the hearing.
Penalties for False Information
Accuracy on the form matters for both tenant and landlord. Under New York Social Services Law §145, anyone who obtains or tries to obtain public assistance through a false statement, deliberate concealment, or impersonation is guilty of a misdemeanor, with heavier penalties when the conduct also violates the Penal Law.9New York State Senate. New York Social Services Code 145 – Penalties The Penal Law adds welfare fraud charges tied to dollar amounts; welfare fraud in the third degree, where the value of improperly obtained benefits exceeds $3,000, is a Class D felony.10New York State Senate. New York Penal Code 158.15 – Welfare Fraud in the Third Degree Scenarios that draw investigations include a landlord inflating the rent so the tenant gets a larger subsidy with the excess kicked back, or a tenant listing people in the household who don’t actually live there.