Chemung County Department of Social Services fax number

Fax destination details

Department

ABAWD Unit, Chemung County Department of Social Services

Purpose

Submitting Able-Bodied Adults Without Dependents (ABAWD) documentation and related DSS forms; e.g., ABAWD Medical Statement, WIOA activity records, SNAP/TA documentation; fax to this number.

Form

ABAWD Medical Statement — ABAWD Medical Statement

Address

425 Pennsylvania Avenue, Elmira, NY 14902

Voice phone

607-737-5302

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

The ABAWD Medical Statement is to be filled out by a health professional (physician, physician's assistant, nurse, nurse practitioner, psychologist, social worker, etc.) and forwarded to the Department of Social Services. The form asks for patient health information, verification of eligibility for ABAWD exemptions or limitations, and the expected time frame. It can be submitted as a fillable PDF or a Word version and must include the signer’s signature and date.