Form ES161.1 "The Self-employment Assistance Program (Seap) Individual Services Plan" - New York

What Is Form ES161.1?

This is a legal form that was released by the New York State Department of Labor - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2019;
  • The latest edition provided by the New York State Department of Labor;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ES161.1 by clicking the link below or browse more documents and templates provided by the New York State Department of Labor.

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Download Form ES161.1 "The Self-employment Assistance Program (Seap) Individual Services Plan" - New York

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Self-Employment Assistance Program Unit
Harriman State Office Campus
Building 12, Room 222
Albany, NY 12240-0001
The Self-Employment Assistance Program (SEAP)
Individual Services Plan
Instructions: Use this form to list the training and skills development classes you will take to prepare for
starting your business. If you need more space, attach additional sheets. You must complete at least 20
hours of classroom training and attend 2 sessions with a business counselor. You do not have to
complete the training or counseling before you send us this form. You will use another form – the
Individual Services Verification – to show that you went to the training.
Submit this form online at: www.labor.ny.gov/signin.
1.
Log into your online services account.
2.
Click on the envelope icon in the upper right to begin a new message.
3.
Select “SEAP – Submit Benchmark Forms" as the first subject line for your message.
4.
Enter the name of the form as the second subject line.
5.
Do not attach more than one form to your message.
You may also return this form by fax to (518) 402-6586 or by mail to the address above. If you fax it, do not
mail the original. If this form is not received by the due date, you will not be eligible for SEAP benefits from
the date the form was due until the date the form was received.
Name:
Last four digits of Social Security Number:
Part I – Business Counselor Information
List contact information below for the business counselor you will be seeing while participating in the
program and your first appointment date.
Business Counselor Name and Title:
Agency/Organization:
Address:
Phone Number:
st
1
Appointment Date:
Part II – Training/Workshops Information
List the training classes that you plan on taking. Do not submit this form unless you have 20 hours or
more of training listed. If you must add or delete a class after you submit this form, call the SEAP Unit at
(518) 485-1597.
ES 161.1 (02/19)
Page 1 of 2
Self-Employment Assistance Program Unit
Harriman State Office Campus
Building 12, Room 222
Albany, NY 12240-0001
The Self-Employment Assistance Program (SEAP)
Individual Services Plan
Instructions: Use this form to list the training and skills development classes you will take to prepare for
starting your business. If you need more space, attach additional sheets. You must complete at least 20
hours of classroom training and attend 2 sessions with a business counselor. You do not have to
complete the training or counseling before you send us this form. You will use another form – the
Individual Services Verification – to show that you went to the training.
Submit this form online at: www.labor.ny.gov/signin.
1.
Log into your online services account.
2.
Click on the envelope icon in the upper right to begin a new message.
3.
Select “SEAP – Submit Benchmark Forms" as the first subject line for your message.
4.
Enter the name of the form as the second subject line.
5.
Do not attach more than one form to your message.
You may also return this form by fax to (518) 402-6586 or by mail to the address above. If you fax it, do not
mail the original. If this form is not received by the due date, you will not be eligible for SEAP benefits from
the date the form was due until the date the form was received.
Name:
Last four digits of Social Security Number:
Part I – Business Counselor Information
List contact information below for the business counselor you will be seeing while participating in the
program and your first appointment date.
Business Counselor Name and Title:
Agency/Organization:
Address:
Phone Number:
st
1
Appointment Date:
Part II – Training/Workshops Information
List the training classes that you plan on taking. Do not submit this form unless you have 20 hours or
more of training listed. If you must add or delete a class after you submit this form, call the SEAP Unit at
(518) 485-1597.
ES 161.1 (02/19)
Page 1 of 2
School/Agency:
Phone Number: (
)
School/Agency Address:
Workshop/Class:
Training Dates:
Number of Hours:
School/Agency:
Phone Number: (
)
School/Agency Address:
Workshop/Class:
Training Dates:
Number of Hours:
School/Agency:
Phone Number: (
)
School/Agency Address:
Workshop/Class:
Training Dates:
Number of Hours:
School/Agency:
Phone Number: (
)
School/Agency Address:
Workshop/Class:
Training Dates:
Number of Hours:
School/Agency:
Phone Number: (
)
School/Agency Address:
Workshop/Class:
Training Dates:
Number of Hours:
Total number of hours =
I certify that the statements above are true and correct.
Signature:
Date:
ES 161.1 (02/19)
Page 2 of 2
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