Applications & Forms

Click on the links below to view and then print the forms.

NOTE: Some of the application(s) require additional information. Please review and complete the application(s) before submitting to an Agency.

Cash & Expenses

Child Tax Credit (CTC)
Form 1040 English

Child and Dependent Care Tax Credit

Earned Income Tax Credit (EITC)
Schedule EIC
English

Worksheet C in the Instructions Form for IT-215
English

Home Energy Assistance Program (HEAP)

Family Services

Child Support Services
Application form with instructions
English
Other Child Support forms (for Custodial and Noncustodial Parents)

Family Planning Benefit Program (FPBP)
Application form with instructions
English | Spanish

Food

SNAP Periodic Report
English | Spanish | Russian | Korean | Chinese | Haitian-Creole | Arabic | Bangla
The SNAP Periodic Report Form asks SNAP recipients to inform HRA of any changes to their case. The report is due every six months after you start receiving or renew your benefits. If you do not submit it within six months, HRA will close your case.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Medical Referral Form
English

Health

NYC Nurse-Family Partnership
If you’re a service provider, you can learn more on the NYC Health website, and you can refer eligible patients/clients by filling out the referral form and faxing it to 347-396-4360 or emailing it to [email protected] .

Referral form with instructions
English

Supplement A
NOTE: This supplement is also required for anyone applying who is age 65 or older, blind or disabled, or seeking long-term care care
English | Spanish | Russian | Korean | Haitian-Creole

Work

Summer Youth Employment Program (SYEP)
Online application

NYS Unemployment Insurance
Online application

Last Updated August 5, 2022