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Rm and these instructions are numbered by section to help you. Please keep the following in mind when filling out the recertification form: PLEASE PRINT CLEARLY. DO NOT WRITE IN THE SHADED AREAS. BE SURE TO COMPLETE EACH SECTION RELEVANT TO THE PERSON(S) FOR WHOM YOU ARE RECERTIFYING. ALWAYS USE LEGAL NAMES, UNLESS OTHERWISE INSTRUCTED. IF YOU ARE RECERTIFYING AS SOMEONE'S REPRESENTATIVE, PLEASE PROVIDE INFORMATION ABOUT THAT PERSON, NOT YOURSELF. MAKE SURE THAT BOTH Y.

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Call NY State of Health at 1-855-355-5777 (TTY: 1-800-662-1220) Log into your account at nystateofhealth.ny.gov, or. Contact an enrollment assistor.

Most benefits are provided on an electronic card that is used like an ATM card. Eligible families may receive up to 60 months of federally funded Cash Assistance under the Temporary Aid to Needy Families Program (TANF).

Recertifications: If you receive a Cash Assistance or SNAP recertification notice by mail or an ACCESS HRA alert that you need to recertify, you must submit your recertification or your benefits will stop. You can use ACCESS HRA, fax, mail, or a drop box at open centers to submit your recertification.

NYC Human Resources Administration (HRA) will send a mail-in Recertification/Eligibility Questionnaire in the fifth month. Households must return the form by the 10th day of the sixth month. The form may be returned in the reply envelope provided by HRA, or bring the completed form to your local job center.

Yes. HRA can seek repayment from you whether or not you still have an open cash assistance case.

If you want to recertify for Medicaid and PA, check (✓) the “Medicaid (MA) and PA” box. If you wish to only recertify for MA, you can go online at https://nystateofhealth.ny.gov/ or call 1-855-355- 5777 for more information or to recertify.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232