Get Ny Hra-102 (e) 2016-2026

The NY HRA-102 (E) form is used to request an appeal of a reasonable accommodation decision. This guide provides step-by-step instructions on how to complete the form online, ensuring that the process is clear and manageable for all users.

Follow the steps to fill out the NY HRA-102 (E) online carefully.

1. Press the ‘Get Form’ button to access the NY HRA-102 (E) form and open it in your online editor.
2. In Section I, provide your personal information clearly: includes your name, case number (if known), social security number (if available), telephone number, and mailing address.
3. In Section II, state the decision(s) you wish to appeal. If there is more than one decision, ensure all are noted.
4. Explain why you believe the decision was incorrect in the provided space. If your explanation requires more space, be sure to attach additional pages.
5. The form requires a signature. Sign and date the form as the HRA applicant/participant or, if applicable, provide the authorized representative's signature, printed name, relationship to the applicant, and their contact information.
6. Review the completed form for accuracy and clear information. Once confirmed, you can save your changes, download, print, or share the form as needed.

Start your appeal process by filling out the NY HRA-102 (E) form online today.