Benefit Applications
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Certain programs have their applications available online. You can go directly to these websites and download the applications, which can be used when applying for the public benefits. We have included links to instructions, when available, as well.Advocacy Fair Hearing - Request Fair Hearing - Request an Adjournment Fair Hearing - Request for Compliance File an appeal for disability benefits from Social Security (SSI or SSDI) Cash Benefits Cash Assistance (formerly known as Public Assistance) - LDSS - 2921 Child Support (For Non-Cash Assistance Recipient) Home Energy Assistance Program (HEAP)- LDSS-3421 Social Security Insurance Benefits - File Online for Social Security Disability Insurance
- File Online for Social Security Retirement Insurance
Unemployment Insurance Benefits (UIB) - File Online for Unemployment Benefits
- Aplicar En Español para Beneficios del Seguro por Desempleo
Veteran’s Application for Disability Compensation and/or Pension - VA Form 21-526 Food Food Stamps - LDSS 4826 Health Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) Elderly Pharmaceutical Insurance Coverage Program (EPIC) Healthy NY Medicaid - Disability Certification Applicants who need to be certified disabled by Medicaid must include two additional forms with the Medicaid application (DOH-4220).
Medicaid Personal Care Services Medicaid- Access NY Supplement DOH-4495A Access NY Supplement must be completed if the applicant is 65 or older, certified blind or disabled or is applying as blind or disabled applicant and Medicaid will certify the individual as blind or disabled, applying for skilled nursing care or community-based long term care services.
Medicaid/PCAP/Family Health Plus/Child Health Plus (Access NY Health Care) DOH-4220 Medicare Part D Extra Help (Low Income Subsidy) Medicare Saving Program - DOH-4328 TRICARE Veteran’s Health Care Option to process an online application or print out a blank application.
Housing Affordable Housing Lotteries Disability Rent Increase Exemption (DRIE) - File Online for DRIE or
New York City Housing Authority (NYCHA Public Housing) Private Federally Subsidized Housing (Project Based Section 8) Senior Citizen Rent Increase Exemption (SCRIE)
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