NEW YORK CITY DEPARTMENT OF CORRECTION Show Cynthia Brann, Commissioner Dr. Larry Johnson, Assistant Commissioner Applicant Investigation Unit Bulova Corporate Center 75-20 Astoria Blvd East Elmhurst, NY 11370 Tel: 718 • 546 • 3238 N.Y.C. Department of Social Service Bureau of Fraud Investigation 250 Church Street * Rm. 422 New York, New York 10013 I hereby authorize the release of any and all information contained in my records and that such information and/or records be disclosed, furnished to, and/or examined by N.Y.C. Department of Correction for the purpose of determining my eligibility for appointment to the N.Y.C. Department of Correction. I acknowledge this authorization that I release you from any obligation of liability in the disclosure of the contents of such records. _______________________________________ ________________________________ Full Name – Printed Candidate’s Signature _______________________________________ ________________________________ Social Security Number Date of Birth Public Assistant Recipient: NO YES Case No.: Current Address: Previous Address: Maiden Name: Mother’s Full Maiden Name: Husband’s Name/Wife’s Full Maiden Name: Currently Employed: NO YES Name/Address of Employer:____________________________ _______________________________________________________________________________________________ _________________________________________ __________ ____________________________ Investigator Shield# Telephone # BUREAU OF CLIENT FRAUD REPLY ____________No Record __________Active Case ____________Closed Case _______Center Date Opened Date Closed Type of Benefits Received: ____________________ Client’s Name Case No.: Client’s Address: Family Composition – (Name, Date of Birth, Social Security No.): _______________________________________________ ___________________________________________________________________________________________________ Cleared by: Telephone Date Additional Remarks: Employment 6 Visit NEW YORK’S BOLDEST on the Web at: www.nyc.gov/boldest NEW YORK CITY DEPARTMENT OF CORRECTION Cynthia Brann, Commissioner Dr. Larry Johnson, Assistant Commissioner Applicant Investigation Unit Bulova Corporate Center 75-20 Astoria Blvd East Elmhurst, NY 11370 Tel: 718 • 546 • 3238 N.Y.C. Department of Social Service Bureau of Fraud Investigation 250 Church Street * Rm. 422 New York, New York 10013 I hereby authorize the release of any and all information contained in my records and that such information and/or records be disclosed, furnished to, and/or examined by N.Y.C. Department of Correction for the purpose of determining my eligibility for appointment to the N.Y.C. Department of Correction. I acknowledge this authorization that I release you from any obligation of liability in the disclosure of the contents of such records. _______________________________________ ________________________________ Full Name – Printed Candidate’s Signature _______________________________________ ________________________________ Social Security Number Date of Birth Public Assistant Recipient: NO YES Case No.: Current Address: Previous Address: Maiden Name: Mother’s Full Maiden Name: Husband’s Name/Wife’s Full Maiden Name: Currently Employed: NO YES Name/Address of Employer:____________________________ _______________________________________________________________________________________________ _________________________________________ __________ ____________________________ Investigator Shield# Telephone # BUREAU OF CLIENT FRAUD REPLY ____________No Record __________Active Case ____________Closed Case _______Center Date Opened Date Closed Type of Benefits Received: ____________________ Client’s Name Case No.: Client’s Address: Family Composition – (Name, Date of Birth, Social Security No.): _______________________________________________ ___________________________________________________________________________________________________ Cleared by: Telephone Date Additional Remarks: Employment 6 Visit NEW YORK’S BOLDEST on the Web at: www.nyc.gov/boldest
How do I contact access to NYC HRA?Call the Human Resources Administration (HRA) information line at 718-557-1399. For SCRIE/DRIE: Call 3-1-1. For Medicaid Renewal: Call the HRA Medicaid Helpline at 888-692-6116.
How do I submit documents to HRA?You can use ACCESS HRA, fax, mail, or a drop box at open centers to submit your recertification. Please make sure that we have your correct phone number. You can check it and update it on ACCESS HRA website or the ACCESS HRA Mobile App. Learn about the ways you can submit your recertification and supporting documents.
How do I email a NYC HRA?Requests and forms should be submitted via email to [email protected].
How do I access my HRA?How do I access my HRA money?. You won't do anything — most plans will reimburse your network doctor directly.. You'll use a debit card tied to the account, if offered by your employer.. You'll pay for expenses up front, then request reimbursement.. |
Nyc human resources administration department of social services forms
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