Form DSS-8I "Cityfheps Packet Cover Sheet - Community" - New York City

What Is Form DSS-8I?

This is a legal form that was released by the New York City Department of Social Services - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 17, 2021;
  • The latest edition provided by the New York City Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DSS-8I by clicking the link below or browse more documents and templates provided by the New York City Department of Social Services.

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Download Form DSS-8I "Cityfheps Packet Cover Sheet - Community" - New York City

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DSS-8i (E) 08/17/2021 (page 1 of 2)
CityFHEPS Packet Cover Sheet - Community
Client’s Information
Client’s Name: ______________________________________________________________________________
Social Security Number: ________________________________ Cash Assistance Case #: _________________
Agency Name: __________________________ Staff Contact: ________________________________________
Staff Phone #: __________________________ Staff e-Mail: _________________________________________
Did you include the following mandatory documents?
DSS-7a or DSS-7c (“Household Share Letter”)
Landlord W9
DSS-8e CityFHEPS Verification of Eligibility
Deed/Landlord Proof of Ownership
DSS-7o or DSS-7q ("Application for CityFHEPS")
DSS-8f or DSS-8g (“Landlord Information
Form")
Proof of last 30 days of Income
(for everyone in the household 18+)
Signed by managing agent or other
W-137A Request for Emergency Assistance
authorized representative? If checked,
DSS-7p Program Participant Agreement
Proof of HPD Registration or
Authorization
Lease or Rental Agreement for 12 months
W-147N Security Voucher (new units only)
Proof of eligibility (veteran status, APS letter, eviction,
transfer approval, vacate)
DSS-8q Landlord Utility Information
DSS-8b Tenant Contact Information
Is the household remaining in place or moving to a new unit?
Remaining in Place
New Unit
DSS-7 or DSS-7b (“Shopping Letter”)
Arrears Documents (court stipulation, rent
breakdown, etc.)
Proof of Apartment/Room Preclearance
Emergency Assistance to Needy Families (EAF)
DSS-10a Apartment Review Checklist
Agreement to Repay Excess Shelter Arrears
(W-147KK)
Emergency Safety Net Assistance (ESNA)
Shelter Arrears Repayment Agreement
(W-147H)
Check the rental type and associated forms included. Also check which landlord incentives apply, if any:
Room Rental?
Apartment/SRO Rental?
DSS-8d Room Allocation Form
HRA-145 Unit Hold Incentive Voucher
CityFHEPS Rental Assistance
Supplement
1 month OR
3 months
(Turn Page)
DSS-8i (E) 08/17/2021 (page 1 of 2)
CityFHEPS Packet Cover Sheet - Community
Client’s Information
Client’s Name: ______________________________________________________________________________
Social Security Number: ________________________________ Cash Assistance Case #: _________________
Agency Name: __________________________ Staff Contact: ________________________________________
Staff Phone #: __________________________ Staff e-Mail: _________________________________________
Did you include the following mandatory documents?
DSS-7a or DSS-7c (“Household Share Letter”)
Landlord W9
DSS-8e CityFHEPS Verification of Eligibility
Deed/Landlord Proof of Ownership
DSS-7o or DSS-7q ("Application for CityFHEPS")
DSS-8f or DSS-8g (“Landlord Information
Form")
Proof of last 30 days of Income
(for everyone in the household 18+)
Signed by managing agent or other
W-137A Request for Emergency Assistance
authorized representative? If checked,
DSS-7p Program Participant Agreement
Proof of HPD Registration or
Authorization
Lease or Rental Agreement for 12 months
W-147N Security Voucher (new units only)
Proof of eligibility (veteran status, APS letter, eviction,
transfer approval, vacate)
DSS-8q Landlord Utility Information
DSS-8b Tenant Contact Information
Is the household remaining in place or moving to a new unit?
Remaining in Place
New Unit
DSS-7 or DSS-7b (“Shopping Letter”)
Arrears Documents (court stipulation, rent
breakdown, etc.)
Proof of Apartment/Room Preclearance
Emergency Assistance to Needy Families (EAF)
DSS-10a Apartment Review Checklist
Agreement to Repay Excess Shelter Arrears
(W-147KK)
Emergency Safety Net Assistance (ESNA)
Shelter Arrears Repayment Agreement
(W-147H)
Check the rental type and associated forms included. Also check which landlord incentives apply, if any:
Room Rental?
Apartment/SRO Rental?
DSS-8d Room Allocation Form
HRA-145 Unit Hold Incentive Voucher
CityFHEPS Rental Assistance
Supplement
1 month OR
3 months
(Turn Page)
DSS-8i (E) 08/17/2021 (page 2 of 2)
Department of Social Services
Human Resources Administration
Do any of the following situations apply?
HRA-146p Domestic Violence Action Form
Broker? If checked,
HRA-121 Broker’s Request for
Enhanced Fee Payment by Check
Broker License (if broker fee)
Comments:
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