Form DSS-8H "Cityfheps Packet Cover Sheet - Shelter" - New York City

What Is Form DSS-8H?

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-8H 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-8H "Cityfheps Packet Cover Sheet - Shelter" - New York City

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DSS-8h (E) 08/17/2021 (page 1 of 2)
CityFHEPS Packet Cover Sheet – Shelter
Client’s Information
Client’s Name: _______________________________________ Social Security Number: ___________________
Agency Name: _______________________________________ Cash Assistance Case #: __________________
Staff Contact: _______________________________________ Staff Phone #: __________________________
Staff e-Mail:
______________________________________________________________________________
Program Analyst: _____________________________________ CARES ID: _____________________________
Program Administrator: ________________________________ Facility Code: ___________________________
Did you include the following mandatory documents?
DSS-7 or DSS-7b (“Shopping Letter”)
Proof of Apartment/Room Preclearance
DSS-7a or DSS-7c (“Household Share Letter”)
DSS-10a Apartment Review Checklist
Deed/Proof of Ownership
Proof of last 30 days of Income
(for everyone in the household 18+)
DSS-8f or DSS-8g (“Landlord Information
Form")
W-137A Request for Emergency Assistance
Signed by managing agent or other
DSS-7p Program Participant Agreement
authorized representative? If checked,
Lease or Rental Agreement for 12 months
Proof of HPD Registration or
Shelter Residency Letter
Authorization
W-147N Security Voucher
DSS-8b Tenant Contact Information
DSS-8q Landlord Utility Information
Landlord W9
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
If a Broker was used, did you include the following documents?
HRA-121 Broker’s Request for Enhanced Fee Payment by Check
Broker License (if broker fee)
Comments: _________________________________________________________________________________
(Turn Page)
DSS-8h (E) 08/17/2021 (page 1 of 2)
CityFHEPS Packet Cover Sheet – Shelter
Client’s Information
Client’s Name: _______________________________________ Social Security Number: ___________________
Agency Name: _______________________________________ Cash Assistance Case #: __________________
Staff Contact: _______________________________________ Staff Phone #: __________________________
Staff e-Mail:
______________________________________________________________________________
Program Analyst: _____________________________________ CARES ID: _____________________________
Program Administrator: ________________________________ Facility Code: ___________________________
Did you include the following mandatory documents?
DSS-7 or DSS-7b (“Shopping Letter”)
Proof of Apartment/Room Preclearance
DSS-7a or DSS-7c (“Household Share Letter”)
DSS-10a Apartment Review Checklist
Deed/Proof of Ownership
Proof of last 30 days of Income
(for everyone in the household 18+)
DSS-8f or DSS-8g (“Landlord Information
Form")
W-137A Request for Emergency Assistance
Signed by managing agent or other
DSS-7p Program Participant Agreement
authorized representative? If checked,
Lease or Rental Agreement for 12 months
Proof of HPD Registration or
Shelter Residency Letter
Authorization
W-147N Security Voucher
DSS-8b Tenant Contact Information
DSS-8q Landlord Utility Information
Landlord W9
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
If a Broker was used, did you include the following documents?
HRA-121 Broker’s Request for Enhanced Fee Payment by Check
Broker License (if broker fee)
Comments: _________________________________________________________________________________
(Turn Page)
DSS-8h (E) 08/17/2021 (page 2 of 2)
Department of Social Services
Human Resources Administration
SUPERVISORY REVIEW (Director of Social Services or higher)
Name
Title
Email Address
Telephone Number
Signature
Date
Page of 2