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NY DHS Form DHS-14 2019-2026 free printable template

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Client Name (First, Last): LOS over 30 days: Yes Appendix 1DHS14 (E) 06/26/2019 (page 1 of 15)DOB: CARES ID:HFDS REFERRAL FORM Screening Tool for Referral from Health Care Facilities: SINGLE Adults
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NY DHS Form DHS-14 Form Versions

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NY DHS Form DHS-14 2019
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Begin by downloading the NY DHS Form DHS-14 from the official website.
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Read the instructions carefully before filling out the form.
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Provide your personal information in the designated sections, including your full name, address, and contact number.
04
Fill out information regarding your household size and income sources as required.
05
Complete information about your living situation, including details about your housing and expenses.
06
Review the form to ensure all information is accurate and complete.
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Sign and date the form at the bottom.
08
Submit the completed form to the appropriate local Department of Homeless Services office either in person or by mail.

Who needs NY DHS Form DHS-14?

01
Individuals or families who are experiencing homelessness or are at risk of becoming homeless.
02
People seeking assistance for emergency housing or shelter services through the New York Department of Homeless Services.
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NY DHS Form DHS-14 is a form used by individuals or organizations to report certain information related to social services or public assistance programs administered by the New York State Department of Homeless Services.
Individuals or organizations seeking assistance or providing information under the programs administered by the New York State Department of Homeless Services are typically required to file NY DHS Form DHS-14.
To fill out NY DHS Form DHS-14, you should carefully read the instructions provided with the form, complete all required sections accurately, provide necessary documentation, and submit it to the appropriate agency.
The purpose of NY DHS Form DHS-14 is to collect essential information necessary for the administration and evaluation of public assistance programs and to ensure compliance with state regulations.
The form typically requires reporting personal identification information, details about housing status, income, family composition, and any other relevant information that supports the individual's or organization's request for services.
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