The NYC HRA authorization form, officially the DSS-20 Authorization to Release Case Information, lets you name someone to speak with the Human Resources Administration about your case and receive information about your benefits. That person can be a family member, a friend, an attorney, or staff at a community organization. The form covers HRA-administered programs including SNAP, Medicaid, and Cash Assistance.1NYC Human Resources Administration. SNAP Benefits Once HRA processes it, the authorization lasts one year from the date you sign.2NYC Human Resources Administration. DSS-20 Authorization to Release Case Information
What You Need Before You Start
Pull these details together before you sit down with the form:
- Your full legal name and date of birth, written exactly as they appear on your HRA case.
- Your case number. It’s on any letter or notice HRA has sent you, and in your ACCESS HRA dashboard if you have an online account.
- Your representative’s full name, mailing address, and phone number. If they work for a community-based organization or legal services office, include the organization’s name and office address.
You’ll also be asked what kinds of information HRA may share. Think ahead about whether your representative needs access to medical records tied to a disability determination, income and employment data, or your full case file. Vague or blanket descriptions don’t satisfy federal privacy rules, which require the authorization to describe the information in a specific and meaningful way.3eCFR. 45 CFR 164.508 – Uses and Disclosures for Which an Authorization Is Required
Where To Get the Form
The DSS-20 is available as a downloadable PDF on NYC.gov.2NYC Human Resources Administration. DSS-20 Authorization to Release Case Information You can print it at home or at a public library. Paper copies are also stocked at HRA Benefits Access Centers (formerly Job Centers) across the city, where staff can help you understand which sections apply to you.4NYC Human Resources Administration. Benefits Access Centers
Work from the current version. An outdated form may be missing fields HRA now expects, which can slow processing or get the form sent back.
Filling Out the Form
It’s a single page in a few short sections. Start at the top with your name, date of birth, and case number.5NYC Human Resources Administration. Authorization to Release Case Information Verify the case number against a recent HRA notice. A transposed digit can send the authorization to the wrong file or get it rejected.
Next, identify your representative. Write their full legal name, mailing address, and phone number, and note their organizational affiliation if they have one. HRA uses that information to verify who they are when they call or visit on your behalf.
Then specify what HRA may share. Check only the categories that apply. If you only need help with a SNAP recertification, don’t mark everything, because that exposes more personal data than you need to. There’s also a space to describe the purpose of the disclosure. Plain language such as “to assist with my benefits application” is enough.
Finish at the signature block. You, or your legal guardian, must sign and date the form. An unsigned form will be returned without being processed.5NYC Human Resources Administration. Authorization to Release Case Information The authorization expires one year from the date you signed.2NYC Human Resources Administration. DSS-20 Authorization to Release Case Information
How To Submit the Completed Form
You have four ways to get the form to HRA. Pick whichever is easiest.
Upload Through ACCESS HRA
The fastest option is uploading a scan or photo through the ACCESS HRA web portal or the ACCESS HRA Document Upload mobile app.6NYC Human Resources Administration. ACCESS HRA Resources Log in, open the document upload section, and select the category for authorization forms. Take a clear photo of every page. Blurry images or cut-off edges are a common reason uploads get kicked back. A confirmation screen appears once the upload is complete.
If you don’t have internet access, mail the form in. Use certified mail so you have a tracking number proving delivery. For Medicaid cases, the mail-in unit address is PO Box 24390, Brooklyn, NY 11202-9814.7NY Health Access. Medicaid Contacts in New York City Other programs may use different addresses, so check your most recent HRA notice for the right destination.
Fax
Fax works well if a community organization is helping you. The Medicaid fax number is 917-639-0732.7NY Health Access. Medicaid Contacts in New York City Keep the confirmation page as proof.
In Person
You can bring the form to any HRA Benefits Access Center and put it in the secure document drop box.4NYC Human Resources Administration. Benefits Access Centers Documents dropped off this way show up in your ACCESS HRA account alongside anything you’ve mailed, faxed, or uploaded.8NYC Human Resources Administration. ACCESS HRA User Guide
Confirming It Went Through
After submitting, log into ACCESS HRA and check the documents tab, which shows anything received within the last 60 days regardless of how it arrived.9NYC Human Resources Administration. ACCESS HRA User Guide – Section: View Recent Documents for Your Case If nothing appears after a couple of weeks, call the DSS OneNumber at 718-557-1399 and have your case number ready.10Human Resources Administration. Contact HRA Once the authorization is on file, your representative can start contacting HRA about your case, and HRA may send a written or digital confirmation.
Canceling or Changing Your Representative
You can revoke the authorization at any time by writing to the Human Resources Administration, Office of Constituent Services, 150 Greenwich Street, 35th Floor, New York, NY 10007.5NYC Human Resources Administration. Authorization to Release Case Information The revocation takes effect once HRA receives it. Anything your representative already did under the authorization before that point still stands.
If you’re switching representatives or no longer want someone on your case, don’t wait for the year to run out. Revoking promptly cuts off access to sensitive information. If you simply let the form expire, the authorization ends automatically at the one-year mark.2NYC Human Resources Administration. DSS-20 Authorization to Release Case Information
Not the Same as a Power of Attorney
The HRA authorization form only lets your representative communicate with HRA and receive case information. It doesn’t give them authority to make financial or legal decisions for you. A power of attorney is a broader legal instrument that does. It doesn’t require notarization, unlike many POA forms used by other NYC agencies. If you already have a court-ordered guardianship or a power of attorney executed under New York’s General Obligations Law, HRA may accept a copy of that document in place of the DSS-20, but contact HRA first to confirm what they’ll accept for your specific program.