How to Fill Out and Submit NYC Form W-147: Residence Verification

NYC Form W-147 is the letter the Human Resources Administration (HRA) sends to your landlord to confirm where you live when you apply for or keep Cash Assistance. Your caseworker fills in your name and case information at the top, you hand the form to your landlord or managing agent, they complete and sign the response section, and you return it to HRA. The form is used when the lease is in your name; a different form covers secondary tenants.¹

When HRA Asks for It

HRA issues the W-147 when it needs to verify your residence during a Cash Assistance application review or an ongoing case check. It also comes up at recertification, which HRA requires at least once a year. If your case is up for renewal and your caseworker needs fresh proof of your address, expect a new W-147 in the paperwork.¹

What Your Landlord Fills In

Section A of the form identifies you and gives your landlord the caseworker’s name and phone number. Section B is what the landlord has to complete:²

Name on the lease
Date the lease was signed
Monthly rent
Last date rent was paid
Number of people in the household
Tenant’s financial references
Names of all household members
Whether you actually reside at the address (yes or no)
Building superintendent or managing agent name and phone number
Landlord signature and date

The signature is required. The form does not need to be notarized. Instructions say to prepare it in duplicate, so photocopy the completed form before you turn it in and keep the copy for yourself.²

Getting a Blank Copy

Usually your caseworker hands you the W-147 with Section A already filled in. If you need a blank version, download the PDF from HRA’s Special Grant Document Guide page on nyc.gov, under the residence verification section labeled “Request for Residence Verification.”¹

When you give the form to your landlord, tell them HRA is reviewing your case and needs it back quickly. The form itself asks for a response “as soon as possible” without setting a hard deadline, but your case has its own timeline, so a slow landlord slows your benefits.²

Returning the Completed Form to HRA

Once Section B is filled out and signed, you have two ways to send it back:

Through the ACCESS HRA mobile app. Log in, open the “Required Documents” tab, and use “Upload Now” to photograph or upload the form. Document uploads are only available on the mobile app; the ACCESS HRA desktop website doesn’t accept document returns.³
In person at the HRA job center handling your case. Locations are listed on nyc.gov.

Either way, keep your photocopy. If HRA later says the form never arrived, that copy is your evidence you turned it in.

If Your Landlord Won’t Cooperate

Some landlords stall or refuse. Tell your caseworker what happened. HRA staff can follow up directly, and the form has a section for the agency to record telephone contact with the landlord, so there’s a built-in path for the caseworker to verify your residence by phone.²

Document your attempts. Note the date you dropped the form off, the name of the person you spoke to, any refusal you got over the phone. A written record of good-faith effort shifts the responsibility to HRA to help rather than close your case for a missing document.

If the Verification Never Comes In

Missing verification can lead HRA to deny or close your Cash Assistance case. If your landlord is dragging and the deadline is close, call your caseworker before it passes. Flagging the delay early gives HRA room to help or extend your timeline instead of closing the case automatically for non-compliance.

1
NYC Human Resources Administration. Cash Assistance Special Grant Document Guide
2
NYC Human Resources Administration. W-147 Letter to Landlord – Request for Residence Verification
3
NYC Human Resources Administration. Access HRA Frequently Asked Questions