How to Fill Out and Submit the NYC HRA Employment Verification Form

The NYC HRA employment verification form is a two-part document that confirms your wages for SNAP, Cash Assistance, or Medicaid: you complete a short personal section, your employer fills in your hire date, gross wages, hours, and pay frequency, and you return it to HRA through the ACCESS HRA app, in person at an HRA center, by fax, or by mail. Standard SNAP decisions come within 30 days of your filing date, and expedited cases within five to seven days.¹

Where to Get a Blank Form

You can pull the form from the ACCESS HRA web portal or mobile app, which also lets you manage your case, view appointments, and upload documents from your phone.² You can also pick one up in person at any HRA SNAP Center or Job Center; the HRA Locations map on nyc.gov shows the nearest office. If your caseworker has mailed you a request for documents, the form is often already inside that packet.

There is no fee for the form, and your employer should not charge you to complete it.

Filling In Your Section

The top of the form is yours. Write your full legal name, Social Security number, and home address, and add your HRA case number if you have one. The name and SSN must match what HRA has on file. If you recently changed your name and haven’t updated your case, fix the case record first — a mismatch is one of the most common reasons caseworkers send follow-up notices.

Print clearly. Anything a caseworker can’t read becomes a request for clarification, and that adds days to your decision.

What Your Employer Fills In

Hand the rest of the form to your employer’s payroll or HR department. They need to enter:

The company’s legal name, address, phone number, and federal Employer Identification Number.
Your hire date.
Your gross wages, before taxes and other deductions, for the most recent pay periods (typically four weeks of pay data).
Your hours per week, and whether the schedule is regular or varies.
Your pay frequency: weekly, biweekly, semi-monthly, or monthly.
The signature and date of an authorized company representative.

Gross wages is the number that matters most. HRA uses it to project your monthly income and calculate your benefit amount, and federal rules require verification of gross nonexempt income before a SNAP application can be approved.³ If your employer writes down net pay instead, the caseworker will reject the form and ask for a corrected version. Make sure whoever fills it out knows the difference before they sign.

If Your Employer Won’t Complete the Form

You are not stuck if the employer refuses. Consecutive pay stubs covering at least four weeks of earnings are an accepted substitute, and federal regulations designate wage stubs as a primary form of income documentation.³ Each stub should show the pay period dates, the employer’s name, your gross earnings, and your hours worked.

A few things trip people up. Gaps between stubs raise questions, so submit consecutive periods. Stubs that show only net pay without a gross figure may not satisfy the caseworker. Handwritten stubs from small employers sometimes get flagged for extra verification. If you’re paid in cash with no formal stubs at all, ask your employer to write a signed letter on company letterhead stating your pay rate, hours, and pay frequency, and bring it to your HRA office with an explanation. Federal rules allow HRA to accept “any reasonable form of documentation” and prohibit limiting verification to a single document type.³

If You’re Self-Employed

Self-employed applicants don’t use the employer form at all. New York accepts your most recently filed federal tax return (itemized) or records of funds received and expenses for the three months before your application.⁴ In practice:

Sole proprietors submit Form 1040 with Schedule C.
Partners submit Form 1040, Form 1065, and Schedule K-1.
New businesses of one year or less submit a written statement of gross income from the start date through the present, itemized deductions, and net income; some caseworkers also ask for bank statements showing deposits.

Gig workers (rideshare drivers, freelancers, delivery couriers) fall into this category. If you haven’t filed a return yet because you started recently, gather what you have: app-based earnings summaries, 1099 forms, invoices, and a simple profit-and-loss breakdown.

Submitting the Completed Form

HRA takes the form four ways:

Through the ACCESS HRA app or web portal, by uploading a photo or scan. This is the fastest option and creates an immediate digital record on your case.²
In person at your assigned SNAP Center or Job Center. Ask for a receipt or have the clerk stamp a copy so you can prove you handed it in.
By fax. Each HRA center has its own fax number, printed on correspondence you’ve received or available by calling the center.
By mail, to the address on your appointment notice or case correspondence. This is the slowest route; if you use it, send it with delivery confirmation.

Keep a copy of everything you submit. If HRA later says nothing arrived, that copy is your proof. The ACCESS HRA portal also lets you track submitted documents, which is another reason to use it when you can.⁵

After You Submit

By law, HRA must decide a standard SNAP application within 30 days of your filing date. Households with very low income or almost no resources qualify for expedited processing and must receive an initial benefit within five to seven calendar days.¹ Cash Assistance and Medicaid have their own processing windows, but the verification form works the same way across all three.

If something on the form is missing or inconsistent — hours-per-week left blank, gross wages that don’t line up with the stated pay frequency — HRA will send a written notice asking for the missing piece. You generally have 10 days from the date on that notice to respond. Miss the deadline and your benefits can be denied or reduced, so treat these notices as urgent. If you need more time, call your caseworker or go to your center before the deadline runs out and explain the situation.

The Form Isn’t Only for Your First Application

You’ll need employment verification again at recertification, which happens at least once a year and sometimes every six months. HRA has to re-verify your income at that point if the source changed or the amount shifted by more than $50 since your last certification.³

Between certifications, you have to report changes in employment or earnings within 10 days.⁶ A new job, lost hours, or a raise all trigger this obligation. Failing to report can create an overpayment that HRA will recoup from later benefits, or in serious cases, an intentional program violation that disqualifies you from SNAP.

If HRA Denies or Reduces Benefits Based on the Form

You can request a state fair hearing if HRA denies your application, cuts your benefits, or closes your case based on the income information it reviewed. Fair hearings are run by the New York State Office of Temporary and Disability Assistance. Call 1-800-342-3334, or 1-800-205-0110 for emergencies in NYC.

Timing matters. If you request the hearing before the effective date of HRA’s action, your current benefits generally continue until the decision is issued. This is called aid continuing. Ask for it in your hearing request. If you wait past the effective date you can still get a hearing, but benefits may lapse while you wait.

At the hearing you can present documents, bring witnesses, and explain why HRA’s determination was wrong. If the hearing officer rules in your favor, HRA has to restore or adjust your benefits retroactively.

1
NYC Human Resources Administration. SNAP Application FAQ
2
NYC Human Resources Administration. ACCESS HRA Mobile
3
eCFR. 7 CFR 273.2
4
LIHEAP Clearinghouse. LIHEAP Income Verification Examples from States
5
NYC Human Resources Administration. ACCESS HRA Frequently Asked Questions
6
ACCESS NYC. Frequently Asked Questions – SNAP Work Requirements