How to Fill Out and Submit the NYC HRA Repayment Agreement Form (W-146E)

NYC HRA Form W-146E is a one-page request asking the Human Resources Administration to pay your rent arrears when your rent is higher than the shelter allowance built into your Cash Assistance grant.¹ You fill out the top half. A third party — someone who agrees to cover the monthly gap between your shelter allowance and your actual rent going forward — fills out and signs the bottom half. Without both halves completed honestly and backed by documents, HRA will not issue the arrears check to your landlord.

When This Is the Right Form

Cash Assistance includes a shelter allowance, but the state caps it by household size, and in New York City those caps sit well below typical rents.² The W-146E exists for the tenant who has fallen behind because rent outruns that cap. HRA is willing to clear the back rent, but only if you can show the shortfall will not simply repeat next month. That is the job of the third-party agreement.

If your rent is within the shelter allowance, or if you need help with something other than rent arrears in excess of the cap, this is not your form. Emergency rent grants (one-shot deals) and the Family Homelessness and Eviction Prevention Supplement are separate programs with their own applications; your caseworker can point you to the right one.³⁴

Where to Get the Form

Download the W-146E as a PDF from nyc.gov/assets/hra/downloads/pdf/benefits/w_146e.pdf, or pick up a paper copy at any HRA Benefits Access Center.¹ If English is not your first language, HRA walk-in locations offer telephonic interpretation in more than 250 languages.⁵

Completing Your Section at the Top

The applicant portion is short. Fill in the date you’re signing, your HRA case number (it appears on any prior HRA notice or benefits letter), the case name, and your full legal name as it appears on the case.

Under those fields sits a printed statement you agree to by signing. It says you are asking for help with rent arrears to avoid eviction, that HRA will pay the arrears by check directly to your landlord, and that if any portion of the arrears duplicates assistance HRA has already provided, the agency may recoup it.¹ Read it before you sign. Recoupment means HRA can reduce your future benefits to recover the overlap.

Sign and date at the bottom of your section. HRA will not process the form without your signature.

Completing the Third-Party Agreement at the Bottom

This is the section that decides most W-146E outcomes. The third party — a parent, sibling, friend, or other supporter — must complete and sign it themselves. You cannot sign for them.

The third party fills in:

Their name and the exact monthly dollar amount they agree to pay, which is the difference between your rent and your shelter allowance.
Your name and address, so the commitment is tied to a specific apartment.
The effective date their payments will begin.
Whether they will pay you directly or pay the landlord; if the landlord, the landlord’s name and address.
Their own total monthly household income.
What they pay for their own shelter.
Proof of their income: pay stubs, a W-2, or a letter on the employer’s letterhead showing the employer’s name and address. If income comes from a non-employment source, they describe it here.
Their relationship to you.
Their home address.

The third party then signs and dates the agreement. HRA reviews these numbers to see whether the person actually has room in their budget to cover their own housing plus your excess rent each month. If the math is tight — income that barely covers the third party’s own shelter — expect denial or a request for more information.¹

Documents to Have Ready Before You Submit

The form calls for documentation but doesn’t list every item HRA may want. Prepare the following:

The third party’s income proof — pay stubs, a W-2, or an employer letter on company letterhead. Self-employment or benefit income should be documented with whatever records show those payments.
A letter or ledger from your landlord stating the total arrears owed and the monthly rent. HRA will cut the arrears check directly to the landlord, so the amount has to be verified.
Your lease, to confirm the rent and the apartment address.
Any housing court papers you already have, including orders and stipulations.

HRA decides what’s required case by case, so your caseworker may ask for more.³ Bringing everything at once avoids the back-and-forth while your arrears keep growing.

How to Submit the Form

You have three practical ways to get the completed W-146E to HRA.

Through the ACCESS HRA mobile app: photograph the signed form clearly and upload it in the Required Documents section. The app keeps your submission history for 100 days and sends notifications about your case. Uploading is not the same as acceptance, so check the My Documents section afterward to confirm the file went through.⁶
Through the ACCESS HRA website at a069-access.nyc.gov, where you can log in and upload a scanned copy.
In person at your nearest Benefits Access Center. This is often the fastest way to confirm the form reached your caseworker, and staff can answer questions while you’re there.

Keep a copy either way. If you upload, screenshot the confirmation. If you hand-deliver, ask for a receipt or write down the date, time, and name of the staffer who took it.

What Happens After You Submit

HRA has to verify eligibility using the best available evidence, starting with what you provide and confirming it with documents.⁷ If the third party’s income checks out and the arrears are verified with your landlord, HRA cuts a check payable to the landlord. The money does not pass through you.

If anything is missing, HRA will ask for it. Respond fast. Delays at this stage are the most common reason arrears keep growing while a request sits open.

If HRA denies the request, you can challenge the decision at a state fair hearing. For Cash Assistance matters, request the hearing within 60 days of the postmark date on the denial notice. If you want your current benefits to continue unchanged while you wait for the hearing, request it within 10 days of the postmark.

Be Honest About the Numbers

Everything on the form — your section and the third party’s — carries legal consequences if it is false. Under New York Social Services Law, obtaining or attempting to obtain public assistance through a false statement, concealment, or other fraudulent method is a misdemeanor, and if the conduct also violates the penal law, the harsher penalty applies.⁸ HRA can also seek civil damages of three times the overstated amount, or, where no specific dollar figure is involved, three times its actual damages or $5,000, whichever is greater.

That liability reaches the third party too. Inflating their income to make the agreement look workable exposes both of you. The usual problem is not fraud but optimism: a supporter who wants to help but cannot really carry the monthly gap. Put down the real numbers. HRA will verify them.

1
NYC Human Resources Administration. W-146E – Request to Pay Rent Arrears in Excess of Cash Assistance Maximum Shelter Allowance
2
Legal Information Institute. New York Compilation of Codes, Rules and Regulations Title 18 Section 352.3 – Rent Allowances
3
ACCESS NYC. Emergency Assistance / One Shot Deal
4
ACCESS NYC. Family Homelessness and Eviction Prevention Supplement (FHEPS)
5
NYC.gov. Language Access Implementation Plan
6
Apple App Store. NYC ACCESS HRA
7
Legal Information Institute. New York Compilation of Codes, Rules and Regulations Title 18 Section 351.5 – Sources of Information
8
New York State Senate. New York Social Services Law Section 145 – Penalties