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FHEPS B IRM
Please complete the following form to determine if the client is eligible for a FHEPS B voucher.
Client Name
Client FJC Number
Client Year of Birth
Please select client's FJC
Bronx
Brooklyn
Manhattan
Queens
Staten Island
Name of FJC partner staff person making referral
Referring FJC staff person's email
Is the client a victim of domestic or gender-based violence?
Yes
No
Is the client living in community (i.e., not in DV or DHS/homeless shelter)?
Yes
No
(client should be directed to the housing specialist at the shelter. FHEPS B is for survivors living in community, not in shelter.)
Was the client issued a FHEPS voucher
in the past 24 months
?
Yes
No
Was the client living in a shelter when the prior voucher was issued?
Yes
No
N/A. Client has not been issued a FHEPS voucher in the past 24 months.
Is the client currently being evicted?
Yes
(client is eligible for regular FHEPS and should be sent directly to homebase. There is no need for the FHEPS B referral form. See link to homebase locations here:
hhttps://www1.nyc.gov/site/hra/help/homebase-locations.page
).
No
Does the client have a child under 18 in their home?
They must have a child under 18 in their home to be eligible for FHEPS B.
Yes
No
Does the client have an active cash public assistance?
They must have an active cash PA case to be eligible for FHEPS B.
Yes
No
Please enter the client's public assistance case number
Does the client want to use the voucher to stay in their existing apartment or move to a new apartment?
Stay in their existing apartment (FHEPS to stay --
this is done through the Benefits Access Center (formerly job center)
)
Move to a new apartment (FHEPS to move --
this is done through Homebase offices
)
Next steps: Once you make this referral, please complete the FJC FHEPS B referral form. An FJC admin staff person will then review and sign the FHEPS B referral form if the client is eligible.
THANK YOU!
Download the FHEPS B Referral and Consent form
here
.
Upload completed and signed FHEPS B Referral and consent form:
Add
For FJC admin only
Shopping letter has been used.
Yes
Submit