137A Form – Fill Out and Use This PDF

137A Form PDF Details

The Form W-137A, officially the "Request for Emergency Assistance or Additional Allowance," is issued by the New York City Human Resources Administration (NYC HRA). This form allows cash assistance participants to request urgent help or apply for extra allowances to cover needs not met by standard aid programs.

The 137A form covers a wide range of urgent needs:

• Back rent payments to prevent eviction
• Repair of essential household items (stove, refrigerator, heating equipment)
• Pregnancy-related allowances and expenses
• Burial and funeral expenses
• Clothing replacement following a fire or other disaster
• Moving expenses and security deposits for a new address
• Work-related supportive services, including child care and public transportation
• Adding a new member to an existing cash assistance case

To submit Form W-137A, gather documentation supporting your request. Your HRA caseworker may schedule a meeting to review your situation in person. For other government assistance forms, browse our financial assistance application or DA Form 137-2.