Form W-147N PDF Details

In an evolving landscape where traditional cash security deposits are increasingly under scrutiny, the W-147N form represents a vital tool for both landlords and tenants in New York City. This security voucher, provided by the Human Resources Administration (HRA), offers landlords a guarantee of payment covering up to one month’s rent in cases where a tenant fails to meet their rental obligations or causes damage to the property. The form, which necessitates completion, notarization, and submission within a specific timeframe—three months after the tenant vacates the premises—delineates a clear process for landlords to claim these funds. Importantly, this form also underscores a broader shift towards recognizing various forms of financial assurance beyond cash deposits, aiming to alleviate the upfront burden on tenants while still protecting landlords’ interests. By embedding within its directives a non-discrimination clause that addresses source of income, the W-147N form further aligns with NYC Human Rights Law, ensuring its role not just as a financial instrument but as a mechanism for broader social equity. The comprehensive approach taken by the W-147N form—requiring thorough documentation and adherence to procedural timelines—illustrates the nuanced balance between tenant protections and landlords' rights, encapsulated within the regulatory frameworks of the NYCDSS and Social Services Law Sec. 143-c and 18 NYCRR 352.6 and 381.3.

QuestionAnswer
Form NameForm W-147N
Form Length2 pages
Fillable?Yes
Fillable fields71
Avg. time to fill out14 min 46 sec
Other names147n, w147n, new york 147n, nyc hra security voucher form

Form Preview Example

Form W-147N (front)

Rev. 11/2/16

Date:

Case Number:

Case Name:

Center:

Security Voucher

This security voucher guarantees that the Human Resources Administration (HRA) will pay up to the equivalent of one month’s rent if it is verified that the tenant who occupied the apartment failed to pay his/her rent and/or caused damage to it. The landlord must submit proof of the unpaid rent and/or damage along with the Landlord’s Claim For Security Voucher Payment (on the back page) within three months after the tenant has vacated the apartment. The Agency will only make a payment if the claim is submitted within three months after the tenant has vacated the apartment and a review of the documentation submitted by the landlord confirms that the tenant failed to pay his/her rent and/or damaged the apartment. This Security Voucher will not be honored until the front and back pages have been completed, signed, notarized, and returned to HRA.

The Human Resources Administration (HRA) does not issue cash security deposits. Instead, the Agency is issuing this Security Voucher. Please be advised that refusal to accept this voucher in lieu of a security deposit may constitute source of income discrimination under the NYC Human Rights Law Sec. 8-107(5)(a)(1)-(2).

This Security Voucher is issued by the New York City Department of Social Services (NYCDSS), having its principal offices at

150 Greenwich Street, New York, NY 10007, to:

Name of Landlord:

Landlord's Address:

City: State: Zip:

as Landlord of the premises to be rented to the participant/tenant located at: (include proof of ownership):

Address:

Apt.

City: State: Zip:

regarding the participant/tenant listed below:

Participant/tenant:

This Security Voucher is being issued pursuant to Social Services Law Sec. 143-c and 18 NYCRR 352.6 and 381.3, to secure the landlord against non-payment of rent and/or damages as a condition of renting the above-identified premises ("Premises") to the above-named Cash Assistance participant/tenant ("Participant/Tenant"). A claim for the payment of this Security Voucher by the landlord must be made after, and within three months of, the participant/tenant vacating the premises. The claim must be made by the full completion and execution of the Claim on page two of this form and cannot exceed the amount of the Tenant's monthly rent

which is $

 

.

Landlord, please acknowledge your acceptance of the Security Voucher in lieu of a cash security deposit by signing this form below:

Landlord's/Authorized Agent 's Name (print):

Landlord's/Authorized Agent's Signature:

 

Date:

(This voucher is not valid until it has been fully completed and authorized in the "For HRA Use Only" section below.)

For HRA Use Only:

Supervisor's Name (Print):

Supervisor's Signature:

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

Control Unit Supervisor's Name (Print):

 

 

 

 

 

 

 

 

Control Unit Supervisor's Signature:

 

 

 

Date:

 

 

 

Control Unit Authorization #:

 

 

 
"I,
true and complete.

Form W-147N (back)

Human Resources Administration

Rev. 11/2/16

Family Independence Administration

Landlord's Claim for Security Voucher Payment

I (we), the Landlord(s) of the premises described on page 1 of this form, certify that

tenant/participant name

has vacated the apartment located at

 

Apt.

 

on or about

 

 

and occupied the

 

address

 

 

 

 

 

date

apartment within three months prior to the date of this certification.

 

 

 

 

 

I hereby request that the security voucher be paid to me for the reason specified below:

 

 

 

 

 

 

 

 

Tenant/Participant defaulted on payment of rent for

 

 

 

 

(provide court

judgment, stipulation, landlord breakdown, etc).

 

 

 

 

Month/Year

 

 

 

 

 

 

 

 

 

 

 

Tenant/Participant caused the following damages to the apartment. (Describe and also include proof of damage[s]: e.g., photographs, estimates, receipts for repairs, etc.)

, hereby swear/affirm, under penalty of perjury, that the information I have given above is

(Signature of Landlord or Office of Corporation)

(Print Name)

Subscribed and sworn to/affirmed before me this (Date)

(Signature)

(Notary Seal)"

Please submit the following items along with this claim form: proof of ownership (of the premises); and

documentation of unpaid rent (e.g., court judgment or stipulation, landlord breakdown, etc.) or documentation to verify the damage(s) to the apartment and the cost of repairs (e.g., photographs, estimates, receipts for repairs, etc.)

Please send claim to:

Office of Central Processing

 

P.O. Box 02 – 9121

 

Brooklyn GPO

 

Brooklyn, NY 11202-9914

For Office of Central Processing use Only

Case Name:

 

 

 

 

 

 

 

 

 

 

Last:

Pick-up Code:

 

 

 

 

 

 

 

 

 

 

 

 

Special Roll ─ 1

 

 

 

 

 

 

 

 

 

 

 

 

Case Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date Form Prepared:

 

 

 

/

 

 

 

 

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

Amount

 

 

From:

Issuance Code

Dollars

Cents

Month Day

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Dollar Amount in Words

First:

Job Center:

Suffix: Authorization Number

 

To:

 

Restricted Indicator

Year

Month

Day

Year

 

 

 

 

Dollars

Cents

Optional Fields(Block Print Only)

Payee Name:

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

State:

 

Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Authorized Signature

 

Print Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

Title:

 

 

 

 

 

 

 

 

 

 

 

OCP Control Clerk:

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OCP CRT Operator:

 

 

 

 

 

 

Date:

 

 

 

 

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