Disability Rent Increase Exemption Initial Application Form
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2DRIE
NYC DEPARTMENT OF FINANCE
PROGRAM OPERATIONS DIVISION
FOR OFFICE USE ONLY
DISABILITY RENT INCREASE EXEMPTION
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TM
INITIAL APPLICATION
Finance
Please complete this form in full and mail it back with all required documents to:
NYC Department of Finance - DRIE Unit, 59 Maiden Lane, 22nd Floor, New York, NY 10038
SECTION 1 - ELIGIBILITY REQUIREMENTS
To qualify for the Disability Rent Increase Exemption, you must:
Be at least 18 years old
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Be named on the lease or rent order or have been granted succession rights to the apartment
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Rent an apartment defined as eligible under the law (Rent Stabilized, Rent Controlled, Mitchell-Lama, Limited
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Dividend, Redevelopment, Housing Development Fund Company (HDFC) cooperative, Section 213 cooperative)
Have a total household income of $50,000 or less after allowable deductions*
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Pay more than one-third of the household monthly income for rent
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Receive Supplemental Security Income (SSI), Social Security Disability Income (SSDI), VA Disability Pension, VA
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Compensation, or Disability-related Medicaid.
*Allowable deductions are Federal, State, Local and Social Security taxes paid.
Tenants who live in private homes, a New York City Housing Authority development and/or receive Section 8 rental sub-
sidies do not qualify for DRIE benefits.
SECTION 2 - APPLICANT INFORMATION
1. Name of
Tenant: a. __________________________________________
b. _____________________________________________
FIRST NAME
LAST NAME
2. Address: _________________ 3. _____________________________________________________ 4. Apt. #: ___________
NUMBER
STREET NAME
5. City: _____________________________ 6. Zip Code: ____________
7. Telephone (_____)__________________________
Email
8. Address: __________________________________________________ 9. Date of Birth: ______________________________
10. Indicate total number of rooms and windows: Rooms ______
Windows______
11. Check one indicating your apartment type:
Rent Stabilized
Rent Controlled
Rent Regulated Room or Hotel
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HDFC coop
Section 213 coop
Mitchell-Lama
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n
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(Also Limited Dividend and Redevelopment)
12. Check all that applies to your rent increase:
1-yr renewal lease
2-yr renewal lease
Fuel
Building Improvement (MCI)
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n
n
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Carrying charge increase
Temporary surcharge or assessment
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Maximum Collectible Rent (MCR)
Other: _________________________
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13. Specify which federal disability benefit(s)
you receive. Check all that apply:
SSI
SSDI
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VA Disability Pension/VA Compensation
Disability-related Medicaid
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14. Have you ever applied for DRIE before?
Yes
No
If “Yes”, enter the ID Number: __________________________
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SECTION 3 - TENANT REPRESENTATIVE
You can have copies of your DRIE notices sent to another person (in addition to you). To select a representative, please complete the following:
1. Name of
2. Email
Representative: _______________________________________________
Address:________________________________
3. Address: _________________ 4. _____________________________________________________ 5. Apt. #: ___________
NUMBER
STREET NAME
6. City: _____________________________ 7. Zip Code: ____________
8. Telephone (_____)__________________________
DRIE Initial Application - Rev. 05.07.2015
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