Application For Appeal Of The Disability Rent Increase Exemption Determination Form (Page 5 of 5) in pdf

Instructions for the Application for Appeal of the DRIE Determination

Page 2

Section C - Ground(s) for Appeal

- Continued

tion of the grounds for the appeal, will result

right to succession following the death of the

in a denial of the application for appeal.

tenant of record, submit a copy of the court

order that shows you have succession rights

to the apartment, or, a copy of the rent regula-

Ineligible Apartment

If you checked 18-1: If you contend that the

tion registration filed at DHCR by your landlord

that shows that you are a tenant of record, or,

apartment is not rent-regulated, you should pro-

a letter from the landlord acknowledging that

vide documentation from DHCR indicating that

you are considered the tenant of record; or,

the apartment is not rent regulated. (Landlords

can obtain from DHCR a list of apartments that

are the spouse of the tenant of record.

have been registered with DHCR as rent-regu-

lated apartments in a particular building.)

Disability-Related Eligible Financial Assistance

Ineligible Tenant

If you checked 17-3a through 3d: You should

If you checked 18-2: If the lease or rent order

submit a copy of a benefit letter from the So-

does not support your appeal on this ground,

cial Security Administration or other govern-

please submit any other documentation from the

ment agency that shows that you receive SSI,

DHCR, court or government entity showing that

SSDI, a Department of Veterans Affairs dis-

the tenant is not eligible. If the DRIE applicant

ability pension or compensation, or disability-

is the disabled spouse or registered domestic

related Medicaid (and have received either SSI

partner of the tenant of record, he/she will be el-

or SSDI in the past.)

igible for DRIE even if not named on the lease

renewal or rent order.

Eligible Income

If you checked 17-4: Please specify amounts of

Note: To expedite review of the Application for

income that should have been excluded from

Appeal, a copy of the Determination Letter is-

countable wages or income that would bring your

sued by the DRIE unit should be provided.

household income below the DRIE threshold.

Section D – Certification

One-third Income For Rent

If you checked 17-5: Please specify all

Everyone who files an appeal should sign the

amounts of countable wages and income that

appeal application form. Anyone who com-

you believe should be excluded, which would re-

pleted the form on someone elseʼs behalf

sult in rent amounting to more than one-third of

should also sign on the “Preparer” line. If you

your household income. You should submit the

do not sign the form, it will be returned to you for

following: a copy of the renewal lease for the

signature, delaying your appeal process.

current period, or, a copy of the rent order is-

sued by the DHCR to show your rent, and a

copy of the most recent federal income tax re-

CUSTOMER ASSISTANCE

turn (Form 1040) for all members of the house-

hold, or other proof of household income.

If you need assistance in

FOR OWNERS:

completing this application,

Please submit a copy of the tenantʼs most recent

lease or rent order. Failure to notify the ten-

please call 311.

ant of the appeal, in writing, with an explana-

Application For Appeal Of The Disability Rent Increase Exemption Determination Form Page 5

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