COVID Rent Relief Extension Program: Appeal Form
Instructions: Please use this form to appeal a denial of a COVID Rent Relief Program application or
to appeal the calculation of your subsidy amount. If you believe your application was improperly
denied or that the amount of subsidy you were approved for has been miscalculated, you have seven
(7) business days from the date of the notification of denial or award to submit this appeal form.
You may visit our website, https://hcr.ny.gov/rrp, for more information. Please note, appeals will
not be considered if funding for the COVID Rental Relief Program has been exhausted.
Please complete all sections of this fillable form. You may submit your appeal by:
Uploading your completed Appeal Form and all required documents to this site
This Appeal Form and all supporting documents must be submitted together by uploading to the site
listed above. Please make sure that you include all documents that support your appeal, as you will
not be permitted to submit additional documentation.
Please note: This form is translated into Spanish, Chinese, Bengali, Korean, Haitian-Creole and
Russian. Translated forms are available here https://hcr.ny.gov/crrp-translated-appeal-information,
however this form must be completed in English.
1. Applicant Information:
Confirmation Number: ________________________________________________
You may authorize a caseworker, attorney or other personal representative to submit an appeal for the
COVID Rent Relief Program on your behalf. You may do so by providing the representative’s name,
organization (if applicable), address, telephone number and email address (optional) and then signing
this form. Your Authorized Representative must also sign this form.
See COVID Rent Relief Program: Authorized Representative Release for Appeal Form at the end of this
application (Appendix A). Please note, the Authorized Representative Release Form (Appendix A) must
be completed in English.