Get Ny Nycha 040.426 2019-2026

The NY NYCHA 040.426 form, also known as the Medical Verification Form, is essential for requesting reasonable accommodations due to mental, developmental, or emotional disabilities. This guide will provide clear, step-by-step instructions to help users fill out this form online.

Follow the steps to fill out the NYCHA 040.426 form effectively

1. Press the ‘Get Form’ button to obtain the NY NYCHA 040.426 form and access it in your preferred document editor.
2. In Section A, provide the case number and fill in your name as the head of the household. Declare the necessity for a reasonable accommodation in relation to the person with a disability.
3. In Section A, Authorization for the Release of Medical Information, enter the household member's name for whom the accommodation is requested, including their last name, first name, and last four digits of their Social Security Number.
4. Also in Section A, provide the date of birth of the individual for whom the request is made. Ensure that this is in mm/dd/yyyy format.
5. In the Authorization to Release Information section, acknowledge that the authorized health care provider may release necessary information to NYCHA. This pertains to the need for a reasonable accommodation or alternative accommodations.
6. Sign and date where indicated in the authorization section, either as the family member with a disability or as their parent or guardian if applicable.
7. Proceed to Section B where the health care provider or social worker will document their professional details and confirm their relationship to the patient or client.
8. In Section B, the health care provider should answer questions regarding their patient or client, including how long they have been a client, the last evaluation date, and whether the individual has an impairment necessitating accommodation.
9. Require the health care provider to provide a brief description of the condition and how the accommodation would support the individual's needs without disclosing the disability.
10. After completing the form, review all information for accuracy before saving changes and preparing the document for submission.

Complete your NY NYCHA 040.426 form online to ensure your reasonable accommodation request is processed swiftly.