How to Fill Out and Submit the HASA Application (Form W-488X)

Form W-488X is the Request for Program Admission you file to enroll in the HIV/AIDS Services Administration (HASA), a division of the New York City Human Resources Administration. You can download it from HRA’s HASA services page or pick one up in person at ServiceLine, 400 Eighth Avenue, 2nd Floor, New York, NY 10001.1New York City Human Resources Administration. HIV/AIDS Services Once the form is complete and submitted with your supporting documents, ServiceLine schedules an intake interview and issues an eligibility decision that opens access to case management, housing, cash assistance, and other supports.

Who Qualifies

Three things have to be true before HASA can enroll you. You must be living with HIV or have an AIDS-defining illness confirmed by clinical documentation, you must be a New York City resident, and you must be low-income as defined by the HRA commissioner.2New York City Administrative Code. New York City Administrative Code 21-126 – Provision of Services to People Living With HIV Symptomatic HIV illness qualifies; you do not need a full AIDS diagnosis.

Income eligibility tracks Medicaid. If you qualify for Medicaid, including through spend-down, you meet the HASA income threshold, and you do not need to be enrolled already. Your caseworker will help with the Medicaid application as part of intake.1New York City Human Resources Administration. HIV/AIDS Services

Citizenship is not required. People with Permanently Residing Under Color of Law (PRUCOL) status can qualify for Medicaid and, through it, HASA. PRUCOL covers a range of situations including deferred action, approved immediate-relative petitions, indefinite stays of deportation, and DACA recipients.3NYC Health. Immigrants: Qualified Aliens/PRUCOL Aliens If your status is unclear, call ServiceLine or one of the legal organizations listed below before submitting the form.

Documents to Gather Before You Start

Most delays trace back to missing paperwork. Have the following ready before you fill anything in.

  • Social Security numbers, full legal names, and dates of birth for you and every person in your household.
  • A government-issued photo ID for the primary applicant: driver’s license, passport, or IDNYC.
  • A laboratory report or written statement from a licensed medical provider confirming your HIV or AIDS diagnosis. This is the “clinical documentation” the statute requires, and a self-reported diagnosis is not enough. Recent CD4 counts or viral load results are worth bringing if you have them.2New York City Administrative Code. New York City Administrative Code 21-126 – Provision of Services to People Living With HIV
  • Financial records: recent pay stubs, benefit award letters (SSI, SSDI, pension), and bank statements. The numbers on the form must match these documents.
  • Housing information: current address, monthly rent or mortgage, and household size. If you are in a shelter or staying with someone temporarily, say so; it changes what housing help HASA can offer.

Filling Out Form W-488X

The form is organized into personal information, household composition, income and assets, and medical verification. Write legibly if completing it by hand. Illegible entries slow processing.

In the personal information section, enter names exactly as they appear on government IDs. A Social Security number that does not match the name on HRA’s records creates a mismatch a caseworker has to resolve before the file can move.

For the financial section, list every source of income: wages, cash assistance, SSI, SSDI, pensions, and any other regular payments. Include asset balances such as checking and savings accounts. The totals must match the pay stubs, award letters, and bank statements you attach. If your income varies, use your most recent documentation and note the fluctuation. Mismatched figures are one of the most common reasons an application gets sent back.

The medical section has to be completed by your healthcare provider. Your doctor or another authorized provider signs off on the HIV or AIDS diagnosis. An unsigned or incomplete medical section will stall the application, so confirm this part is done before you submit.

How to Submit the Application

Every HASA application goes through ServiceLine, which is the single intake point for the program.1New York City Human Resources Administration. HIV/AIDS Services You can get your completed W-488X and supporting documents there four ways:

  • In person at 400 Eighth Avenue, 2nd Floor, New York, NY 10001, Monday through Friday, 9 AM to 5 PM.
  • By phone at 718-557-1399 during business hours to start the process and get submission instructions.4ACCESS NYC. HIV/AIDS Services Administration (HASA)
  • By email to ServiceLine@hra.nyc.gov with scanned documents.
  • By mail to the ServiceLine address above.

Whichever route you use, ask for a receipt listing the date, the type of request, and every document you turned in. That receipt is your proof of filing if a document is later lost or the filing date is disputed. Medical providers and community organizations can also refer you directly to ServiceLine.1New York City Human Resources Administration. HIV/AIDS Services

What Happens After You Submit

ServiceLine will schedule an intake interview once your form and documents are received. At the interview, a caseworker verifies your identity, reviews your medical documentation, confirms your living situation, and assesses your immediate needs. Bring originals of everything you submitted; the caseworker may need to compare them against the copies in your file.

Where city law does not set a specific deadline for a particular benefit, agencies generally must act within about 20 business days of receiving a complete application. If HRA asks for more information, that clock pauses until you respond, so watch your mail and return calls quickly.

The determination notice will say one of three things: approved, denied, or additional documentation needed. Approval triggers case management and connections to the services HASA administers, including cash assistance, emergency and long-term housing, Medicaid, SNAP, home care, mental health and substance use referrals, employment services, transportation help, and assistance applying for SSI or SSDI.1New York City Human Resources Administration. HIV/AIDS Services

If You Need Emergency Housing

Do not wait for a full eligibility determination if you are homeless or about to lose your housing. Emergency transitional housing is one of HASA’s core services, and you can raise the need when you first contact ServiceLine.1New York City Human Resources Administration. HIV/AIDS Services Call 718-557-1399, or go to the ServiceLine office in person during business hours if the situation is urgent. The intake team can assess your need for immediate placement while your W-488X moves through the regular process.

If Your Application Is Denied

A denial is not final. You have 60 days from the date on the notice to request a fair hearing through the New York State Office of Temporary and Disability Assistance.5Legal Information Institute. New York Comp. Codes R. and Regs. Tit. 18 358-3.5 – Requests for a Fair Hearing If you are already receiving HASA benefits and the agency is reducing or terminating them, request the hearing within 10 days of the notice to keep your current benefits going while the appeal is pending.

Fair hearings are decided by an administrative law judge who reviews the agency’s decision independently. You can attend by phone or in person. Bring medical records, income verification, and every letter you have received from HRA. Representation makes a difference at these hearings, and several organizations offer free legal help to New Yorkers living with HIV:

  • HIV Law Project / Housing Works: free legal help for low-income NYC residents on public benefits, housing, and immigration matters. Intake: 212-577-3001.
  • GMHC: civil legal services including public benefits and eviction prevention for registered clients. Legal services line: 212-367-1144.
  • The Family Center (Legal Wellness Institute): representation in administrative hearings covering HASA, SSI/SSDI, Medicaid, and NYCHA. Intake: 718-789-3841 x150.
  • New York Legal Assistance Group (NYLAG): civil legal services including public benefits. Phone: 212-659-6161.
  • Legal Services NYC: representation for low-income LGBTQ+ clients and people living with HIV. Hotline: 917-661-4500, Monday through Friday, 9:30 AM to 4 PM.

Call as soon as you get the denial notice. These offices need time to review your file and pull records before they can appear with you.