* - Indicates required fields
In order to process your request, select "Confirm Request" from the drop-down box below. By clicking Submit, you are giving your express permission to formally change your billing address with the City of New York.
I hereby attest that I am the above stated individual and that I am authorized to complete the above referenced form and that the above is my current address. I understand that if I provide false information I may be liable for any penalty applicable under law, including possible loss of benefits.
Please click on SUBMIT to send this information to HRA Claims and Collections