Legal Document: Opal Meeks v. Department Of Homeless Services

On April 19, 2024 a NOTICE OF PETITION (Motion #001) *Corrected* was filed involving a dispute between Opal Meeks, and Department Of Homeless Services, for Torts - Other Negligence (Discrimination) in the District Court of Queens County.

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(FILED: QUEENS COUNTY CLERK 0471972024 04:41 PM INDEX NO. 708485/2024
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INSTRUCTIONS: FILL IN THE NAMES OF THE PARTIES AND THE INDEX NUMBER. COMPLETE
THE BLANK SPACES NEXT TO THE INSTRUCTIONS IN BOLD. PRINT AND USE BLACK INK ONLY.

SUPREME COURTOF THE STATE OF NEW YORK
COUNTY OF. Se tAc e OS
soma i aX
In the Matter of the Application of
-
Index No. 20S 48S 2024
RAL Me ees NOTICE OF PETITION
[FILL IN NAMES] Petitioner(s)

- against -

VME RP AAIMERT PF ASIMICLESS Seta Es
[FILL IN NAMES Respondent(s)
= i xX

PLEASE TAKE NOTICE that upon the verified petition of
—
XY RAL Meese [INSERT YOUR NAME] sworn to on the _

OM day of AAT , 208.4, [INSERT DATE PETITION SWORN TO IN THE PRESENCE OF A

NOTARY PUBLIC] and the exhibits attached thereto, and upon ail the proceedings in the

case to date, the petitioner(s){INSERT NAMES OF ALL PETITIONER(S)}
K Jyrau M\cekwS
will petition this court,

at's
al AM. on the S¢ day of _T'G4 206L4{INSERT RETURN DATE] at The
Supreme Court, County of Queens-Civil Term Courthouse, located at:

1. 88-11 Sutphin Boulevard, Jamaica, N.Y., in \AS Part 5

2.. 25-10 Court Square, Long Island City, N.Y., in IAS Part_X__,.

[STRIKE CHOICE THAT DOES NOT APPLY}, for a judgment, pursuant to Civil Practice Law and

Rules granting the following relief to the petitioner(s): [NSERT BRIEF STATEMENT OF RELIEF

REQUESTED} Please See SNect vec) Occume SY

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Circumstances surrounding immigration

| entered the U.S. from Jamaica in May 2010 on a B2 visiting visa due to escalating gang
violence in my community. The environment had become increasingly unsafe, leading to the
loss of a number of friends and loved ones. Unfortunately, my child's father became involved,
putting our lives at risk due to our mere affiliation.

The situation reached a critical point with the reprisal deaths of 2 of my daughter's uncles,
prompting me to make the difficult decision to flee the environment entirely. | was the one who
identified one of the bodies at the back of a house a few blocks from where we'd lived. The
same night, another body was laid lifeless just about 4 houses from where we'd found him.

Under these life threatening circumstances it was impossible for us to depart at the end of our
authorized stay. Tragically, my child's father, after serving 7 years in prison, was shot and killed
upon his return to the community in 2017 and it's still unsafe.

Circumstances surrounding supportive housing.

Here in America, | found solace and opportunities, but my undocumented status and financial
constraints hindered my pursuit of higher education. Legal avenues were explored, but marriage
to a U.S. citizen seemed to be the only viable option, leading me into challenging relationships
that further complicated my situation. Unable to navigate these circumstances successfully ;
Mental health issues intensified and compounded my struggles. | was diagnosed with ADHD in
2013. Following this | had a psychotic break in 2014, became dysfunctional and was evicted
from my apartment.

Subsequently, | entered the New York City shelter system, where | dedicated myself to learning
about mental health and seeking ways to restore normalcy.

| was diagnosed with depression in 2015 while residing at Volunteers of America’s Bushwick
family residence in Brooklyn. And in 2018, | was diagnosed with generalized anxiety.

| was told | was not eligible for food stamps, public assistance or cash assistance of any kind. |
was also advised there was no housing program to help in the transition from the shelter system
into independent living for undocumented families. As a result | began making my own natural
juices in the space | was provided and began pedaling from door to door to earn an income.
However, | was only making enough for food. | was unable to offset the cost of rent and the
means needed to sustain myself and daughter.

After my 7th year in the shelter, Covid 19 occurred, my business collapsed and | was left
unemployed. This was a difficult period for myself and daughter as we were advised by HRA we
still didn’t qualify for any support. However, we were able to get help from the food pantry and it
was during this period my psychiatrist did an evaluation and recommended supportive housing.

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In the middle of the pandemic my program program director (who told me he often mentioned
my case in the meetings with DHS), informed me that there was finally a new housing program
specifically geared toward undocumented clients in my situation.

Working closely with my social work representative Shawnette Ransome, we reviewed my case
and highlighted the fact that | did not have public assistance or a social security number.
However | had started building websites, as such | was told that | could provide proof of the
income | was making from my web design business and that would be sufficient to move
forward with the case.

It took a while for the application to be submitted and approved. There were roughly 8 failed
attempts as the system was mostly down. At other times the person to whom the information
was being submitted asked for more details. However, none of the failed attempts was because
| didn’t have public assistance or a social security number.

Subsequently, | was given a letter that | will attach to this email, stating | was approved for
supportive housing between the periods May 15, 2023 to May 16, 2024. | was listed as the head
of household on this approval letter.

After my 7th months of waiting for an interview , | visited the coalition for the homeless to ask for
help. However, they advised they would've only been able to assist with housing if | were in a
single adult facility.

In November of 2023, | was given my first interview via zoom by representatives from Union
commons in the Bronx. However, shortly after this interview, | was told that | was not accepted
because | was undocumented.

My daughter had graduated high school in August of 2023, and went to Texas for college as she
explained our situation was too difficult for her to remain in New York.

Due to her absence; after my first failed interview, my case work supervisor provided me the
address for The Franklin Williams Women’s intake center and told me to go there for them to
place me in a single adult shelter as | could not remain in the family shelter while waiting for
placement.

| was working at PM Dental Services in Queens at the time and so after leaving work the
following week, | went to the facility and explained my circumstances. Roughly 2 AM a
representative approached me in the waiting area and advised me that they wouldn't be able to
host me there. They told me to return to Volunteers of America as they should have room for
me at the facility. Confused, | explained the reason | was there a second time but was given a
letter with the same instructions. | returned to Volunteers of America after 4 am that morning
and later on gave the letter to my case work supervisor. They advised me to remain there until |
received placement.

My second interview was at 1899 Crotona Avenue. | advised Ms. Wright, my interviewer, that |
was denied placement in my first interview because | was undocumented and asked if they

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accepted undocumented immigrants at her facility. She assured me my circumstance would not
be a problem as there were undocumented clients residing in the Crotona building. However,
after waiting a while for a response, | was advised my interview was unsuccessful because |
was undocumented.

| spoke with Leticia Dempts from council woman Sandy Nurse's office who contacted Ms. Ortiz,
the representative on the supportive housing approval letter. She told her | did not have a public
assistance case and that | would have to wait until they found a facility that accepts
undocumented immigrants for the program to which | was approved.

With two months left for my approval to expire | contacted a number of city offices as | was
confused. However, every one seemed to be just as confused as | was.

Following this, | received a letter from DHS that | didn’t understand. It seemed like a
determination for temporary housing assistance that was denied. It mentioned failure to respond
to appointment slips to be assessed for an interview and that | had the right to a fair hearing; but
| had not submitted any recent requests so | gave this information to the District Attorney's office
in Queens. They in turn submitted this information to their sister office in Brooklyn because of
my location but | was never contacted.

Roughly 2 weeks ago my program director approached and asked to speak with me. We went
over the series of events explained above. He advised me that it was unfortunate but it seemed
DHS made a mistake in their decision for me to receive supportive housing and that | would
have to find a way to move forward. | explained | had nowhere to go. | was waiting for
placement. | didn’t understand why | had to pay for a mistake | did not make.

A week later | received a letter from the front desk, stating that | needed to return to path in
person for reinstatement. Upon arrival | explained my circumstances but they told me there was
no longer a child on the case as my daughter is now 19 and that they couldn't assist with
reinstatement. | would be required to leave the facility.

| went back to Council woman Sandy Nurse’s office. They explained It was clear DHS made a
blunder. | shouldn't have been approved because | was undocumented but unfortunately |
couldn't stay at Volunteers of America. They were going to ask the program director to provide
me a grace period to exit the facility and this would be between 3 to 10 days. They provided me
with the address for 116 Williams Avenue at the Help Women’s intake Center so instead of
becoming homeless once again, | would be placed in a single adult shelter instead.

Upon arrival on the 25th around 11pm. | eventually met with a female representative. She
advised me | was a migrant because | didn’t have a social security and as a result referred me
to the migrant shelter in Manhattan. However, when | arrived at the facility shortly after 2am, |
was told | would have had to only be in the country for 2 years to be admitted and that they

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wouldn't be able to assist me there. With no where to go | contacted someone | knew in Queens
and asked if they could hold my bags and suitcase for the night. This was after 4 am.

The next morning | went back to Council woman Sandy Nurse's office and explained the
experience. | was told | should not have been turned away and as such Carlos and the manager
of the facility walked with me to Williams avenue to investigate the matter.

We spoke with a manager who was just as concerned about the incident. She also confirmed
that | shouldn't have been turned away and attended to me right away.

| met with a supervisor today March 28, and explained my circumstances. | was assisted and
referred to Mr. Patterson the housing representative who listened and understood my concerns.
He advised me to document all my information and proceed with the instructions he provided. |
was guided to visit the Family Justice Center to speak with an attorney regarding my experience
and he also informed me of another possible option.

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and granting such other and further relief as this Court may deem just and proper.

PLEASE TAKE FURTHER NOTICE that, pursuant to Civil Practice Law and

Rules 403(b), a notice of petition together with the petition and affidavits specified in the

notice, shall be served on any adverse party at least eight (8) days before such time at

which the petition is noticed to heard. An answer and supporting affidavits, if any, shall be

served at least two days before such time. A reply, together with supporting affidavits, if

any shall be served at or before such time to appear. An answer shall be served at least

seven (7) days before such time, if a notice of petition served at least twelve (12) days

before such time so demands; where upon any reply shall be served at least one day

before such time to appear.

Dated: ee Qheos _ New York
ae2Bir S26 + Qoa4

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Respectfully Submitted,
- =<
~ SA Mice ws

Wek WELR vlome dS Cente (

Wo VN Wi ams Aneacre—

Brooth4q, ale LOANS le WSF
Petitioner(s)
[PRINT NAME AND ADDRESS]

Attorney(s) for Respondent(s)
[PRINT ATTORNEY'S NAME AND ADDRESS]

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HP PAS AL 2. < set D.NYSCEF: 04/19/2024,
6 EA Ty R \ c fy TIN¢
t

Human Resources
Administration
Department of
Social Services.
Gustomized
Acsstance Saracen,

150 Greenwich Street, 30th Floor Date: 05/16/2023
New York, NY 10007
(929) 221-4500
NYC Supportive Housing Application Determination Letter

To: JONITA WOOTEN-MICHEL Applicant: OPAL MEEKS
VOA Preferred or AKA:
BUSHWICK FAMILY RESIDENCE SSN:
1675 BROADWAY HRA Client ID#: 267942
BROOKLYN, NY 11207 Ref Date: 05/15/2023
(212) 865-7000
All applications are reviewed for Supportive Housing developed under the NY/NY |, II, and III
agreements, NYC 15/15, ESSHI and other types of housing with services for individuals at risk of
homelessness and/or history of homelessness.

Below are the housing categories the applicant was reviewed for and the resulting outcome:

Application Type: Family (Includes pregnant Housing Type: Scatter; Congregate*
youth)
Approval Period: 05/16/2023 - 05/15/2024
Approvals: NY/NY Ill; NYC 15/15; ESSHI Medicaid Redesign Team: Yes
Standard Vulnerability Assessment: Low
* The housing type determination ‘is applicable only for NY/NY III and/or NYC 15/15 supportive
housing. ‘ ,

Housing Category Eligibility Determination Contact for Housing Referral
NY/NY III (Population D)
v Eligible Office of Supportive/Affordable
Housing & Services
Families that are chronically Referral and Placement
homeless or at risk of placementinquiries@hra.nyc.gov
homelessness, in which the
head of household requires
support due to an SMI or who
are SMI with a co-occurring
substance use disorder. — ~

This Letter is Not a Rental Voucher

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NYC Suppertive Housing Application Determination Letter Applicant: OPAL MEEKS
HRA Client ID#: 267942
Date: 05/16/2023

Housing Category Eligibility Determination Contact for Housing Referral
NY/NY Ill (Population G) Se Ineligible

Families who are chronically Has a serious mental
homeless or at risk of illness
homelessness in which the
head of household requires
support for a substance use
disorder, a disabling medical
or mental health condition or
HIV/AIDS.
NYC 15/15 Adult Family v Eligible Office of Supportive/Affordable
Housing & Services
Families in which the head of Referral and Placement
household requires support placementinquiries@hra.nyc.gov
due to an SMI and/or a
substance use disorder who
are HUD chronically
homeless.
NYC 15/15 Families with Ineligible
Children
Not a family household
Families in which the head of with children
household requires support
due to an SMI and/or a
substance use disorder who
are HUD chronically
homeless.
ESSHI MH-FA
v Eligible Center for Urban Community
Services (CUCS)
Families that are homeless or (212) 801-3333 or (212) 801-
at risk of homelessness, in 3300
which the head of household housinginfo@cucs.org
requires support due to an
SMI or who are SMI with a co-
occurring substance use
disorder.

This Letter is Not a Rental Voucher

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NYC Supportive Housing Application Determination Letter Applicant: OPAL MEEKS
HRA Client ID#: 267942
Date: 05/16/2023

Housing Category Eligibility Determination Contact for Housing Referral
ESSHI SUD-FA Ineligible

Families who are homeless or No significant functional
at risk of homelessness in impairments due to
which the head of household recent substance use or
requires support for a successful
substance use disorder. participation/completion
in substance use
treatment

The following services are recommended for the applicant:
Mental Health/Day Treatment Program
Ongoing Psychiatric Treatment
TB testing within sixty days of placement into supportive housing unless tested within the last
year

Additional services to be considered for the applicant:
. Money Management Services

To learn more about the criteria for supportive housing please review the Supportive Housing
Description and Criteria sheet available in the Coordinated Assessment and Placement System.

If you have questions about this application determination or disagree with the assessment, please
contact me by telephone or email as listed below.

Best regards,

Michelle Ortiz-Alvarez, LMSW
Senior Consultant Public Health Social Worker
Placement Assessment and Client Tracking (PACT) Unit
ortiz-alvarezm@hra.nyc.gov
(929) 221-4488

This Letter is Not a Rental Voucher

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SCHUMER, CASE WORK

First Conversation

Subject: Fwd: Undocumentation and Housing update with all documents
Email: < i_ruiz-i V>

Cc:

Hey Gandhi,

This is Opal Meeks. Re our conversation this morning, I'm just sending two
attachments and additional information for your perusal.

We spoke about my status as an undocumented immigrant, my mental
breakdown, eviction from my apartment and my stay in the Volunteers of
America Bushwick family residence. | will attach a letter | recently sent to
the Department of homeland security that explains the circumstances
surrounding my status and the letter of approval for supportive housing. |
am hoping to receive assistance to mediate the process between The
Department of homeland security and myself as well as directions to
connect with the direct personnels in charge of placement for
undocumented immigrants approved for supportive housing

e | entered the U.S on May 2nd 2010 due to life threatening
circumstances
e | was diagnosed with ADHD in 2013
e | had a psychotic episode or mental breakdown in 2014 and was
evicted from my apartment

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| entered the Volunteers of America Bushwick family residence and
was diagnosed with depression in 2015
| was diagnosed with generalized anxiety in 2018
| was approved for supportive housing on May 05, 2023
The offer expires May 15, 2024

Within the 8 months since the approval for supportive housing | was sent to
Union Commons at 1007 Union avenue, Bronx New York, 10459 and 1899
Crotona Ave, Bronx Ny 10457 to be interviewed. However on both
occasions | was advised that | was not approved because | am
undocumented

Since then | have visited and contacted

The office of Council member Natasha Williams (27th District)
Coalition for the homeless (129 Fulton Street)
Office of Council Member Sandy Nurse (56 Pennsylvania avenue
Brooklyn, NY 11207)
Congress Member Gregory Meeks' office ( 153-01 Jamaica
Avenue, Ja, Ny 11232
Commission on Human Rights( 153-01 Jamaica Ave, room 203
Jamaica, NY 11432
e And other offices

However, no one was able to assist

Outside of the issue with my immigration status my greatest concern is to
find a supportive housing facility that accepts undocumented immigrants. |
have resided at the Bushwick family residence for 9 years. My psychiatrist

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recommended supportive housing in 2020. My application was approved in
2023 and currently | only have 4 months left before it expires. If you need
any additional information please feel free to reach out via phone or email.
My number is 3476269533. Thanks in advance for your kind support and
help.

Best regards,

Opal

Second Conversation

From: Fogel-Intern, Hudson (Schumer)

Subject: Follow Up - Senator Schumer's Office

Good Afternoon,

Unfortunately, we wouldn't be able to override NYCHA's restriction on

undocumented individuals’ non-eligibility to receive subsidy, but we
can look into the USCIS aspect of your request. In order to do that we
need your physical signature on the privacy release form to begin
processing your casework.

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Please go to this link to fill out the form:
https://www.schumer.senate.gov/services/immigration
Once completed, please return the signed form via email to
casework_schumer@schumer.senate.gov or fax it to us at (202)
228-2838.

Thank you, and please let us know if you have any questions or
concerns.

Sincerely,

Hudson Fogel

Third Conversation

To: Fogel-Intern, Hudson (Schumer)

Cc: Ruiz-Intern, Gandhi (Schumer)

Subject: Supportive Housing

Hey Mr. Fogel,

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Thank you so much for reaching out. | really appreciate it. | just want to
expound on the supportive housing part of the request to provide a bit more
context.

Because of the mental breakdown | experienced | was evicted from my
apartment and was directed to a shelter in Brooklyn . For roughly 6 of the 9
years | spent trying to return to normalcy | was advised that | was not
eligible for supportive housing. However, in 2020 my program director (who
told me he often mentioned my case in the meetings with DHS), informed
me that there was finally a new program specifically geared toward
undocumented clients in my situation.

Working closely with my social work representative Shawnette Ransome,
we reviewed my situation and highlighted the fact that | did not have a
public assistance case or a social security number. However | was told that
| could provide proof of the income | was making from my web design
business and that would be sufficient to move forward with the case.

It took three years for the application to be submitted and approved after
the information was released. Subsequently, | was given a letter that | will
attach to this email, stating that | was approved for supportive housing
between the periods May 15, 2023 to May 16, 2024.

During my 8 month waiting period | was sent on two interviews. One at
union commons and the other at 1899 Crotona Avenue. Roughly 3 months
after my first interview | was told that | was not accepted because | was
undocumented.

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However, after waiting roughly 2 months for a response | contacted
councilwoman Sandy Nurse’s office to request help . That’s when they
contacted Ms. Ortiz whose name is on the letter attached below. She
informed them that the facility at which | did the interview denied approval
because | did not have a Public assistance case and that | would have to
wait until they find a facility that accepts undocumented immigrants for the
program to which | was approved.

This is the reason | am reaching out. The letter of approval | received
expires in 4 months and | am desperately looking to be placed before it
expires. As an undocumented immigrant with mental challenges, it is
extremely difficult for me not only to find employment but to afford living
accommodations in the way | would like. | believe this is one of the reasons
based on the letter attached that | was approved for assistance. My
greatest fear is that | will re-emerge into independent living unprepared and
have a relapse. This would be counterproductive as | would end up
returning to the shelter system as a liability instead of contributing in a
functional way to the environment | have come to know as my home. It's
the reason | am reaching out for help.

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| hope this provides a bit more context. From my understanding it’s not a
situation of overriding NYCHA's decision or policies as | was approved. My
concern is finding out who is in charge of placing undocumented
immigrants in housing for the program to which | was approved before the
remaining 4 months ends. Thanks again for all your help and support. | look
forward to working with you.

Best regards,

Opal

Fourth Conversation

Email: Casework_Schumer@schumer.senate.gov

CC: Frenkel-Intern, Sarah (Schumer)"

Hello Ms. Meeks,

Your email was forwarded over to me for review. It seems your concerns
would be best addressed by your city council member since they would be
able to provide more guidance regarding city agencies, NYC public
assistance and if there are any local agencies available to assist with
finding suitable housing.

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Our office would be limited to matters involving federal agencies. It's my
understanding my colleagues already submitted an inquiry to USCIS
regarding your immigration matter. If you have another pending issue with
a federal agency, please let us know.

Thank you,

Signed: Joyce Chang
Director of Constituent Services | New York City Operations Manager
CHARLES E. SCHUMER
United States Senate Majority Leader
212-486-4430

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Memo:

Date: 3/15/24

To: OPAL MEEKS (unit #214)

From: Residential Service Manager (RSM)

This memo is to inform you that you must return to PATH so that you can be
reinstated as a client at the Bushwick Family Residence shelter. The reinstating
process, as per PATH, states that; “All clients must return to PATH by 9am the
following day after being served their ineligibility documents.” You were served
ineligible notice paperwork from PATH since 3/5/24. As of this date, you have not
returned to PATH to be reinstated. Please note that the process to have you
removed from Bushwick Family Residence will be applied, if you fail to return to
PATH and be reinstated as residences at our shelter by 3/16/24: Note that as per the
city CARES system, you have been removed from our roster by DHS CARES
system since 3/7/24.

RSM:

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Rosario, Maritza

From: Rosario, Maritza
Sent: Monday, March 18, 2024 12:04 PM
To: Sanhueza, Francisca
Subject: Constituent with DHS issue
Attachments: 2773_001.pdf

Hello Fran,

I hope you’re doing well. I’m reaching out to you on behalf of Opal Meeks, who resides
at Bushwick Family Residence, 1675 Broadway, Unit 214, Brooklyn, NY 11207. Ms.
Meeks spoke with someone at your office regarding her shelter placement issue. She’s
been interviewed for supportive housing only to be told that she doesn’t qualify for
it. Ms. Meeks has been told to go back to PATH and then back to Bushwick Family
Residence and no one has been able to provide a resolution to this issue. I don’t know
what your office can for her but I’m concerned that they may tell her to leave and she
has no where else to go.

Also, she did visit your office but saw a sign that says Mondays are by appointment
only. Is it possible for someone to call her? I would appreciate anything you can
do. Thank you in advance.

Thank you in advance.

Maritza Rosario
Staff Assistant
Congresswoman Velazquez Office
7th District, New York
266 Broadway, Suite 201
Brooklyn, NY 11211
P: (718) 599-3658
F: (718) 599-4537

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Department of
Homeless Services

-DHS/DSS-4002F (Rev. 08/06)

ACTION TAKEN ON YOUR REQUEST FOR- ASSISTANCE TO
MEET AN IMMEDIATE NEED OR A SPECIAL ALLOWANCE

NOTICE EFFECTIVE NAME AND ADDRESS OF AGENCY/CENTER OR DISTRICT OFFICE
DATE DATE
03/05/2024 03/05/2024
CASE NUMBER
22541891 ge
CASE NAME (And C/O Name if Present And
ADDRESS)

GENERAL CONTACT INFORMATION
OPAL MEEKS QUESTIONS OR HELP
1675 BROADWAY
Family Unit 214
OR to request an Agency
Conference
BROOKLYN, NY 11207
Fair Hearing Information and Assistance sees 800-205-0110
800-342-3334
Record
Access ... ‘ecordaccess@dhs.nyc.go'
By Mail: DHS Records Access 150 GreenwichSt
38th Floor NY NY 10007
Legal Assistance Information ..._See Legal Assistance Section_

On 09/21/2023 you asked for help with a special/immediate need of TEMPORARY HOUSING ASSISTANCE.

0 Weill help you by:
f] Meeting your need in the following way:

YA
DOC|100237
1 ofS
21 of 27 CARES Case Number: 22541891
INDEX NO. 708485/2024
*NYSC 0G, 2 on RECEIVED NYSCEF 04/19/2024

Department of
Homeless Services

[%] We cannot help you because you have failed to:

{] demonstrate that other housing is unavailable to you at:

[@] cooperate with agency efforts to verify your eligibility by:
XA — Non-Cooperation for Failure to Respond to Appointment Slips to be assessed for an Interview

{] demonstrate that you are a family unit under DHS' family eligibility guidelines. However, you may
qualify to receive shelter services in the shelter system for single adults. Please contact 30th St. men's
Shelter at 400-430 E. 30th St., New York, NY (212-701-4300) or the HELP Women's Center (HWC) at
116 Williams Ave., Brooklyn, NY (718-483-7700).

The LAW(S) AND/OR REGULATION(S) which allow(s) us to do this is 18 NYCRR Sections 351.8, 352.23(a) &
352.35, and DHS Non-financial eli ity rules.

YOUR RIGHT TO AN AGENCY CONFERENCE AND/OR STATE FAIR HEARING

You may appear in person at located at ) on before for an Agency conference to review the Agency's
decision on your application. Prior to that time, you may call to request a postponement
upon a showing of above. If you do not contact the office by phone or in person as noted above, you waive
your right to an Agency conference to review your ineligibility determination. If you do not request or attend an
Agency conference, you may still request a State Fair Hearing as described in the Ineligibility Notice.

Staff:
Print Name

Date: Time:

Service Rendered: O n-Person O under Facility Door O mail

On you asked for help with a special/immediate need of Temporary Housing Assistance.

Upon review of your application at an agency conference, we have decided that:

[] We will help you by:
[] We cannot help you because:

2 ofS
22 of 27 CARES Case Number: 22541891
INDEX NO. 708485/2024
NYSC 2 sm RECEIVED NYSCEF 04/19/2024

Department of
Homeless Services

THE LAW(S) AND/OR REGULATION(S) which allow(s) us to do this is 18 NYCRR Sections 351.8, 352.23(a)
& 352.35,
and DHS Non-financial eligibility rules.

PUBLIC ASSISTANCE - If you are also applying for ongoing public assistance, you will receive a separate
notice telling you of the decision on your application. If you are getting public assitance and your request for
more help is denied, your ongoing public assistance case will not be affected.

FOOD STAMPS - If your request for assistance is met, and you are currently receiving food stamps, your
household's Food Stamp benefits m

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