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HELP USA Homebase Program

Eligibility Screening Form

Welcome to the Homebase Eligibility Screening

This brief questionnaire will help determine if you qualify for Homebase homelessness prevention services.

About Homebase

Homebase helps New Yorkers overcome immediate housing problems that could result in becoming homeless. They can assist with eviction prevention, benefits advocacy, emergency rental assistance, and more.

Personal Information

We'll send updates about your application status
Enter the ZIP code where you currently stay or receive mail

You are outside our service area

You are outside our service area. Please visit the NYC Homebase locations page for assistance.

NYC Homebase Locations 

You're in our service area

You're in our service area! Your ZIP code matches with:

Household Composition

Anyone 18 or older in the household
Any minors under age 18 in the household

Household Income

Include all sources of income from all household members

Privacy Information

Your information will be kept confidential and used only to determine your eligibility for services. By submitting this form, you confirm that all information provided is accurate to the best of your knowledge.