New York State Residential Rental Application

This New York State Residential Rental Application is prepared in compliance with the Housing Stability and Tenant Protection Act of 2019 (HSTPA) and applicable provisions of the New York Real Property Law and New York City Human Rights Law (where the property is located in New York City).

Under HSTPA, screening or application fees are capped at $20 or the actual cost of the background check, whichever is lower. The landlord must provide the applicant with a copy of any consumer report obtained. The fee must be disclosed as non-refundable if that is the case.

New York and New York City provide robust fair housing protections beyond the federal Fair Housing Act, including source of income, lawful occupation, immigration status (NYC), age, sexual orientation, gender identity, and others. Landlords must use objective, consistently applied criteria.

This application includes FCRA-compliant consent language and adverse action procedures., -

Section 1, Property Information

Date of Application: [[Application Date]]

Property Address: [[Street Address]], [[City / Borough]], New York [[ZIP Code]]

Unit #: [[Unit Number]]

Monthly Rent: $[[Monthly Rent]]

Security Deposit: $[[Security Deposit Amount]] (subject to NY limits where applicable)

Desired Move-In: [[Date]]

Lease Term: [[12 months / Month-to-Month / Other]]

Landlord / Managing Agent: [[Full Name or Company]]

Contact Phone: [[Phone]] Email: [[Email]]

Application / Screening Fee: $[[Fee Amount, max $20 or actual cost of background check]] (non-refundable; actual cost documentation available upon request), -

Section 2, Applicant Personal Information

Full Legal Name: [[Full Legal Name]]

Date of Birth: [[MM/DD/YYYY]]

Social Security Number (for screening only): [[SSN, collected securely]]

Government ID: [[Driver's License / State ID / Passport]] Number: [[ID #]] State/Country: [[ ]]

Phone (Primary): [[Primary Phone]] Email: [[Email Address]]

Current Address: [[Current Address, City, State, ZIP]]

Length of time at current address: [[Years / Months]]

Reason for moving: [[Reason]]

Emergency Contact: [[Name]], [[Relationship]], Phone: [[Phone]]

Co-Applicants / Additional Adult Occupants: [[List names and relationship or "None"]], -

Section 3, Residency History

List current and at least one prior residence (last 2-3 years preferred).

Current Residence

Previous Residence

Section 4, Employment and Income

Current Employer / Source of Income: [[Employer or Income Source Name]]

Position: [[Title or Description]]

Length of Employment: [[Years / Months]]

Gross Monthly Income: $[[Amount]]

Other Income (SSI, pension, child support, etc.): [[Type and monthly amount]]

Employer Contact (HR / Supervisor): [[Name]] Phone: [[Phone]]

If self-employed or other income: [[Provide recent tax returns, bank statements, or award letters as requested]], -

Section 5, Rental History References and Screening Authorization

Prior Landlord Reference #1: [[Name]] Phone: [[Phone]] Relationship to tenancy: [[ ]]

Prior Landlord Reference #2 (if available): [[Name]] Phone: [[Phone]]

Credit / Background Screening Consent (FCRA and NY compliant):

I authorize the Landlord and its authorized screening providers to obtain consumer credit reports, criminal background reports, eviction history, and other permissible reports for the purpose of evaluating my rental application. I understand that:

• The screening fee is limited to $20 or the actual cost of obtaining the report(s), whichever is lower.
• If a consumer report is obtained and used in whole or in part for an adverse decision, I will be provided:
• Notice of the adverse action
• The name and contact information of the consumer reporting agency
• A free copy of the report (upon request within the required time)
• The opportunity to dispute the accuracy of the report

Applicant Initials acknowledging fee cap and report copy right: [[Initials]] Date: [[Date]], -

Section 6, Screening Criteria

The landlord uses the following objective criteria, applied consistently to all applicants:

• Income: Gross monthly income at least [[2.5x or 3x]] the monthly rent (or other disclosed formula: [[ ]]). Verifiable income from all lawful sources is considered.
• Credit: Minimum score or acceptable alternative payment history. Negative items evaluated individually with explanations accepted.
• Rental History: No evictions within [[X years]]; positive landlord references preferred. Outstanding debts to prior landlords generally disqualifying unless resolved.
• Criminal: Reviewed per New York and NYC fair housing guidance. Only convictions directly related to tenancy risk (e.g., violence, property damage, drug trafficking on premises) within relevant look-back periods are considered. Arrest records without conviction are not used.
• Other: Complete and accurate application; no material misrepresentations.

Applicants may submit additional information or explanations for consideration., -

Section 7, Fair Housing and Protected Classes

We are an Equal Housing Opportunity provider. We comply with:

• Federal Fair Housing Act (race, color, religion, sex, national origin, familial status, disability)
• New York State Human Rights Law
• New York City Human Rights Law (if property in NYC): additional protections for source of income, lawful occupation, immigration or citizenship status, age, sexual orientation, gender identity or expression, marital status, and others.

We do not discriminate against applicants based on lawful source of income, including housing vouchers. Guarantors or co-signers are accepted when they meet objective criteria and may be requested where income alone does not satisfy guidelines., -

Section 8, Guarantor / Co-Signer (if applicable)

Guarantor Option: [[Available upon request / Required if income or credit does not meet threshold]]

Guarantor Full Name: [[Guarantor Name]]

Guarantor Relationship: [[ ]]

Guarantor Address: [[ ]]

Guarantor Phone / Email: [[ ]]

Guarantor will execute a separate Guaranty Agreement if approved., -

Section 9, Pets, Occupants, Vehicles, and Other

Intended Occupants (all ages): [[List or "Applicant only"]]

Pets (including emotional support or service animals): [[None / Describe number, type, size, weight]]

Note: Service and emotional support animals are not "pets" and are accommodated per fair housing law with proper documentation. Pet fees or deposits may apply to non-service animals per building policy and law.

Vehicles: [[Number and types]]

Smoking: [[Non-smoking building / Permitted in designated areas]]

Additional Requests or Notes: [[ ]], -

Applicant Certification

I certify under penalty of perjury that all statements in this application are true and complete. I understand that any material false statement may result in denial of the application or termination of tenancy. I have received a copy of the fee disclosure and understand my rights regarding consumer reports.

Applicant Signature: _______________________________________________ Date: [[Date]]

Printed Name: [[Full Legal Name]], -

Landlord Use Section

Fee received: $[[Amount]] on [[Date]] Method: [[Cash / Check / Other]]

Report(s) ordered from: [[Agency Name]]

Report provided to applicant (copy): [[Yes, Date]] [[N/A, No report used]]

Decision: [[Approved / Conditionally Approved (Guarantor) / Denied]]

Adverse action notice sent (if applicable): [[Date]], -

Sources and Notes (as of June 2026)

• Housing Stability and Tenant Protection Act of 2019 (HSTPA), screening fee cap and consumer report copy requirements.
• New York Real Property Law and New York State Human Rights Law.
• New York City Human Rights Law (NYC Admin. Code § 8-107), source of income and additional protected classes.
• Federal Fair Credit Reporting Act (FCRA) adverse action and disclosure obligations.
• HUD and New York State Division of Human Rights guidance on tenant screening.

> ⚠️ Template example, not professional (legal/financial/medical) advice. Confirm current fee limits, protected classes, and procedures with current New York statutes and local rules (NYC has additional requirements). Provide the actual consumer report copy when required. Consult counsel for jurisdiction-specific use. All user inputs shown as [[Merge Fields]].

End of New York Residential Rental Application