Please complete the following fields to create a Social Services account.

Organization Information

Company, Agency, or Apartment Building: Address:
DBA, if different:  
Management Company, if different: City:
Main Contact: State:
Title: Zip:
Phone Number: Ext.
Fax #:

Fax Number to Register


Date you would like to begin

Start Date (mmddyyyy):

Tax Exemption Status

Is your agency tax exempt? Yes No

Agency Type

State or County Social Services/Human Services Agency Social Security Administration
Work Program (WIA) Housing Authority
Low-Income Housing (i.e. Sec. 8, Sec.42) Child Support Enforcement
Third Party Vendor for Government Agency Other

Specific Programs or Divisions that will use this Service

Food Stamps TANF General Cash Advance Low-Income Energy Assistance
IEVS Fraud Investigations Quality Control Housing Assistance
Title IV-D Emergency Assistance Title II Title XVI
Collections Pre-employment Medicaid Daycare Assistance
Work-related Assistance   Mortgage Loans Apartment Complex
Other: Please indicate other programs that will use this service:

Apartment/Property Management

If you are an Apartment Complex or Property Management Company, please answer the following questions:
How many units do you have?
  How many of those are subsidized units?
Are you affiliated with a City/State Housing Authority? Yes No
  If yes, please include the name: