TO:	Commissioners; TA & FS Directors; EBT Coordinators; Finance Directors; WMS Coordinators; CAP Coordinators, NVRA Site Coordinators, HEAP Directors

FROM:	Patricia A. Stevens, Deputy Commissioner
	Division of Temporary Assistance

SUBJECT:	Revision to the NYS Agency-Based Voter Registration Form

EFFECTIVE DATE:	Immediately

CONTACT PERSON:	Central Regional Team @ 1-800-343-8859, extension 4-9344

	On February 5, 2004, National Voter Registration Act site coordinators received a letter from the State of New York State Board of Elections advising them of a revision to the “NYS Agency-Based Voter Registration Form” (NVRA-05-rev. 10/03).  Upon receipt of this revised form, districts must begin using it for those applicants/recipients who indicate a desire to apply to register to vote.  Districts may continue to use the existing stock of forms for those applicants or recipients who decline to apply to register to vote or those who claim to be already registered to vote.  For those applicants/recipients who request a mail-in registration form, districts must provide the revised mail-in (blue dot) registration form referenced in the February 5, 2004 letter.  The State of New York Board of Elections will provide an initial supply of these forms under a separate cover.  Districts may order additional forms by calling (518) 474-1953 or by fax using the “NYS Agency-Based Voter Registration Additional Supply Order Form”.  Districts should fax the completed request to (518)-473-8315.

	The NVRA-05 will be included as part of future forms revisions by this Office.