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

FROM:	Russell Sykes, Deputy Commissioner
	Division of Temporary Assistance

SUBJECT:	NYS Agency-Based Voter Registration Form (NVRA-05(10/03))

EFFECTIVE DATE:	Immediately

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

National Voter Registration Act site coordinators received a letter from the New York State Board of Elections in February 2004 and a GIS 04 TA/DC003 issued by OTDA, dated February 18, 2004 advising them of a revision to the “NYS Agency-Based Voter Registration Form (NVRA-05-rev. (10/03))”.  Upon receipt of the revised form from the NYS Board of Elections, districts were to begin using these forms for those applicants/recipients who indicate a desire to register to vote. It has come to our attention that outdated NYS Agency-Based Voter Registration Form – (NVRA-05-rev.(4/01)) is continuing to be used for those applicants/recipients who desire to register to vote. For each applicant/recipient who completes the outdated form, the Local Board of Elections is required to contact each applicant/recipient in writing to request that they complete the current form (NVRA-05-rev. (10/03)).

Districts must ensure that the revised “NYS Agency-Based Voter Registration Form (NVRA-05-rev.(10/03))” is being used for applicants/recipients who desire to register to vote. Districts can only continue to use the existing stock of forms for those applicants or recipients who decline 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 from the NYS State Board of Elections.  The New York State Board of Elections provided the initial supply of both these forms in February 2004 and districts must 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.

If you have any questions, you may contact the Cash Assistance Bureau at the number listed above.