Client Record Request

Clients may request specific records or their “client file.” The client file includes all documents related to the client's application, eligibility, and participation in the program. Clients will receive copies of the documents (not originals) unless directed by court order.

Client Record Request Policy

Indicates required field

Requestor's Contact Information

Name

Phone

Address

City

State

ZIP

Please identify your status:

Current program participant (self)

Former program participant (self)

Program household member

Authorized representative

Other

For the file you are requesting:

Full name:

Date of birth

Please specify the records you are requesting:

How would you like to receive records?

I will pick up records in person from the HACC Admin Office

Please mail records to the mailing address above

Please send via secure email to the email address above

I certify the information provided here is true to the best of my knowledge.

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Client Record Request

Requestor's Contact Information

For the file you are requesting:

SHORTCUTS

ELECTED OFFICIALS

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