Apply to Address Confidentiality Program

• Victims of domestic violence who have moved or are planning to move to a new location for safety reasons
• Anyone living in the same household as the victim may also be eligible, such as children, parents or siblings
• Participation is limited to New York State residents

You may apply online or by completing a pdf application.  Completed applications may either be mailed or faxed.  Filing instructions are on the form.

THIS ONLINE PORTAL IS TO BE USED ONLY FOR NEW APPLICATIONS.  DO NOT USE FOR RENEWALS OR CHANGES TO AN EXISTING RECORD

Apply online

This application should be used to make changes to application information submitted by the program:

change/withdrawal notice