Agency Membership & Information Form

Thank you for your interest in NYSACRA membership. We ask that you provide us with information about your agency so that we may be a strong and respected advocate for your agency and the people you support.

NOTE: The agency, primary, secondary, chief executive officer and fiscal officer contact information will appear in the next edition of the NYSACRA Membership Directory. The directory will also include a list of the services provided and the number of people served by the agency.

Agency Contact Information

Primary Contact Information

Agency Services Provided

 Article 16 Clinic
 Article 28 Clinic
 Article 31 Clinic
 Community Habilitation
 Community Residence (CR)
 Day Habilitation
 Day Training
 Day Treatment
 Family Care
 Family Support Services (FSS)
 Individual Residential Alternative (IRA)
 Individual/Community Support (ISS/CSS)
 Intermediate Care Facility (ICF)
 Medicaid Service Coordination (MSC)
 Mental Health Residence
 Primary Medical Services
 Private School
 Sheltered Workshop
 Skilled Nursing
 Supported Work
 Supportive Apartment