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How to Get More Information or Begin the Application Process

You can get more information or begin the application process by either:

  • Calling us toll free at: 1-877-ICS-2525.
  • Emailing us at intakereferrals@icsny.org
  • Filling out a short form, which you can do right now, below.

Please note that membership in ICS is dependent upon meeting our eligibility requirements, a medical assessment, active Medicaid status, and approval by New York State. Completing our online form or contacting us by phone or email is a way to get more information or to take the first step in becoming a member of ICS.

Online Request for Information or to Begin the Application Process

The information you provide will be kept completely confidential, available only to appropriate ICS staff.

First Name* required

Middle Initial

Last Name

City

Street Address

Apartment Number

Zip Code

Daytime Phone Number

Evening Phone Number

Cell Phone Number

Email Address* required

Do you have an active Medicaid number?

If Yes, please provide the number

How did you find out about ICS?

That’s all we need for now.