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New York State Human Trafficking Referral Form

Referral of Human Trafficking Victim

Social Services Law § 483-cc requires that this form be completed and sent to the Division of Criminal Justice Services and the Office of Temporary and Disability Assistance as soon as practicable after a first encounter with a person who reasonably appears to be a human trafficking victim.


Please contact Carl Boykin by email at carl.boykin@dcjs.ny.gov or by phone at 518 485-7718 if you encounter difficulty completing or have questions regarding the form.
This question requires a valid date format of MM/DD/YYYY.
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5. Please check one or both *This question is required.
8. Is the victim willing to assist in the investigation/prosecution of trafficker(s)? *This question is required.
9. Was the victim arrested? *This question is required.