You can request a copy from your landlord and they must provide it within 5 days of request.
DHCD has now posted the form on-line as a fillable PDF. If you have access to a computer or smartphone with Internet access, you can fill out the form on-line, electronically “sign” it by typing your name on the signature line, and emailing it to your landlord or management agent.
If you do not have the ability to complete the form electronically, you can send a signed letter or an email to your landlord explaining that you missed the rent payment due to a financial hardship due to COVID-19. In that letter, provide detailed information about how your income and expenses have been directly impacted by COVID-19. Give details to your landlord about your income and expenses prior to the State of Emergency and after the emergency. Attach any relevant documentation to the letter (notice of termination, layoff, or furlough from employer, notice of closure of business, etc).