Clermont County Community Housing Improvement Program (CHIP) Housing Rehabilitation Application

Transcription

1 Clermont County Community Housing Improvement Program (CHIP) Housing Rehabilitation Application Dear Applicant, To complete your application please review the conditions that apply to a Home Repair versus a Private Owner Rehabilitation and indicate which program you will be applying for by checking the appropriate box: Home Repairs May Include: (generally only 1 or 2 repairs; will be subject to a 0% interest, 100% deferred/declining forgiveable loan; requests are inspected by rehab specialist to determine eligibility): Roof repair or replacement Furnace repair or replacement Gutters & downspouts Flooring issues Handicap accessibility Plumbing repairs Misc. household repairs I am applying for a Home Repair Private Owner Rehabs May Include: (can have more than one repair; will be subject to a 0% interest, 85% deferred/declining loan and 15% permanent lien; requests are inspected by rehab specialist to determine eligibility ): Roof repair or replacement and/or Furnace repair or replacement Gutters & downspouts and/or Flooring issues Handicap accessibility Plumbing repairs Misc. household repairs I am applying for a Private Owner Rehab NOTE: All income for program eligibility is based on current income. yearly gross income. Current income will be projected to 1. Does the applicant s total household income fall below the applicable Maximum Low-Income limit listed below? Yes No 2014 Maximum Low-Income Limit: Size of Household: 1 Person 2 Person 3 Person 4 Person 5 Person 6 Person 7 Person 8 Person Maximum Income: $38,400 $43,850 $49,350 $54,800 $59,200 $63,600 $68,000 $72,350 As soon as the office receives this information, we will contact you regarding your next qualifying step. Completion of this application does NOT guarantee funding. HR.POR Applicatons 00

2 If you have any questions regarding the application please call: Mail the completed application and necessary paperwork to the address below. Return this application to: Clermont County Community and Economic Development Attn: Annette Decatur 101 E. Main St., 3 rd Floor Batavia, Ohio As soon as the office receives this information, we will contact you regarding your next qualifying step. Completion of this application does NOT guarantee funding. 2

3 CHIP APPLICATION Checklist for Homeowner Please include all of the following to assure that your CHIP application will be processed promptly: Proof of current gross income is included for all household members (must have two months of consecutive payments) for all household members (i.e., pay stubs, or letter of income, social security, child support, alimony, etc.) Copy of most recent bank statement Copy of most recent IRS 1040 or signed IRS 4506 Documentation showing that you are current with property taxes Documentation showing that you are current with mortgage (last 6 months) Documentation showing that you are current on your water bill Copy of driver s license Documentation that you have homeowner insurance (Declaration page) Copy of the deed for your home Completed application with signatures Homeowner Affidavit returned with signatures Completed and signed Lead Base Paint Notification If you need assistance with filling out the application, please contact the CHIP Office listed on the application. 3

4 CHIP Application and Analysis Staff use only: Application No.: Date: APPLICANT (head of household) Full Name Address , if applicable: Home Phone Age* Birth date (*This information is being collected as there may be agencies or other resources available to offer additional assistance with home repairs or accessibility issues to seniors or disabled persons) CO-APPLICANT Full Name Address , if applicable: Home Phone Age* Birth date (*This information is being collected as there may be agencies or other resources available to offer additional assistance with home repairs or accessibility issues to seniors or disabled persons) Please Select One: I am applying for a Home Repair OR I am applying for a Private Owner Rehab 1. Year home was constructed:, How long have you lived at the above address? 2. Type of Structure : ( Single Family, duplex) 3. Type of Construction: (frame, block, other) 4. Number of bedrooms: Is there a complete bath? Y N 5. How many people live in the unit? 6. *Are any of the current occupants disabled or handicapped? Y N (*This information is being collected as there may be agencies or other resources available to offer additional assistance with home repairs or accessibility issues to seniors or disabled persons) 4

5 7. Are any members of the household full time students? If so, please list name below and include proof of student status: 8. Please list the items that you feel need replaced or repaired in your home: 9. Have you received public funding, CHIP, or a commitment for rehabilitation on this property in the past? Y N If so, please explain both the type of commitment and why additional funding is necessary. 10. Have you received Weatherization through Community Action? Y N If so, when?. 11. Were you referred by Weatherization? Yes No 12. Do you own other property/land? Yes No 13. I certify that I am / am not (check one) an employee or a family member (grandparent, parent, spouse, children whether dependent or not, grandchildren, brother, sister, or any person related by blood or marriage and residing in the same household) of an employee of an elected official of Clermont County, Ohio. (Clermont County employees are not eligible to participate in the CHIP program) 5

6 DOCUMENTATION OF INCOME Complete the chart below to indicate household income for the next 12 months. This includes wages and salaries, overtime pay, commissions, fees, tips, bonuses; interest, dividends, and other gross income from real or personal property; social security, annuities, insurance policies, retirement funds, pensions, disability; unemployment pay, worker s compensation and severance pay; alimony and child support; and pay received as a member of the Armed Forces. Please provide proof of income of all household members. Total Household Income Family Members (Name) Position in Family (i.e., head of household, spouse, etc) Age Income - (Hourly, Monthly or, Yearly) Source: (place of employment, social security, etc) Do you anticipate any changes to household income within the next year (i.e., pay raise, layoff, etc.) If you do not have any of the following - please state NONE I. SAVING/CHECKING ACCOUNTS Name of Institute Type of Account/Number II. ASSETS (see attached asset information sheet attach separate sheet if necessary) Source Description / Value 6

7 CERTIFICATION AS TO VERACITY The undersigned certifies that all information in this application, and all information furnished in support of this application, is given for the purpose of obtaining rehabilitation assistance and is true and complete to the best of the undersigned's knowledge and belief. The undersigned agrees to occupy the property as his/her/their primary residence and represents that the property will not be used for any illegal or restricted purpose that would lead to forfeiture of, modification of, or other deleterious effect on the property; and he/she/they agree to remain in conformity with any agreement, law regulation or order governing the present use of the property, including, but not limited to, health regulation regarding the use, maintenance and location of septic tank leach beds. The undersigned agrees to allow the Clermont County to verify any of the information contained in this application may be obtained from any source, upon the written request of the City, or their representatives, to the agency or individual having that information. The undersigned acknowledges that the Clermont County will retain the original or copies of this application, even if assistance is not granted. Under the Right to Financial Privacy Act of 1978, the U.S. Department of Housing and Urban Development has a right to financial records held by grantees and sub-grantees in connection with the consideration or administration of assistance to the undersigned. The undersigned hereby authorizes access to and disclosure of all information contained herein and elsewhere in support of this application to the Ohio Development Services Agency (ODSA). Financial records involving the undersigned's transactions will be available to HUD and ODSA without further notice to or authorization by the undersigned but will not be disclosed or released to another agency or department without the undersigned's consent except as required or permitted by law. The undersigned fully understands that it is a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, U.S. Code, Section I/we have been given copies and have read the following documents: Fair Housing Information CHIP Client Homeowner Affidavit/Client Complaint Procedure Lead information Signature: date Signature: date Witness: date 7

8 Statistical Data Please check the appropriate boxes below. This optional information is to be used for statistical and report information only: Are you head of household: Yes No Are you or members of your household disabled: Yes No If yes, how many Applicant Ethnicity: (A.) White (B.) Black or African American (C.) American Indian, Alaska Native (D.) Asian (E.) Native Hawaiian or Other Pacific Is., (F.) American Indian, Alaska Native & White (G.) Black, African American & White (H.) American Indian, Alaska Nat. & Black, Afr. Amer. (I.) Asian & White (J.) Hispanic or Latino (K.) Other Multi-Racial Co-Applicant Ethnicity: (A.) White (B.) Black or African American (C.) American Indian, Alaska Native (D.) Asian (E.) Native Hawaiian or Other Pacific Is., (F.) American Indian, Alaska Native & White (G.) Black, African American & White (H.) American Indian, Alaska Nat. & Black, Afr. Amer. (I.) Asian & White (J.) Hispanic or Latino (K.) Other Multi-Racial Staff use only: Application No.: Date: 8

9 HOMEOWNER AFFIDAVIT CLERMONT COUNTY CHIP I, certify the following: Certification of Veracity: I certify that all information supplied by me to the CHIP Housing Rehabilitation Program is accurate, true and complete to the best of my knowledge and belief. I understand and acknowledge that the Penalty for false or fraudulent statements under U.S.C. title 18 Section 1001, Provides: Whoever, in any matter within the jurisdiction of any false, fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both. Permanent Residence: The property to be improved with the proceeds of the Program Funds is a permanent structure used for year-round residential use and is not recreational or second home. Use of Program Funds: All proceeds of the Program Funds will be used to substantially protect or improve the basic livability or energy efficiency of the property. None of the proceeds will be used to finance any improvements undertaken prior to the closing of this program funding or to refinance any prior indebtedness. Purpose of Assistance: I hereby give my consent to have rehabilitation work done on my property with Federal and State financial assistance, and therefore, I certify that I will abide by the Community Housing Improvement Program Office CHIP Policies and Guidelines in the selection of work to be done, in the selection of a contractor, in the monitoring (inspection) of the contractor s work, and in authorizing payments when the work is satisfactorily completed, as well as all other applicable program requirements. Civil Rights: I certify that I will not discriminate against any contractors or suppliers I may use on the basis of race, creed, national origin, sex, age, or handicap. Architectural Drawings: I understand that should the inspector(s) detect a serious finding to the structure, architectural drawings may be required. The fee for said drawings is an eligible grant expense. Specifications are provided by the CHIP Office. Competitive Bidding: To permit the CHIP Office to seek competitive bids from qualified contractors for all rehab work. Bids will be requested according to procedures established and in accordance with applicable federal, state and local laws. Agreement with Contractor: To enter into a contract with the lowest and best bidder. I understand that may reject in writing the low bidder in favor of the next highest bidder if in my opinion the low bidder does not possess the experience, skill or resources to satisfactorily complete the job, the ability to proceed in a timely manner, or who has not visited my residence before preparing the bid. In that case, the project will be re-bid. Side Agreements: To refrain from making side agreements with the contractor for work not included in my Owner Contractor Agreement with the contractor, or not included in any written Change Orders approved by the Rehab Specialist until all work under the 9

10 HOMEOWNER AFFIDAVIT CLERMONT COUNTY CHIP contract is satisfactorily completed. The CHIP Office assumes no responsibility for the cost or quality of work not covered by the Agreement or approved Change Orders, but the unit must meet OCD-RRS/local codes prior to the grant completion date. Walk Away: A residential unit will be determined a walk-away when staff or contractor estimates exceed the maximum limit of the Home Repair Program. Hazard Insurance: To obtain hazard (fire, property and liability damage) insurance on the property to be rehabilitated in an amount based on its value after rehabilitation. Right to Financial Privacy: The Federal Financial Privacy Act of 1978 guarantees financial confidentiality to persons requesting assistance directly or indirectly from the federal government. To comply with this law, the CHIP Office must inform the rehabilitation client that no financial information will be disclosed or released to another government agency (except ODSA i and HUD ii, which may review the file on a monitoring visit,) without the prior written consent of the client. Financial records involving my transaction will be available to ODSA i and HUD ii without further notice or authorization, but will not be disclosed or released to another government agency or department without my consent except as required or permitted by law. Public Officials Disclosure (Please check one): I certify that I am not an elected official, a direct employee and/or a family member (grandparent; parent; spouse; children - dependent or not; grandchildren; brother; sister; or any person related by blood or marriage and residing in the same household) of a direct employee or an elected official of Clermont County who is responsible for the decision-making of the local CHIP. Or I certify that I am an elected official, a direct employee and/or a family member (grandparent; parent; spouse; children - dependent or not; grandchildren; brother; sister; or any person related by blood or marriage and residing in the same household) of a direct employee or an elected official of Clermont County who is responsible for the decision-making of the local CHIP, but the public servant that I am related to has no decision-making capacity in the local CHIP to the best of my knowledge. 14. Mechanics Liens: No unpaid improvements have been made, or materials or machinery or fuel delivered to the premises within 90 days immediately preceding the date hereof which might form the basis of a mechanics lien. The affidavit acknowledges payment in full of the contract price if the transaction is pursuant to a home purchase contract or a home construction contract. 15. Additional encumbrances: There are no mortgages, judgement liens, security interests arising under the uniform commercial code, tax liens, or other encumbrances of any nature, whatsoever affecting the said premises and the Affiant has no knowledge of any off record or undisclosed legal or equitable interest in the premises. 10

11 HOMEOWNER AFFIDAVIT CLERMONT COUNTY CHIP 16. Rights of Possession: There are no rights of possession, use or otherwise, outstanding in any third persons by reasons of unrecorded leases, sale contracts, options, land contracts, or other documents. 17. Taxes and Assessments: Affiant has not received notice, either orally or in writing of the existence of, or the intention to create assessments affecting the premises from any public authority, including tax recoupment, nor any notice of condemnation, or other exercise of the power of eminent domain. 18. Legal Ability: Each affiant is at least eighteen (18) years of age and is not under any legal disability; that the marital state of each affiant is as shown on the deed, and all prior marriages, if any, have been legally terminated; and no proceedings in bankruptcy have been instituted by or against any of the affiant(s). 19. Environmental Protection: The premises are not in violation of any Federal, State, or local law, ordinance, statute, or regulations relating to hazardous or toxic materials or substances. Affiant has no knowledge nor has affiant received notice, either orally or in writing, of any governmental authority or agency undertaking to remove, clean or otherwise address the presence of hazardous or toxic materials or substances on or about the premises. 20. Purpose of Assistance: I understand that Deferred or Leveraged Loans are to be used for the sole purpose of bringing my home into compliance with the CHIP PROGRAM REQUIREMENTS and that the loan/grant amount is fixed and limited and will be used to correct those problems which the CHIP Rehabilitation Specialist determines are necessary to bring the house into compliance with the CHIP PROGRAM Requirements. Home repair assistance will be provided as a 0 percent interest, 100 percent deferred/declining forgivable loan with a term not to exceed two (2) years. All loans must be secured through the use of a mortgage lien recorded on the property for the length of the affordability period. 21. Permanent Liens: (applies only to POR) As a recipient of Federal and State housing rehabilitation funds, I hereby consent to and acknowledge that a lien will be placed against my property assistance shall be provided as a 0 percent interest, deferred/declining loan, with a term not exceeding five (5) years. Eighty five percent (85%) of the loan will decline in equal increments, on an annual basis, over the term of the loan. The remaining 15% will be due should the homeowner(s) vacate the home and or transfer the property to another person(s). CLIENT/CONTRACTOR COMPLAINT PROCEDURE: Communities receiving a Community Housing Improvement Program (CHIP) grant award through the Office of Community Development (OCD) are required to establish and implement a complaint procedure for dis-satisfied CHIP participants and/or awarded contractors, for rehabilitation work performed within the CHIP program requirements. 11

12 HOMEOWNER AFFIDAVIT CLERMONT COUNTY CHIP Dispute Resolution and Conflict Management Process 1. If there is any dispute regarding the scope of work, workmanship or material quality/selection or any other discrepancy, the homeowner must notify the contractor immediately. If the contractor is not on site, the disputed work must stop and the contractor will be notified. Disputed work will not proceed until the issue is resolved. 2. Both the homeowner and contractor shall contact the administrator immediately when/if the dispute is not resolved between the contractor and the homeowner at step #1. 3. The administrator and/or grantee, rehabilitation specialist, contractor and the homeowner shall make a good faith effort to resolve the dispute at this time. If resolved, details of the dispute and resolution must be documented and signed at this time. The documentation will be placed in the client file. 4. If the dispute is not resolved at step #3, the homeowner must submit a written complaint to the grantee within five working days, on the Dispute Resolution Form provided. Note: Disputed work that is necessary for the health and safety of the occupants, sanitary reasons or the protection of the structure and/or property should proceed to the extent necessary to safeguard until the dispute is resolved. 5. Upon receipt of a written complaint, the administrator shall notify the grantee of the dispute. The grantee may attempt local resolution at this point, but in any case, shall require the administrator to respond in writing within 15 working days of receiving the complaint. Local resolution may be, but is not limited to, a review committee comprised of impartial members. Procedures for local resolution methods must be attached to this policy, and described in the grantee s local Policies and Procedures Manual. 6. The homeowner shall provide a statement, in writing, within 15 working days of the grantee s response date either accepting the proposed resolution or requesting mediation. 7. Within 15 working days of the date of the homeowner s response requesting mediation, the grantee and administrator shall provide the homeowner with the option of two dates for mediation.* *The grantee may opt to proceed directly to arbitration. Mediator Responsibilities If the dispute cannot be resolved through negotiations with all parties, it may be submitted to mediation if the grantee chooses. The mediator is responsible for assisting the parties, impartially, in reaching an agreement on the disputed matter within 30 days of receiving the dispute. 12

13 HOMEOWNER AFFIDAVIT CLERMONT COUNTY CHIP The grantee may use the assistance of, but are not limited to, the Ohio Mediation Association to identify a mediator. The Ohio Meditation Association can be reached at P.O. Box 473, Columbus, Ohio, 43216, and can be contacted by telephone at (614) , and by at Arbitrator Responsibilities If the dispute cannot be resolved through negotiations with all parties or through the optional mediation process, the dispute must be submitted to arbitration. The arbitrator is responsible for providing a resolution to the dispute submitted by the applicant within 60 days of receiving the dispute. The administrator may use the assistance of, but are not limited to, the American Arbitration Association. The American Arbitration Association is located at 250 East Fifth Street, Suite 330, Cincinnati, Ohio and can be contacted by telephone at (513) or by fax at (513) For more information regarding the American Arbitration Association, visit THE UNDERSIGNED ACKNOWLEDGES AND AGREES TO THE ABOVE CONDITIONS. ATTEST: Applicant Date Co-Applicant Date i ODSA: Ohio Development Services Agency ii HUD: United States Department of Housing and Urban Development 13