APPLICATION FOR AFFORDABLE HOUSING

Transcription

1 APPLICATION FOR AFFORDABLE HOUSING WELCOME! We are very happy you are interested in Our Family Services affordable housing. Our units are spacious, comfortable and have easy access to bus lines and shopping with a tenant driven community attitude. We are highly invested in making your tenancy with us a successful, positive experience. Our affordable housing is a compliance monitored program. This means you will need to meet some basic requirements. To help you decide whether you qualify, we are asking you review the requirements and to do some self-evaluation before submitting your application. Application fee is $30.00, is NON-REFUNDABLE and is due when you submit your application. BASIC REQUIREMENTS: Minor child(ren) in your physical custody at least 50% of the time Meet the income requirements, both minimums and maximums Able to obtain TEP and SW gas accounts Able to pay deposit and calculated rent at lease signing Able to provide copies of social security cards, birth certificates and driver s license or other official ID Able to pass the criminal background check review INCOME REQUIREMENTS, APPLICATION INSTRUCTIONS AND PAPERWORK: The below step-by-step guide will help you work through the self-evaluation and application process. Step 1. Your income will need to meet certain minimum levels to qualify for housing. Please compare your current income to the levels listed below to see if you meet the minimum income requirements. 2 Bedroom Gross annual income must be at least $16,300 - $18,000 (site specific) 3 Bedroom Gross annual income must be at least $20,400 You can calculate your annual income by taking your hourly rate, multiplying it by the average number of hours you work per week, then multiplying this number by 52 weeks. Example: $10.00 per hour x 40 hours per week = $400 per week. $400 per week x 52 weeks = $20,800 per year Compare your annual salary of $20,800 to listed minimums. You meet minimum income for 2 or 3 bedroom units. Step 2. Your maximum annual income cannot exceed certain limits. If your annual income exceeds $38,350, please call our office, ex Maximum limits increase with family size so you may still qualify. Step 3. Review your expenses. We have included a budget sheet (next page) to help you figure your monthly expenses and the amount you would have to pay for rent. Please try to be accurate! Our rents range from $430 to $695. Step 4. Once you determine you meet the basic income guidelines, you will need to fill out the attached application. Application must be completed by the applicant. Co-applicants must fill out a separate application Print legibly and in ink Fill out EVERY field. Do not leave any fields blank. Use N/A for fields which do not apply to you Sign application where indicated Step 5. Submit your application with your $30.00 non-refundable fee. You will need to provide COPIES of the following documentation with the application. Do not bring originals. We are not able to copy the documents for you. 4 weeks of pay stubs. They must be the most recent and concurrent Other income information such as letter from social security, unemployment benefit information, child support, cash assistance (income list attached) Step 6. Prior to signing your lease for your new home, you will need to submit additional documentation. However, when you submit the information is up to you. You are welcome to submit all the documentation with your application, or we can review and qualify you first, then you can bring in the additional paperwork. The choice is yours! However, be aware that we will need all of the documents and documentation before your lease is signed. Thank you so much for your interest in our affordable housing. We hope you decide to join us. Please feel free to call our office with any questions or if you need assistance with the application, ex Return completed application(s) and fee(s) to: Our Family Services, 2590 N. Alvernon Way, Tucson, AZ

2 APPLICATION FOR AFFORDABLE HOUSING Budget Worksheet Please use this worksheet as part of your initial self-evaluatio on to see if you might qualify for our affordable housing. Our apartments are wonderful and our rent extremely reasonable, however, we still are an affordable housing program which will require more paperwork than a market place apartment. Part of the advantage to applying for our affordable housing is our ability to accept tenants with credit issues and some eviction history. In addition, once you apply, your application is screened on an individual basis and YOUR situation is assessed. To help uss in our assessment process and to potentially save you a NON-REFUNDABLE $30 application fee, we highly encourage you to review our basic criteria to qualify, income ranges, and complete the below budget self-evaluation. Self- Evaluation of Estimated Monthly Expenses Gas & Electric Telephone / Internet / Cable Daycare Expense / Tuition Food Clothing / Household Supplies Auto Expense (payment, gas, insurance) Debt (student loan, credit card, court fees, etc.) Other expense Other expense Total of Your Estimated Expenses Monthly Income Calculate your monthly income by: 1) Take gross annual income calculated in Step 1of your application 2) Divide by it by 12 Total of your Estimated Monthly Income How much rent can Enter Estimated Monthly Income Subtract Estimated Monthly Expenses Remaining amount for rent Compare to rent ranges listed on front I afford? Example: Monthly income = $1,700. Monthly expensess = $ ( = 750) Remaining amount towards rent = $ Compare too rent range of $430 - $695 Return application and documentation to: Our Family Services, 2590 N. Alvernon Way, Tucson, AZ We have resources available if you feel you would not qualify for our Affordable Housing. Please contact our Pathways to Home

3 APPLICATION FOR AFFORDABLE HOUSING CHECK SHEET OF REQUIRED INFORMATION We need to verify and document ALLL your income for our program reporting requirements. You may have one form of income or a combination of several forms of income. Please indicate all that apply. You will need to provide documentati ion. You will need to provide COPIES of your documentation. Please do not bring originals. We are not able to copy the documents for you. INFORMATION YOU MUST SUBMIT WITH YOUR APPLICATION, AS IT APPLIES TO YOU: EMPLOYMENT AND/OR INCOME (Please check all that apply to you and provide documentation): PAY STUBS Four (4) most recent, consecutive weeks and for all working family members o OR VERIFICATION OF EMPLOYMENT FROM EMPLOYER o OR IF SELF EMPLOYED, SELF EMPLOYMENT CERTIFICATION (Ask us for the form) o OR UNEMPLOYMENT AWARD LETTER SOCIAL SECURITY AWARD LETTER (SSI and / OR SSDI) PUBLIC ASSISTANCE AWARD LETTER TANF AWARD LETTERS SCHOOL TUTION, STUDENT LOAN/GRAN TS / FINANCIAL AID DOCUMENTS, SCHOOL SCHEDULE COURT DOCUMENTS FOR CHILD SUPPORT OR ALIMONY ANY OTHER RELEVANT DOCUMENATIONN TO ASSIST IN VERIFICATION OF INCOME OTHER: OTHER: INFORMATION YOU MUST SUBMIT ONCE YOU ARE APPROVED AND WANT TO PROCEED: CHECKING Six months of most recent, consecutivee statements SAVINGS current monthly savings statement OR ASSET VERIFICATION FORM FROM YOUR FINANCIAL INSTITUTION RECURRING CASH CONTRIBUTION FORM must be MAILED or FAXED into the office from contributor TAX RETURN: Last or most recent year filed. If not filed, why? LEGAL DOCUMENTS: SOCIAL SECURITY CARDS (for any children born/in custody since move-in) BIRTH CERTIFICATES (for any children born/in custodyy since move-in) DIVORCE DECREE Or court related documents to petition for divorce CHECK SHEET OF REQUIRED INFORMATION this form AFFORDABLE APPLICANT HOUSING INCOME CHECKLIST (attached). Additional documentation may be requested depending on your answers to the Income Check List FORMS YOU MAY NEED TO COMPLETE AT LEASE SIGNING IN ADDITION TO LEASE/ADDENDUMS You may need to fill out additional affidavits, depending on your situation. If any of the below affidavits are equired, you will be asked at lease signing to fill out and sign them. AFFIDAVIT OF NO CHILD SUPPORT One (1) form perr each child GENERAL TENANT RELEASE AND CONSENT FORM SELF EMPLOYMENT CERTIFICATION FORM UNEMPLOYMENT AFFIDAVIT Return application and documentation to: Our Family Services, 2590 N. Alvernon Way, Tucson, AZ If you have any questions concerning the application or application process, please call our Alvernon front desk, , ex. 410.

4 APPLICATION FOR AFFORDABLE HOUSING Applicants will receive consideration without discrimination of race, national origin, ancestry, disability, gender identity, marital status, color, age, religion, gender (sex), sexual orientation, familial status. Reasonable accommodation and alternative format for people with disabilities are available upon request. Please call (520) ex. 410 for assistance. INSTRUCTIONS: Application is to be completed by the applicant. Please print legibly in ink. Do not leave ANY blanks. Use N/A for questions or fields which do not apply to you. Return completed application and documents to: 2590 N. Alvernon Way, Tucson AZ BASIC INFORMATION APPLICANT: FIRST MIDDLE LAST CURRENT CONTACT NUMBER: SOCIAL SECURITY NUMBER: - - DATE OF BIRTH: / / STUDENT STATUS: _YES _NO_ MARITAL STATUS: SINGLE SEPARATED MARRIED DIVORCED (please provide divorce decree) CURRENT ADDRESS: DEPENDENTS: ADDRESS CITY STATE ZIP (1) (2) (3) (4) (5) (6) CO-APPLICANT Must fill out a separate application: (1) DO YOU HAVE AN OUTSTANDING BALANCE WITH OUR FAMILY OR NEW BEGINNIGS FOR WOMEN & CHILDREN? _YES_NO_ HOW MUCH? $ THE BALANCE MUST BE PAID BEFORE LEASE SIGNING 2. EMPLOYMENT INFORMATION EMPLOYMENT STATUS: EMPLOYED FULL-TIME EMPLOYED PART-TIME SELF-EMPLOYED UNEMPLOYED_ CURRENT EMPLOYER: POSITION: CURRENT WAGES: $ PER: HOUR WEEK BI-WEEKLY SEMI-WEEKLY MONTH YEAR AVERAGE HOURS WORKED PER WEEK: HOW LONG HAVE YOU BEEN AT YOUR JOB? OTHER SOURCES OF INCOME: Page 1 of 3 Application for Affordable Housing revised Feb 2014

5 3. STUDENT STATUS ARE ALL APPLICANTS/ DEPENDENTS FULL TIME STUDENT? IF YES, COMPLETE THE FOLLOWING: DOES THE HOUSEHOLD RECEIVE TANF? IS THE HEAD OF HOUSEHOLD IN A JOB TRAINING PROGRAM? IS THE HOUSEHOLD COMPRISED OF A SINGLE PARENT AND DEPENDENT CHILD (REN)? ARE APPLICANT AND CO-APPLICANT MARRIED AND DO THEY FILE A JOINT TAX RETURN? 4. VEHICLE INFORMATION - PROVIDE A COPY OF CURRENT REGISTRATION(S) AND INSURANCE WITH APPLICATION DO YOU OWN VEHICLE(S)? IF YES, PLEASE PROVIDE THE FOLLOWING INFORMATION: Vehicle: Make Model Year Color Plate # Vehicle: Make Model Year Color Plate # 5. LEGAL INFORMATION PLEASE ATTACH A DETAILED EXPLANATION FOR ANY YES ANSWERS HAVE YOU EVER BEEN INCARCERATED? IF YES, ARE YOU CURRENTLY ON PROBATION OR PAROLE? HAVE YOU EVER BEEN CONVICTED OF A SEX OFFENSE? HAVE YOU EVER BEEN IN A GANG? IF YES, DO YOU HAVE CURRENT GANG AFFILIATIONS: ARE YOU CURRENTLY INVOLVED WITH THE COURT SYSTEM? 6. CERTIFICATION OF DIVESTITURE OF ASSETS I hereby certify that during the two (2) year (24 month) period preceding the effective date of my certification/recertification of eligibility for program participation, I HAVE NOT disposed of any asset(s) valued at more than $1,000. I hereby certify that during the two (2) year (24 month) period preceding the effective date of my certification/recertification of eligibility for program participation, I HAVE disposed of the following asset(s) (TOTAL VALUE OF ALL ASSET(S) DISPOSED OF IS GREATER THAN $1,000.00) as identified below (if necessary, attach additional information): ASSET(S) FAIR MARKET VALUE AMOUNT(S) RECEIVED I have been made aware of the provisions of Section 1001 of Title 18 of the U.S. Code. I understand it is a criminal offense, punishable by a $10, fine or 10 years imprisonments or both, to make willful statements of misrepresentation to any Department or Agency of the United States as to any matter within its jurisdiction. I certify that the information I have provided is true and complete to the best of my knowledge. 7. AGREEMENTS, AUTHORIZATIONS, ACKNOWLEDGEMENTS AND EXPECTATIONS Initial each of the following: 1. I understand a refundable security deposit of $ is required prior signing the lease. The deposit may not be used as payment of outstanding rent during my occupancy. It is refundable after move out as long as the conditions outlined in the lease are met. 2. I understand participation in Our Family s affordable housing program requires annual income certification and household size verification. I agree to provide the appropriate documents necessary to Our Family staff by the deadline given to me. Failure to comply could result in termination of housing. 3. I understand I must pay a non-refundable $30.00 application fee in the form of a money order or cashier s check with my completed application for affordable housing. 4. I understand and consent for Our Family staff to run a credit and criminal background check. The reports will be obtained to verify my credit information and criminal record report and will be used in determining whether I am eligible for affordable housing offered by Our Family. Should I be accepted into affordable housing, I understand Our Family staff has continued rights to review my credit information / criminal records for review purposes. 5. I agree to provide additional documentation if there are judgments on my credit report which individually exceed $2,000. I also agree to provide documentation of payment on certain outstanding utility accounts. Page 2 of 3 Application for Affordable Housing revised Feb 2014

6 6. I agree to provide additional documentation Our Family staff may request as a result of my criminal background report. RELEASE OF INFORMATION: To establish initial or continuing eligibility, I must provide documentation of income, assets, and household composition to the authorized Agency representative for the unit I wish to rent. This information is provided by me at an eligibility certification or recertification conducted by the authorized agency representative and is considered confidential. By my signature, I authorize the release of information I provided to the authorized agency to the City of Tucson Community Services Department. This information may be exchanged only between the agency and the City of Tucson for the purpose of determining my eligibility for the agency s rental program and for reviewing my file for accuracy and program compliance. I understand no information will be divulged to any party who is not directly with this program. TUCSON/PIMA COUNTY HMIS CLIENT AUTHORIZATION: Our Family uses the Tucson/Pima County Homeless Management Information System (HMIS), a secured internet-based database, to track information on the people it serves. The information we collect and input helps us to plan for and provide services to clients. The information is also necessary for us to maintain our funding due to grant reporting requirements. Homeless provider agencies across Pima County use this common database, and with authorization this information can be shared among agencies in order to improve coordination and service delivery. By signing below you are: Acknowledging the demographic information about you and your family will be entered into (HMIS) and allowing basic demographic information about you and your family to be viewed by other agencies providing homeless services. This includes name, social security number, date of birth, and gender Understanding the sharing of this information will allow you to be served by other agencies without repeating your basic information and the agency entering your information will not be identified with you Understanding information such as health, medical needs, mental health, or domestic violence will NOT be shared without your specific written approval. I understand this authorization will be in effect for the duration of the Tucson/Pima County HMIS unless I revoke authorization. I understand this authorization can be revoked at any time, discontinuing future sharing of information. APPLICANTS WILL BE DENIED FOR THE FOLLOWING REASONS: Conviction of a violent crime, manufacture or distribution of a controlled substance within seven (7) years prior to application date. Conviction for drug related offenses within one (1) year prior to the application date. Conviction of a sexual offense. Previous evictions for reasons other than non-payment of rent. Income unqualified. Use of threats, intimidation, and / or violence towards Our Family staff, clients and / or applicants. Our Family has final and conclusive interpretation of these rules. I have read and understand the reasons for which I may be denied housing with Our Family. GRIEVANCE PROCEDURE: The grievance procedure allows an applicant, client or tenant a formal process to voice concerns regarding denial of housing application, discrimination or quality of services. This procedure does not guarantee a reversal of a decision, but provides an avenue for formal consideration. A grievance must be submitted in writing within ten (10) days of the date of denial of the application to the New Beginnings Program Director (or designee). Grievance will be reviewed by the Executive Director. New Beginnings Program Director will meet with the individual within five (5) days of receipt of the written grievance. A final decision will be made in writing within ten (10) days of receipt of the written grievance. If the applicant is not satisfied with the decision, an appeal may be made to the Our Family s Board of Directors. An appeal should be submitted to the President within five (5) days of receipt of the final decision. The Board President will respond in writing within ten (10) days of receipt of the appeal. At any time applicant, client or tenant may contact AZ Dept. of Economic Security (DES) directly to express their grievance. Grievances must be directed to Donna Bleyle, State Homeless Coordinator, Department of Economic Security, Division of Aging & Adult Services, 1789 W. Jefferson St., Phoenix, AZ Phone: (602) I understand the grievance procedure outlined above. ACKNOWLEDGMENT: I acknowledge and attest that all information contained in this application is complete and true to the best of my knowledge. I understand that willful falsification or omission of information may result in the denial of my application or future termination from Our Family housing. Please return application to: Our Family Services, 2590 N. Alvernon Way, Tucson, AZ Please call our front office, Ex. 410 with any questions about the application or application process. Page 3 of 3 Application for Affordable Housing revised Feb 2014

7 AFFORDABLE APPLICANT HOUSING INCOME CHECKLIST DOCUMENTATION NEEDED BEFORE LEASE IS SIGNED Please complete a separate checklist for each member of the household who is 18 years or older. You will need to provide documentation for all items which are checked YES including any authorization we may need to verify these items. Please be aware, we will need all the indicated documentation and failure to provide it before lease signing could result in the denial of your application or termination of your housing. NAME: SS#: Telephone: YOU MUST COMPLETE EACH ITEM. CHECK EITHER YES OR NO I have a job and receive money/tips/wages. Company Name: I have more than one job. Company Name(s): I am unemployed. Do you receive unemployment benefits? You must complete Unemployed Affidavit. If receiving benefits, provide documentation of benefits I am self-employed. You must complete the Self-Employment Certification form. I am a student. Are you Full or Part-Time student? Circle one: FULL-TIME PART-TIME You must provide your school schedule, tuition costs, fees, loans, etc. I receive educational grants, scholarships or financial assistance to pay for school. You must provide documentation. I receive cash or gifts to help pay rent, utilities or living expenses from persons not living with me. I receive them regularly and on an ongoing basis. Name of Contributor: Contributor must complete and fax / mail back Verification of Recurring Cash Contribution form. I receive Public (Cash) Assistance. You must provide documentation I have Checking Accounts: Name of Institution Acct# Please provide most recent 6 months of statements OR have Financial Institution complete and FAX or MAIL back form Asset Verification. I have Savings Account(s): Name of Institution Acct# Provide current month statement OR have Financial Institution complete and FAX or MAIL back form Asset Verification. I have Money Market Account(s). I receive Social Security or Supplemental Social Security (SSI). Indicate which one: I receive disability benefits from sources OTHER than Social Security. I receive periodic payments from a trust, annuity, inheritance or lottery winnings. I receive periodic payments from Worker s Compensation. Page 1 of 3 Affordable Income Checklist revised Feb 2014

8 I receive military pay, Veteran s Benefits, or GI Bill Benefits. I receive payments from insurance policies and/or have policies with cash surrender valued at $. I receive periodic payments from a pension, annuity or retirement benefit account. I receive income from property rentals or real estate or I own real estate or have land contract(s). I hold personal property (coins, stamps, gems) for investment purposes. I have Certificates of Deposits, Time Certificates, Treasury Bills or Savings Bonds. I have IRA, Keogh, 401k, Annuity or similar retirement account. I have Stocks, Bonds, Mutual Funds, Capital Investments or a Whole Life (not TERM) Insurance Policy, where you can make withdrawals prior to death. I HAVE sold or given away or transferred ownership of assets within the last 2 years. These items are:. I have additional income or assets that were not described above. DO NOT include personal use vehicles, furniture, clothing, etc. These items are:. I expect changes in my household s income during the next 12 months. If Yes, please describe:. CHILD SUPPORT AND ALIMONY INFORMATION Please check which situation applies to you and fill in the requested information (PLEASE LIST ANY ADDITIONAL CHILDREN, THEIR INFORMATION AND ANY OTHER ON SEPARATE SHEET) I have COURT ORDER(S) and RECEIVE FULL AMOUNT of child support, alimony, other compensation 1) I receive the full amount ordered. Amount ordered: Name of person(s) obligated to pay: 2) I receive the full amount ordered. Amount ordered: Name of person(s) obligated to pay: 3) I receive the full amount ordered. Amount ordered: Name of person(s) obligated to pay: I am NOT receiving the full ordered amount of child support, alimony, or other compensation 1) What is the FULL amount you are supposed to receive each month? What is the amount you ARE receiving each month? Name of who pays: Are you making efforts to collect the full amount? Circle one: Page 2 of 3 Affordable Income Checklist revised Feb 2014

9 Please explain these efforts: 2) What is the FULL amount you are supposed to receive each month? What is the amount you are receiving each month? Name of who pays: Are you making efforts to collect the full amount? Circle one: Please explain these efforts: 3) What is the FULL amount you are supposed to receive each month? What is the amount you are receiving each month? Name of who pays: Are you making efforts to collect the full amount? Circle one: Please explain these efforts: I am NOT receiving ANY of the full ordered amount of child support, alimony, or other compensation Total amount ordered? Are you making efforts to collect the full amount? Circle one: Please explain these efforts: I am NOT currently entitled BUT expect to receive a court order for child support or other compensation within the next 12 months. Name of person(s) you are seeing support / alimony from: If child support, name of child(ren): What is the amount you expect to receive? $ per What date do you think the payments will begin? I receive child support, alimony or other compensation that are NOT COURT ORDERED. You must fill out recurring cash form. Name of person(s) paying: Amount: $ For child(ren) I do NOT have a court order for child support, alimony or other compensation nor am I receiving any support or other compensation. Please return completed check list and supporting documentation to: Our Family Services, 2590 N. Alvernon Way, Tucson, AZ If you have questions, call Ex. 410 for assistance. I certify that to the best of my knowledge that all statements are true and factual. When or if any circumstances change I will notify Our Family Services for possible recertification and program compliance. I understand that providing false information and/or withholding information can result in denial and/or termination of housing. Print Name: Signature: : Page 3 of 3 Affordable Income Checklist revised Feb 2014