Home Repair Program Home Repair Income Guidelines

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1 Habitat for Humanity of Green County Giving a hand up, not a hand out! _ Home Repair Program Thank you for your interest in Habitat for Humanity of Green County s (HHGC) Home Repair program. HHGC s work through the Home Repair Program will include handicap accessibility modifications (wheelchair ramps, grab bars, and handrails), floor repair, and other health and safety home repairs. The Home Repair Program is NOT an emergency repair program; there will be a months-long waiting period for repair work to be done. Eligibility Criteria for the Home Repair program are as follows: You must own the home where the repairs are to be made. You must occupy the home as your primary residence. The home must be located in Green County, Wisconsin. You must have homeowners insurance. You (or a member of your household) must have a need that makes the requested repairs necessary. Your household income must fall below 60% of A.M.F.I. (Area Median Family Income). See income guidelines listed below and on page 2. Those receiving Home Repair services must be present during the duration of the repair work. Roof replacement or projects that involve asbestos, mold or other hazardous materials are not eligible for this program. Important to understand: We may only be able to commit to part of what a house needs. The cost to the family for repairs made will be based on your income. The maximum cost will be $250. A home visit by members of the HHGC Selection Committee is part of the application process. There will be a sweat equity requirement. The amount required will be based on the cost and scope of the project. Physical limitation of family members will be taken into consideration. (These criteria are subject to change.) 2015 Home Repair Income Guidelines (Less than 60% of Area Median Family Income) Monthly Gross Household Income (before taxes): Household Size No more than: 1 $1,139 2 $3,081 3 $3,568 4 $3,907 5 $4,594 6 $4,079 7 or more $3,188

2 Yearly Gross Household Income (before taxes): Household Size No more than: 1 $13,663 2 $36,970 3 $42,818 4 $46,887 5 $55,125 6 $48,949 7 or more $38,250 Supporting Documents Needed for Home Repair Application You will need to provide proof of home ownership and total household income by providing copies of the supporting documentation listed below. Your application will be considered incomplete if copies of supporting documentation are not provided with the application. If you need assistance in completing the application, call the HHGC Office at (608) Provide the following documents when you return your application: Copies of Driver s License and/or Wisconsin I.D. for all adult family members (18 years and older) Copy of the deed for your home or evidence of current mortgage payments Copy of declarations page of your Homeowners Insurance policy Proof of Income o Copies of current Award Letters or most recent stubs for: Social Security SSI Pension or Retirement Disability (SSDI) Child Support o Copies of Pay Stubs for the most recent two months Habitat for Humanity of Green County P.O. Box 398 Monroe, WI

3 Habitat for Humanity of Green County Giving a hand up, not a hand out! Home Repair Application Dear Applicant: We need you to complete this application to help determine if you qualify for Habitat for Humanity of Green County s (HHGC) Home Repair program. Please fill out the application as completely and accurately as possible. All information you include on this application will be kept confidential. Applicant Information Name: Address: _City: State: Zip: Years at Address: _ Do you own the home where work is to be done? YES or NO Home Phone: Work Phone: Cell: Date of Birth: Marital Status: Married Separated Unmarried (Single, Divorced, Widowed) Is anyone in your household a veteran? Yes No Name: Have you every applied to HHGC? If yes, when? Do you have pets? If yes, what kind and how many? Number of persons living in your home (including applicant): Mortgage Information Are you making loan payments on your home? YES or NO If yes, what is your monthly payment? $_per month. Are your loan payments current? YES or NO Do you currently have homeowner s insurance? YES or NO

4 Requested Repairs Please check ( ) the types of repairs or modifications you are requesting for your home. Ramp access to primary entrance Hand Rail to primary entrance Grab bars in bathroom Floor repair Plumbing Electrical Other Please provide a description of the work required: Personal Statement Please write a brief explanation of why you are in need of Home Repair services. Habitat for Humanity of Green County P.O. Box 398 Monroe, WI

5 Anticipated Gross Monthly Income List the names, relationship to applicant, ages, and monthly gross income of all people living in the home. You must provide proof of all household income. Name Relationship Age Gross Monthly Income (before taxes) Self Income Source (Employment Income, Social Security, SSI, Child Support, Veteran s Benefits, ect...) I certify that the income reported above represents 100 percent of the total monthly income for my household: Applicant Signature Date Permission to Refer If your needs can be met more appropriately by another program, may we share your application with them? (circle one) YES NO Unless you give us permission to share your information with other organizations, your application will be kept confidential.

6 Applicant Agreement I understand that by filing this application, I am authorizing Habitat for Humanity of Green County to evaluate my need for home repairs and my willingness to be a partner family. I understand that the evaluation will include a home assessment and income verification. I have answered all the questions on this application truthfully. I understand that if I have not answered the questions truthfully, my application may be denied, and that even if I have already been selected to be eligible to receive Home Repair services, I may be disqualified from the program. The original or a copy of this application will be retained by Habitat for Humanity of Green County even if the application is not approved. Applicant Name (Print) Applicant Signature Date Complete the following if you are not the Applicant but are assisting the Applicant in completing the application: Name Date Contact Number Organization Send completed application along with supporting documentation to: Habitat for Humanity of Green County P.O. Box 398 Monroe, WI 53566