Administrative Office Kennewickha Org-Books Pdf

ADMINISTRATIVE OFFICE kennewickha org
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SUBSIDIZED HOUSING,KHA Official Use Only,KHA Local Preferences. PREAPPLICATION FORM,Elderly Disabled,Domestic Violence KHA MAIN. Veterans ADMINISTRATION OFFICE,1915 W 4TH PLACE,Time Initials. KENNEWICK WA 99336,PHONE 509 586 8576 Received at AO CPA. TTY 509 586 4460, Place an X in the box of the program s for which you are applying.
Housing Choice Voucher S8 Public Housing Program, Kennewick Richland Benton County Sunnyslope Homes Keewaydin Plaza. Section 8 Project Based Program,Columbia Park Apartments. Mitchell Manor Development,Moderate Rehab Program Units in Richland. Disabled Households Only Units in Kennewick,NED Voucher Program. Non Elderly Disabled Households Only,Family Unification Program FUP.
Voucher Program,Check this box if you require a,Referral Required wheelchair accessible unit. Please specify jurisdictional preference if applicable. Kennewick Jurisdiction Richland Jurisdiction, Please Note Kennewick Housing Authority KHA Is A Tobacco Smoke Free Housing Authority. KHA s Tobacco Smoke Free Housing Workplace Environment Policy states Smoking or tobacco use is not permitted. anywhere on KHA properties including but not limited to apartments single family dwellings grounds common areas. offices maintenance facilities non residential buildings vehicles etc except where KHA has established a designed. viable smoke area for each of its housing development workplace property sites. Applicant needs to provide an answer to each application question if a question does not pertain to. Applicant s household write N A or NONE All incomplete applications are immediately. 1 Name Maiden s Other Name s Used,Head of Household. 2 Address City ZIP Code,3 Home Phone Cell Phone Work Phone. 4 Household Composition List below all members of your household including unborn child ren and. expected birth date who will be living with you in your household if eligible to be assisted by the KHA. All requested information must be completed on each family household member. Rev 7 14 Page 1, Household Members Start with head of household then list spouse co head then minors then any other adults.
Legal Name Sex Relationship to Social Security Date of Birth Place of Birth. Last First Middle Initial M F Head Number Month date year City State. Do you have full custody of your child ren,Explanation. Are there any absent household members who under normal circumstances would live with you such as a family. member away in military duty,Explanation, 5 a If any of the above listed family household members used any other Name or Social Security. Number list Name s and Numbers describe why, 5 b Race of Head of Household Check Box that apply. White Black Asian Pacific Islander American Indian Alaskan Native. 5 c Ethnic Group of Head of Household Check Box that apply. Hispanic Non Hispanic, 6 Preference Category The KHA has three 3 Local Preferences Check which Preference s. you are disclosing your household qualifies for, You will need to provide verification of the Preference s you check Failure to provide verification will result in.
denial of preference claimed, Elderly Disabled Handicap Elderly families 62 years of age or older or families whose Head of. Household spouse or co head is a person who experiences permanent disability ies as per HUD. definition of a person with disability ies, Domestic Violence Victim Households Households who are Victims of Domestic Violence. Certification documentation of victim status is required. Veteran Households Households of veterans with other than dishonorable discharge status. Certification documentation of discharge status is required. Rev 7 14 Page 2, 7 Income Information Please list the source and amount of all current income received by all household. members including your children and yourself,Income Source Monthly Hourly Wage of. Household Member Name, List Name Address Phone Number Amount Hours per week.
ZERO INCOME VERIFICATION, Are YOU or any other ADULT family member claiming zero income NO YES If yes who. DISPOSITION OF ASSETS, Have you or any family member disposed of or given away any asset s for LESS than fair market value within the past two 2. Years NO YES If yes please provide details below,ASSET INFORMATION. Include all assets held and the corresponding annual interest rate dividends and or other income derived from the asset An asset is defined as a. lump sum amount that you hold and currently have access to Any Yes for questions 1 9 requires a detailed explanation below. DO YOU OR ANYONE IN YOUR HOUSEHOLD HOLD,YES NO Checking or savings accounts Explain. YES NO CDs money market accounts or treasury bills Explain. YES NO Stocks bonds or other securities Explain,YES NO Trust funds Explain.
YES NO Pensions IRAs KEOGH or other retirement accounts Explain. YES NO Cash on hand over 500 not in the bank Explain. YES NO Real estate rental property land contracts contract for deed or other real estate holdings i e your personal residence mobile. homes vacant land farms vacation home or commercial property Explain. YES NO Personal property as an investment i e paintings coin or stamp collections artwork collector or show cars and antiques. YES NO A safe deposit box If yes what are the contents Explain. QUESTION FAMILY ASSET ACCOUNT TYPE INTEREST AMOUNT. NUMBER MEMBER NUMBER ANNUAL, Ex 1 John HAPO Community Credit Union 123456 Savings 1 273 78. Rev 7 14 Page 3,8 Personal Reference, You must provide at least one 1 Personal Reference For Public Housing Applicants without 5 years of. landlord references please provide at least three 3 personal references. NAME RELATIONSHIP,ADDRESS CITY STATE ZIP,PHONE NUMBER S YEARS KNOWN. 9 Landlord References For Public Housing Applicants KHA requires references from the last five 5. years including addresses where your name was not listed on a lease or if you lived with family or. friends issue complete names addresses For additional references please list them on a separate. piece of paper,CURRENT ADDRESS, PHONE NUMBER MOVE IN DATE MOVE OUT DATE AMOUNT OF RENT. LANDLORD OWNER COMPLEX NAME,LANDLORD OWNER COMPLEX ADDRESS.
LANDLORD OWNER COMPLEX PHONE NUMBER Are you listed on the lease YES NO. If not list the person who is,REASON FOR MOVING,PREVIOUS ADDRESS. PREVIOUS PHONE NUMBER MOVE IN DATE MOVE OUT DATE AMOUNT OF RENT. LANDLORD OWNER COMPLEX NAME,LANDLORD OWNER COMPLEX ADDRESS. LANDLORD OWNER COMPLEX PHONE NUMBER Were you listed on the lease YES NO. If not list the person who was,REASON FOR MOVING,PREVIOUS ADDRESS. PREVIOUS PHONE NUMBER MOVE IN DATE MOVE OUT DATE AMOUNT OF RENT. LANDLORD OWNER COMPLEX NAME,LANDLORD OWNER COMPLEX ADDRESS. LANDLORD OWNER COMPLEX PHONE NUMBER Were you listed on the lease YES NO. If not list the person who was,REASON FOR MOVING,Rev 7 14 Page 4.
10 Background Information, a Have you or any family member been arrested or convicted of a crime during the past five years. NO YES If yes give details of the crime when it took place and where. Family Member Crime, b Have you or any family member ever been convicted of manufacturing or producing. methamphetamine NO YES, c Are you or any family member subject to registration as a sexual or violent offender NO YES. d Are you or any member on this application currently living in or have you ever lived in Public. Housing or lived in housing with a Section 8 voucher NO YES. Family Member Dates assistance received,Assisted Unit Address. Housing Authority Agency Landlord, 11 Student Information Is any adult 18 years of age or older in the household currently a full time student.
or planning to be one within the next Twelve 12 months NO YES If Yes list the name of. the student and the school,STUDENT NAME NAME OF SCHOOL ENROLLED. 12 Falsification I We understand that provision of false information in this housing application or any other form. completed or my refusal to provide management with complete and accurate information will result in automatic. rejection of my application for federal housing or assistance. Applicant Head of Household s Initials Applicant Spouse and or Co Head Initials. Applicant Adult Member Initials Applicant Adult Member Initials. 13 Updating Application Changes All changes in application information i e family composition income. preference eligibility address phone number etc must be reported in writing and submit verification of such. change by the applicant within fourteen 14 calendar days of the date of occurrence. Applicant Head of Household s Initials, 14 Annual Purge The waiting list is purged each year It is imperative that you respond to the notices sent during the. purge process Failure to respond will remove you from the waiting list. Applicant Head of Household s Initials, 15 No Duplicate Residence or Assistance I We certify that the house or apartment will be my principal residence and. that I will not obtain duplicate Federal housing assistance while I am in this current program I will not live anywhere. else without notifying the Housing Authority immediately in writing I will not sublease my assisted residence. Applicant Head of Household s Initials,Rev 7 14 Page 5. 16 Cooperation I We know I am required to cooperate in supplying all information needed to determinate my. eligibility level of benefits or verify my true circumstances Cooperation includes attending pre scheduled meetings. and completing and signing needed forms I understand failure or refusal to do so may result in delays termination. of assistance or eviction,Applicant Head of Household s Initials.
17 Certification I We fully understand that Title 18 Section 1001 of the United States Code states that a. person is guilty of a felony for knowingly making false or fraudulent statement to any department or agency of the. United States,Applicant Head of Household s Initials. I We understand that false statements or information are punishable under federal law Incidence of fraud willful. misrepresentation or intent to deceive is a federal crime I We also understand that false statements or information are. grounds for termination of tenancy or housing assistance By signing below releases the Kennewick Housing Authority to. contact persons and or agencies listed on this application for the purposes of verification and or coordinate services. APPLICANT SIGNATURES Household Member s who are 18 years and older must sign date. Signature of Head of Household Date,Spouse and or Co Head of Household Date. Other Adult Member of Household Date,Other Adult Member of Household Date. The Housing Authority City of Kennewick KHA does not discriminate on the basis of any protected classes in. admission or access to its programs, The Executive Director s designees have been designated to coordinate compliance with nondiscrimination. requirements contained in HUD s regulations implementing Section 504. Angela Fragozo,1915 W 4th Place,Kennewick WA 99336.
509 586 8576 TTY 509 586 4460, If you need to request a Reasonable Accommodation contact the KHA Section 504 Coordinator at 509 586 8576. Rev 7 14 Page 6,DECLARATION OF CITIZENSHIP,Part 1 Applies to All Family Members. Each person who will benefit under the subsidized housing program must either be a citizen or national of the. United States or be a noncitizen that has eligible immigration status that qualifies them for rental assistance as. determined by the U S Department of Housing and Urban Development and the U S Immigration and. Naturalization Service, One box on this form must be checked for each family member indicating status as a citizen or a national of. the United States or a noncitizen with eligible immigration status Family members residing in the unit to be. assisted that do not claim to be a citizen or national of the United States or do not claim to be a noncitizen with. eligible immigration status should not check any box. All adults must sign where indicated For each child who is not 18 years of age the form must be signed by. an adult member of the family residing in the dwelling unit who is responsible for the child Use blank lines to. add family members who are not listed,I am a noncitizen. citizen or with eligible Signature of Adult Listed to the left. national of immigration or Signature of Guardian for. First Name Last Name Age the U S status Minors, Warning Title 18 US Code Section 1001 states that a person is guilty of a felony for knowingly and willingly making a false or.
fraudulent statement to any department or agency of the United States If this form contains false or incomplete information you may. be required to repay all overpaid rental assistance you received fined up to 10 000 imprisonment for up to 5 years and or prohibited. from receiving future assistance, NOTE Family members who have checked a box indicating that they are a noncitizen with immigration status must complete Part 2 of this form. Part 2 Applies to Noncitizen Family Members Only, All family members who have claimed eligible immigration status on Part I of this form must provide this office. with an original of one of the following documents. 1 Form I 551 Alien Registration Receipt Card, 2 Form I 94 Arrival Departure Record with appropriate annotations or documents. 3 Form I 688 Temporary Resident Card,4 Form I 688B Employment Authorization Card. Rev 7 14 ADMINISTRATIVE OFFICE 1915 W 4th Place Kennewick WA 99336 Phone 509 586 8576 TTY 509 586 4460 SUBSIDIZED HOUSING APPLICATION PROCEDURES

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