Form Housing Application For Admission & Rental Assistance

To Whom It May Concern: 

Enclosed please find an application for subsidized housing. To be eligible, the head of household or spouse must be at least 62 years old or handicapped or disabled and have very low income. Tour application data is the date that we receiva a COMPLETED application in our office. If you are eligible, based on the information in your completed application, you will be placed on our waiting list according to your data of application, income limits, and type of unit Be advised that at the present time our waiting list is approximately 4 years, but this changes depending on unit turnover. During that time you must keep us advised as to your current address so that we may mail annual updates to you as required. FAILURE TO RESPOND TO OUR ANNUAL UPDATE WILL CAUSE YOUR NAME TO BE REMOVED FROM THE WAITING LIST WITHOUT FURTHER NOTIFICATION. 

Enclosed: 

• Applicant Declaration Form on which you must declare your Citizenship or Non-citizenship status. A form must be completed for each household member.
• Disclosure Statement Form required by the State of New Jersey. Please be 1111V to sign and return it with your application. 

**Tenon. (Selection Plan available upon request.* 
 
Sincerely,

Dawn L. Davis
Property Manager

Things You Should Know

Don't risk your chances for Federally assisted housing by providing false, incomplete, or inaccurate information on your application forms.

Purpose

This is to inform you that there is certain information you must provide when applying for assisted housing. There are penalties that apply if you knowingly omit information or give false information.

Penalties for Committing Fraud

The United States Department of Housing and Urban Development (HUD) places a high priority on preventing fraud. If your application or recertification forms contain false or incomplete information, you may be:

• Evicted from your apartment or house
• Required to repay all overpaid rental assistance you received:
• Fined up to $10,000
• Imprisoned for up to 5 years; and/or 
• Prohibited from receiving future assistance.

Your State and local governments may have other laws and penalties as well.

Asking Questions

When you meet with the person who is to fill out your application, you should know what is expected of you. If you do not understand something, ask for clarification. That person can answer your question or find out what the answer is.

Completing The Application

When you answer application questions, you must include the following information:

Income

• All sources of money you or any member of your household receive (wages. welfare payments, alimony, social security, pension, etc.);
• Any money you receive on behalf of your children (child support, social security for children, etc.);
• Income from assets (interest from a savings account, credit union, or certificate of deposit: dividends from stock, etc.);
• Earnings from a second job or part-time job;
• Any anticipated income (such as a bonus or pay raise you expect to receive)

Assets

• All bank accounts, savings bonds, certificates of deposit, stocks, real estate, etc... that are owned by you and any adult member of your family's household who will be living with you.
• Any business or asset you sold in the last 2 years for less than its full value, such as your home to your children.
• The names of all of the people (adults and children) who will actually be living with you, whether or not they are related to you.

Signing the Application 

• Do not sign any form unless you have read it, understand it, and are sure everything is complete and accurate.
• When you sign the application and certification forms, you are claiming that they are complete to the best of your knowledge and belief. You are committing fiaud if you sign a form knowing that it contains false or misleading information.
• The information you give on your application will be verified by your housing agency. In addition, HUD may do computer matches of the income you report with various Federal, State, or private agencies to verify that it is correct. 

Recertifications

You must provide updated information at least once a year. Some programs require that you report any changes in income or family/household composition immediately. Be sure to ask when you must recertify. You must report on recertification forms:

• All income changes, such as increases of pay and/or benefits, change or loss of job and/or benefits, etc., for all household members.
• Any move in or out of a household member; and,
• All assets that you or, your household members own and any assets that were sold in the last 2 years for less than its full value.

Beware of Fraud 

You should be aware of the following fraud schemes: 

• Do not pay any money to file an application;
• Do not pay any money to move up on the waiting list;
• Do not pay for anything not covered by your lease;
• Get a receipt for any money you pay; and,
• Get a written explanation if you are required to pay for anything other than rent (such as maintenance charges).

Reporting Abuse 

If you are aware of anyone who has falsified an application, or if anyone tries to persuade you to make false statements, report them to the manager of your complex or your PHA. If that is not possible, then call the local HUD office or the HUD Office of Inspector General (OIG) Hotline at (800) 347-3735. You can also write to HUD-OIG HOTLINE, (GFI) 451 Seventh Street, S.W.., Washington, DC. 20410. 
 

HOUSING APPLICATION FOR ADMISSION & RENTAL ASSISTANCE

1. MAIL OR HAND-DELIVER THE COMPLETED ORIGINAL APPLICATION TO: SBCDC, Charleston Place, 3424 Route 27, Kendall Park, New Jersey 08824

2. SBCDC, Charleston Place, will NOT accept e-mailed or faxed applications. Original signatures required.

3. If, due to disability you need assistance completing this application, please advise us of your needs when you receive the application or call SBCDC, Charleston Place, between the hours of 9:00 am and 4:30 pm at 732-297-7966.

4. We require disclosure of SSNs for the applicant and for all members of the applicant's household, except those household members who do not contend eligible immigration status. We require information from applicants who were 62 or older as of January 31, 2010, and who do not have a SSN, if they were receiving HUD rental assistance at another location on January 31, 2010. This information is needed in order for the owner to verify whether the applicant qualifies for the exemption of disclosing and providing verification of a SSN.

PLEASE PRINT LEGIBLY 

Applicants must provide a complete list of ALL states in which he/she has resided:

Other Contact Information -- If you would like to designate another person for us to communicate with regarding this 

application, please complete the following information:

* ALL APARTMENTS ARE SMOKE-FREE!

Power of Attorney - If you have a power of attorney, please email a copy to dawn@sbseniorhousing.org

INCOME

This section MUST be completed by the applicant in order to process this application. List all gross monthly income. If you do not have the income, write "N/A" on the line provided.

Have you taken any "regular or predictable" distributions (for example: monthly, twice a year, quarterly, annually) from any of the following investment accounts? Please mark an "X" in either the "Yes" or "No" box and list the amount that was taken out. Specify whether it was monthly, quarterly, yearly or other.

If you answered "YES," to any of the above questions, please complete the following information:

ASSETS 

This section MUST be completed by the applicant. Provide the monetary value of your assets and the anticipated income. If you do not have the asset, write "N/A" on the line provided.

IF YOU HAVE RESIDED AT YOUR CURRENT ADDRESS FOR 5 YEARS OR MORE, THERE IS NO NEED TO COMPLETE THE FOLLOWING PREVIOUS LANDLORD/ADDRESS SECTION.

*Note: SBCDC tenants are allowed one (1) pet per household. Weight limit is 30 lbs.

and height limit is 18". Pets must be licensed and vaccinated.

Applicant's Certification (Please read this carefully before you sign)

1. I understand that apartments located at 3424 Route 27, Kendall Park, NJ are subsidized. I understand that the head of household or spouse must be 62 years of age or older, OR handicapped or disabled. I understand that I must be BOTH program and income eligible at the time of application AND when called for a financial interview. 
2. I understand that before I can be approved for tenancy all adult members of the household must sign the required Consent Form ("Authorization for Release of Information") and individual verification forms.
3. I understand that SBCDC is a smoke-free community; no smoking of any type will be permitted in any apartment, common area or on the grounds.
4. The wait list is on a first-come, first-served basis. Applications will be received and date-stamped prior to placement on the waiting list. Wait list assignment is not a guarantee of eligibility.
5. I understand that if I am selected to receive assistance, the unit I occupy will be my sole residence.
6. I understand that all application information is being collected solely to determine my eligibility.
7. I authorize the owner/manager to verify all information provided on this application, to check my credit history, perform a criminal background check, contact previous and/or current landlords, review records of court proceedings and to collect information which may be released to appropriate Federal, State, or local agencies.
8. I understand that if I am eligible, the rent is 30% of adjusted income.
9. I understand that the applicant will be removed from the wait list if the applicant is offered an apartment and refuses the apartment for reasons other than medical.
10. I agree to notify management in writing immediately regarding any changes in household address, telephone number, and household composition. I understand that if management cannot reach me by telephone or by US Mail, my name will be taken off of the wait list.
11. I understand that applications will be rejected for the following reasons, including but not limited to: 
    • Faxed, emailed or incomplete application• Applicant does not meet program or income guidelines• Applicant with poor credit history, ie, any credit history that is an indication of irresponsible behavior or that may indicate future problems for the development• Poor tenant/landlord history• Applicant subject to a state lifetime sex offender registration program• Applicant was convicted for making meth in federally-assisted housing.• Household member fails to provide verification/proof of social security number
12. I certify that the statements made in this application are true and complete to the best of my knowledge and belief. I understand that falsification of information is grounds for rejection and is punishable under Federal Law.

IF YOU FILED A FEDERAL TAX RETURN WITHIN THE LAST 2 YEARS, YOU MUST SUBMIT A COPY OF YOUR MOST RECENT 1040 FEDERAL INCOME TAX RETURN WITH COPIES OF ALL ATTACHED SCHEDULES and 1099's WITH THIS APPLICATION! 

NATIONAL TENANT NETWORK RELEASE FORM

P.O. Box 1023Turnersville, NJ 08012

I hereby grant SBCDC, Landlord and its designee, National Tenant Network, a credit reporting agency, the right to process this Credit Application for the purpose of obtaining a rental lease and/or the renewal of an existing lease based on the dates and terms of the lease. In compliance with the FAIR CREDIT REPORTING ACT, this notice is to inform you that the processing of this application includes, but is not limited to, making inquiries deemed necessary to verify the accuracy of the information herein, including procuring consumer reports from consumer reporting agencies, obtaining credit information from other credit institutions, records of court proceedings and criminal background checks from appropriate law enforcement agencies. You have the right to make a written request within a reasonable period of time to receive additional information about the nature of this investigation. The undersigned agrees that this application and reports shall remain the sole property of SBCDC regardless if rental lease is granted or renewed.

Supplemental and Optional Contact Information for HUD-Assisted Housing Applicants

SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING This form is to be provided to each applicant for federally assisted housing

Instructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing, the name, address, telephone number, and other relevant information of a family member, friend, or social, health, advocacy, or other organization. This contact information is for the purpose of identifying a person or organization that may be able to help in resolving any issues that may arise during your tenancy or to assist in providing any special care or services you may require. You may update, remove, or change the information you provide on this form at any time. You are not required to provide this contact information, but if you choose to do so, please include the relevant information on this form.

Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the issues or in providing any services or special care to you.

Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the applicant or applicable law.

Legal Notification: Section 644 of the Housing and Community Development Act of 1992 (Public Law 102-550, approved October 28, 1992) requires each applicant for federally assisted housing to be offered the option of providing information regarding an additional contact person or organization. By accepting the applicant's application, the housing provider agrees to comply with the non-discrimination and equal opportunity requirements of 24 CFR section 5.105, including the prohibitions on discrimination in admission to or participation in federally assisted housing programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on age discrimination under the Age Discrimination Act of 1975.

The information collection requirements contained in this form were submitted to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The public reporting burden is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers participating in HUD's assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option to include in the application for occupancy the name, address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such information is to facilitate contact by the housing provider with the person or organization identified by the teaant to assist in providing any delivery of services or special care to the tenant and assist with resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information. Providing the information is basic to the operations of the HUD Assisted-Housing Program and is voluntary. It supports statutory requirements and program and management controls that prevent fraud, waste and mismanagement. In accordance with the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless the collection displays a currently valid OMB control number.

Privacy Statement: Public Law 102-550, authorizes the Departinent of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be need by HID to protect disbursement data from fraudulent actions.

Citizenship Declaration

Instructions: Complete this Declaration for each member of the household listed on the Family Summary Sheet

INSTRUCTIONS: Complete the Declaration below by printing or typing each household members first name, middle initial, and last name in the space provided (if completing for child, use child's name). Then review the sections shown below and complete either section number 1, 2, or 3

DECLARATION

SECTION 1 

SECTION 2

Citizenship Declaration

SECTION 3 

NOTE: If you checked the above section and you are 62 years of age or older, you need only submit a proof of age document together with this form.

If you checked the above section and you are less than 62 years of age, you should submit the following documents

a. Verification Consent Form

AND

b. One of the following documents:

(1) Form I-551, Permanent Resident Card 

(2) Form I-94, Arrival-Departure Record, with one of the following annotations:

(a) "Admitted as Refugee Pursuant to section 207";

(b) "Section 208" or "Asylum";

(c) "Section 243(h)" or "Deportation stayed by Attorney General"; or

(d) "Paroled Pursuant to Sec. 212(d)(5) of the INA."

(3) If Form I-94, Arrival-Departure Record, is not annotated, it must be accompanied by one of the following documents:

(a) A final court decision granting asylum (but only if no appeal is taken);

(b) A letter from a DHS asylum officer granting asylum (if application was filed on or after October 1, 1990) or from

an DHS district director granting asylum (if application was filed before October 1, 1990);

(c) A court decision granting withholding or deportation; or

(d) A letter from a DHS asylum officer granting withholding of deportation (if application was filed on or after

October 1, 1990),

(4) A receipt issued by the DHS indicating that an application for issuance of a replacement document in one of the above- listed categories has been made and that the applicant's entitlement to the document has been verified.

(5) Other acceptable evidence. If other documents are determined by the DHS to constitute acceptable evidence of eligible immigration status, they will be announced by notice published in the Federal Register.

If for any reason, the documents shown in subparagraph 2.b, above are not currently available; complete the Request for Extension section below, 

REQUEST FOR EXTENSION

I hereby certify that I am a noncitizen with eligible immigration status, as noted in section 2 above, but the evidence needed to support my claim is temporarily unavailable. Therefore, I am requesting additional time to obtain the necessary evidence, I further certify that diligent and prompt: efforts will be undertaken to obtain this evidence.