Fillable ANNUAL CERTIFICATION OF SERVICE COORDINATION Service coordination is (New Hampshire Housing)

Fill Online, Printable, Fillable, Blank ANNUAL CERTIFICATION OF SERVICE COORDINATION Service coordination is (New Hampshire Housing) Form

Use Fill to complete blank online NEW HAMPSHIRE HOUSING pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

ANNUAL CERTIFICATION OF SERVICE COORDINATION Service coordination is (New Hampshire Housing)

On average this form takes 10 minutes to complete

The ANNUAL CERTIFICATION OF SERVICE COORDINATION Service coordination is (New Hampshire Housing) form is 3 pages long and contains:

  • 1 signature
  • 18 check-boxes
  • 27 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your New Hampshire Housing forms online.

BROWSE NEW HAMPSHIRE HOUSING FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Annual Certification of Service Coordination
1
R
ev. 9/2019
ANNUAL CERTIFICATION OF SERVICE COORDINATION
Property Name: Reporting Period:
Service Coordinator:
Phone: Email:
The number of hours per week that service coordination is provided for this property:
Service coordination is provided: Onsite Remotely Both
During this reporting period did the service coordinator:
1. Collect rent, inspect units, make determinations on requests for reasonable
accommodation, investigate lease violations, or issue eviction notices?
Yes
No
2. Have a private space to meet with residents or meets with residents in their
homes?
Yes No
3. Have access to a telephone and internet when meeting with residents?
Yes No
4. Assess resident’s service needs within 60 days of move-in?
Yes No
5. Follow up with residents to address needs identified in their service plans?
Yes
No
6. Maintain documentation of resident service needs assessments and follow-up
in a secure location?
Yes
No
Coordinated Service #1
Service provider contact person:
Phone: Email:
The dates the service was provided during this reporting period:
The number of residents served:
Provide a brief description of the service:
Annual Certification of Service Coordination 2 Rev. 9/2019
Coordinated Service #2
Service provider contact person:
Phone: Email:
The dates the service was provided during this reporting period:
The number of residents served:
Provide a brief description of the service:
Are agreements for services on file (if any) and evidence that the services are
being provided (e.g. sign-in sheets, letters/memos to tenants advertising the
event/service, service logbook and/or activity reports) maintained at the
property?
Yes No
Was an annual survey conducted of all residents regarding their need for and
satisfaction with the service coordination, including coordinated services (not
required for first year of occupancy)?
Yes
No
Are any changes to Service Coordination or Coordinated Services being proposed
for the next reporting period? (If yes, prior approval is required. Submit change
request to the Asset Manager for the property.)
Yes
No
Who conducted the survey?
Phone: Email:
Note: Failure to complete this form in its entirety will result in noncompliance with program
requirements. In addition, any individual other than an owner or general partner of the
project is not permitted to sign this form, unless permitted by the state agency.
The project is otherwise in compliance with the Code, including any Treasury Regulations, the
applicable State Allocation Plan, and all other applicable laws, rules and regulations. This
Certification and any attachments are made UNDER PENALTY OF PERJURY.
Annual Certification of Service Coordination 3 Rev. 9/2019
I hereby certify that the above information is complete and true.
Name Title
Company
Signature Date
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

ANNUAL CERTIFICATION OF SERVICE COORDINATION Service coordination is (New Hampshire Housing)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document