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Application Guidelines (Harris County Information Technology Center)

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H. 8c. July 26, 2019 Page 1 of 12
Application Guidelines
The Harris County Home Repair Program provides grants to low-income elderly (62 years or older)
or households with a disabled person. If qualified, we provide the following:
Minor Home Repair:
1) For the very low-income elderly 62 years or older (with income levels not exceeding 50% of the
median family income limits) or households with a disabled person disability must be
documented and the disabled person must reside in the home and have proof of residence at
the time of application up to $20,000 assistance in the form of a grant for minor home repairs
for qualified housing including, but not limited to, roof repair/replacement, handicap
accessibility improvements, mechanical, electrical, weatherization, and plumbing improvements;
Septic and Water Well:
2) Up to $40,000 funding in the form of a grant or deferred payment loan for the purpose of
repairing and/or replacing water wells and septic systems that are not functioning or have
received health safety violation citations. To be eligible there is no age limit but all other
eligibility requirements must be met; or
3) In certain designated revitalization areas up to $80,000 for major rehabilitation or up to
$135,000 for reconstruction. The funding assistance is in the form of an in terest only loan with
the principal deferred and forgivable upon complying with a five/ten year affordability period
and major rehabilitation/reconstruction contract terms. Rehabilitation or Reconstruction of a
property is determined on the extent, type and cost of repairs and based on the “75% Rule”.
The 75% rule is that a housing unit is suitable for rehabilitation if the estimated cost of
improvements will be less than 75% of the Harris County appraisal value as determined by the
Harris County Appraisal District. Housing units with an estimated cost of improvement 75% or
greater may be eligible for reconstruction. A housing inspector will inspect the home to
determine the cost of the repair.
Applicant’s housing front end ratio cannot exceed 39% and the Debt-to-Income cannot exceed
42%. Very low income (50% AMI or less) applicants may qualify for no payments and the higher
the applicant’s income, the more they will have to pay.
Property Location:
4) Applicants must reside within the Harris County Community Services Department’s service area
which includes the unincorporated areas of Harris County and the 12 cooperative cities which
have signed agreements with Harris County for service. Residents of the cities of Houston,
Baytown, and Pasadena are not eligible for assistance in this program.
H. 8c. July 26, 2019 Page 2 of 12
Requirements:
5) The home must be a single-family dwelling and owner-occupied by an elderly or disabled head of
household that demonstrates they are unable to afford the repair(s) needed. (Please review
Income Limits below.) A feasibility inspection must be performed to determine if a home is
eligible for assistance.
Mobile homes are not eligible under this program unless they are located in a revitalization area,
and assistance is available and provided for total reconst ruction. For mobile homes, please call
prior to submitting an application to determine if you are in a revitalization area.
To apply for assistance in this program, please complete the attached Application including
attachments listed below, and submit it to the Harris County Community Services
Department, Attention: Home Repair Program, 8410 Lantern Point, and Houston,
Texas 77054.
All of the following documents must be submitted before your application for assistance can be
processed:
1. Signed and Completed Application Form
2. Copy of Valid Current Identification (e.g., Driver’s License, OR State of Texas ID Card)
3. Proof of Citizenship Status
4. Verification Forms (please complete highlighted sections of these forms only and return with
your Application):
Verification of Employment for all wage earners is required and copies of paycheck stubs
for the last sixty (60) days
Verification of Mortgage or Deed of Trust
5. Employment/Income Information for all adult members of the household:
Copies of Paycheck Stubs for the last sixty (60) days for all wage earners
Copies of signed current two (2) years Federal Income Tax Returns if self-employed,
including all schedules for all persons in the household, 1099’s, etc.
Other Income Documentation (provide Copy of Award Letter, etc.):
Retirement
Disability Award Letter or a letter from a qualified physician stating disability
The Temporary Assistance for Needy Families (TANF)
Interests on Savings Accounts/Income Earning Accounts
6. Two (2) most recent Bank Statements to include all pages for each account
7. Provide copies of the most recent utility statements such as electricity and gas
H. 8c. July 26, 2019 Page 3 of 12
HUD INCOME LEVELS
For MINOR HOME REPAIR - Median Family Income (MFI) Limits
INCOME LEVELS
HOUSEHOLD SIZE
1
2
3
5
6
7
8
Low (50% of Median
Family Income)
26,750
30,550
34,350
41,250
44,300
47,350
50,400
Source: U.S. Department of Housing and Urban Develo pment, July 1, 2019
For MAJOR REHABILITATION - Median Family Income (MFI) Limits
INCOME LEVELS
HOUSEHOLD SIZE
1
2
3
5
6
7
8
Low (80% of Median
Family Income)
42,750
48,850
54,950
65,950
70,850
75,750
80,600
Source: U.S. Department of Housing an d Urban Development, July 1,2019
Attached to this Application is a Pamphlet entitled “Protect Your Family from Lead in
Your Home.” Please retain this pamphlet and these Application Guidelines for your
records.
If you need assistance in completing this Application or have questions about this
program, please contact the Home Repair Program staff at
(832) 927-4957.
A PROGRAM OF THE
HARRIS COUNTY COMMUNITY SERVICES DEPARTMENT
ATTN: HOME REPAIR PROGRAM
8410 LANTERN POINT DRIVE
HOUSTON, TX 77054
(832) 927-4957
July 26, 2019 Page 4 of 11
APPLICATION COVER PAGE
PLEASE COMPLETE THE FOLLOWING INFORMATION ABOUT YOUR HOUSE:
Year your home was built:
Number of Bedrooms: Number of Bathrooms:
Utilities: Gas Electricity City Water Water Well Sewer Septic Tank
Air Conditioning: Central Air Window Unit
Has your home flooded: Yes No When: 2015 2016 2017
PLEASE DESCRIBE THE REPAIRS NEEDED:
PLEASE DESCRIBE HOW THE NEED FOR THESE REPAIRS AFFECTS YOUR HEALTH
AND/OR SAFETY:
Name:
Property
Address:
City/State/Zip:
Phone:
Date:
H. 8c. July 26, 2019 Page 5 of 12
The information collected in this application will be used to determine eligibility. The
Harris County Community Services Department will not disclose any information in this
application without your consent except as required by law.
Previous
Rehabilitation:
Has your home been repaired in the past with funding from a City,
County, State or Federal Grant? YES NO
If yes, please provide the date and cost:
Date: Cost:
I. PROPERTY INFORMATION
Address of Property (Street, City, State, & Zip Code)
Owner: YES NO
How many years?
Mailing Address, if different from Property Address above:
II. APPLICANTS INFORMATION
HEAD OF HOUSEHOLD
SPOUSE OR CO-APPLICANT
Name:
Name:
Date of Birth:
Date of Birth:
SSN:
SSN:
TDL or ID#:
TDL or ID#:
Marital Status:
Marital Status:
No. of Dependents:
No. of Dependents:
Home Phone:
Home Phone:
Name of contact person not residing with you:
Name:
Address:
City:
State: Zip Code:
Phone:
Relationship (Select One) Neighbor Relative Family Friend Other
H. 8c. July 26, 2019 Page 6 of 12
III. EMPLOYMENT INFORMATION
Employed Yes No
Employed Yes No
Self-Employed Yes No
Self-Employed Yes No
Retired Yes No
Retired Yes No
Current Employer:
Current Employer:
Address:
Address:
City/State/Zip:
City/State/Zip:
Earnings: $
Earnings: $
Pay Period
Pay Period
Job Title/Position:
Job Title/Position:
Work Phone:
Work Phone:
How long at this job?
How long at this job?
OTHER INCOME
Other Income $
OTHER INCOME FOR SPOUSE OR
CO-APPLICANT
Other Income $
SSA
$
SSI
$
PENSION
$
CHILD
SUPPORT
$
RENT
$
OTHER
$
TOTAL
$
IV. HOUSEHOLD COMPOSITION
(Please list all household members including dependents)
Name
Date of
Birth
Relationship
Social Security No.
Sex
Employed
(Y/N)
xxx- xx- __ __ __ __
xxx- xx- __ __ __ __
xxx- xx- __ __ __ __
xxx- xx- __ __ __ __
xxx- xx- __ __ __ __
H. 8c. July 26, 2019 Page 7 of 12
Do You have a mortgage? Yes No
If no, proceed to VI. Insurance Information.
V. MORTGAGE INFORMATION
Name(s) that appears on the title/deed:
Additional information may be required for any additional person(s) listed on the deed.
Are Taxes and Insurance included?
Yes No
Is your mortgage current?
Yes No
VI. INSURANCE INFORMATION
Is the property in the 100-year Flood
Plain?
If property is located within 100-
year Flood Plain, you must have flood
insurance to receive assistance.
Yes No
Do you have flood insurance?
Yes No
Do you have property insurance?
Yes No
Insurance Company Name:
Address:
City/State/Zip:
Amount of Premium
$
Coverage
Amount
$
Agent Name
Expiration
Date of
Policy
Telephone Number:
H. 8c. July 26, 2019 Page 8 of 12
VII. INCOME AND ASSETS
(Please include all assets for both Applicant and Spouse/Co-Applicant)
DESCRIPTION
CASH OR MARKET VALUE
Checking and Savings Account No.:
$
Bank Name:
Address:
City/State/Zip:
Stocks and Bonds
$
Real Estate Owned
$
Vested Interest in Retirement Fund
$
Other Assets (itemize on separate sheet)
$
VIII. ADDITIONAL APP LICANT INFORMATION
Are there any known judgments against and/or liens on the property? Yes No
If Yes, please explain:
Any negative liens affecting the property may disqualify you for assistance.
Are property taxes current or in deferment? Yes No
If No, please explain:
H. 8c. July 26, 2019 Page 9 of 12
IX. ACKNOWLEDGEMENT OF NOTICES
Initial
Below
As an applicant for and potential recipient of home repair assistance
from Harris County, I/we understand and agree to the following:
Lead Paint Poisoning: The pamphlet entitled “Protect Your Family From
Lead in Your Home” is available on the website at
https://www.epa.gov/lead/protect-your-family-lead-your-home. After
reviewing the pamphlet, please confirm your review by initialing this section.
Credit Check and Verification: I/we understand and agree that Harris
County will verify all information contained in this application and check
my/our credit through a national credit bureau.
Federal Equal Credit Opportunity Act: The Federal Equal Credit
Opportunity Act prohibits creditors from discriminating on the basis of race,
color, religion, national origin, age, sex, marital status, whether all or part of
the applicant’s income is derived from any public assistance program, or if the
applicant has in good faith exercised any right under the Consumer Credit
Protection Act title VIII of the Civil Rights Act of 1968. Fair housing, likewise,
prohibits discrimination on the basis of race, color, religion, sex or national
origin. The Federal Agency which administers compliance with this law is the
Comptroller of the Currency, Consumer Affairs Division, Washington, DC 20219.
Right to Financial Privacy Act: This is to notify you, as required by the
Right to Financial Privacy Act of 1978 that the Department of Housing and
Urban Development has a right of access to financial records held by any
financial institution in connect with the consideration of administration of the
rehabilitation loan or grant for which you have applied. Financial records
involving your transactions will be available to the Department of Housing and
Urban Development without further notice or authorization but will not be
disclosed or released to another Governmental Agency or Department without
your consent except as required or permitted by law.
House Evaluation: I/we understand that Harris County will conduct a feasibility
assessment of my/our property for the purposes of determining whether my/our
home is eligible to receive assistance. I/we understand that Harris County has
maximum limits that can be spent to repair my/our home. If my/our home
cannot be repaired within the maximum dollar limit allowance, I/we understand
that I/we will not be eligible for the Home Repair Program.
Work Scope Preparation: If approved for assistance after evaluation,
contractors shall have access to my/our home and property for preparation of
bids so that they may obtain necessary information about my/our hom e and
the needed repairs.
Photo Release: As owner(s) of the property listed in this application, I/we
understand and agree that if approved for assistance, photographs will be
taken of my/our home before, during and after repair assistance is pr ovided,
and that such photos may be used in reports published by Harris County.
H. 8c. July 26, 2019 Page 10 of 12
Harris County Home Repair Program works in partnership with other agencies that perform home
repair for homeowners. These other agencies may be able to provide you with a dditional home
repair assistance. If permission is given, we may share your information with other agencies for
possible assistance for you.
I/we give Harris County Home Repair Program permission to release my/our information to other
agencies that perform home repair assistance? Yes No
X. APPLICANT
Is the homeowner/applicant or co-applicant a U.S. Citizen or Eligible Immigrant?
Yes No
ELIGIBLE IMIGRATION STATUS
Please indicate if your temporary U.S. Residency statu s was granted pursuant to 254A or 210 of
the Immigration and Nationality Act.
Yes No or Not Applicable
XI. CERTIFICATION AND AGREEMENT BY APPLICANT(S)
I/We, the undersigned, specifically acknowledge and agree that:
1. All forms and copies of documents obtained by Harris County to complete this
application for assistance are the property of Harris County;
2. Verification and re-verification of any information contained in the application may
be made at any time by the County, either directly or through a credit reporting
agency, from any source named in this application in any of the material facts
which I/we have represented herein should it change prior to signing contracts.
Certification: I/We certify that the information provided in this application and all
information furnished in support of this application are given for the purpose of obtaining
financial assistance under the Harris County Home Repair Program and are true and
correct as the date set forth opposite my/our signature(s) on this application and
acknowledge my/our understanding that any intentional or negligent misrepresentation(s)
of the information contained in this application may both under the provision of Title 18,
United States Code, Section 1001, et seq. and liability for monetary damages to the
County, its agents, successors, and assigns, insurers and any other person who may
suffer any loss due to reliance upon any misrepresentation which I/we have made on the
application. I/We understand that any willful misstatement of material facts will be
grounds for disqualification for assistance. I/We further certify that I am/we are the
owner(s) and occupant(s) of the property to be repaired, and upon completion of all
repairs, I/we will occupy/re-occupy this property.
Signature of applicant:
Date
Signature of co-applicant:
Date
H. 8c. July 26, 2019 Page 11 of 12
FOR OFFICE USE ONLY
Zip Code:
Flood Zone Map
Yes No
Key Map:
Precinct
Flood Zone:
Request BFE
Response Rec’d:
Elevation
Service Area
Yes No
Rejected Reason
Year Built:
Acknowledgement
Letter Sent
Project Entered:
Feasibility
Inspection Date
H. 8c. July 26, 2019 Page 12 of 12
XII. OPTIONAL-RACE AND ETHNICITY
The following information concerning race and ethnicity is requested for statistical and
reporting purposes only and has no bearing on the approval of this application. If you
choose not to complete this section, please be advised that Harris County staff is
required to note race and ethnicity on the basis of sight and/or surname.
Please check the appropriate box for your Ethnicity and Race:
1) Ethnicity
Hispanic
Non-Hispanic
2) Race
One Race:
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific Islander
Multi-Racial:
Black/African American and White
Asian and White
American Indian/Alaskan Native and White
American Indian/Alaskan Native and Black/African
American
Other Multi-Racial
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