COVID-19 CERTIFICATION
Please provide a brief description on how your household income was impacted by the
COVID-19 pandemic.
APPLICATION CERTIFICATION:
I/we understand that the above information is being collected to determine if I/we are eligible to
receive emergency rental assistance. I/we authorize Harford County Office of Community & Economic
Development to verify all information provided on this application.
____________________________________________________________________
Head of Household Signature Date
____________________________________________________________________
Spouse Signature Date
Please complete and return to:
Harford County Ofce of Community & Economic Development
15 South Main Street, Bel Air, MD 21014 OR
commdev@harfordcountymd.gov
If you are determined to be eligible for assistance, you will be contacted by a housing counselor and you will
be required to provide copies of the following documents:
• Proof of termination of employment (if available)
• Last three pay stubs prior to job loss or decrease in employment
• Most recent bank statement
• Verification of benefits within the last 30 days (unemployment, food stamps)
• W-2/1099 tax forms for 2019 and/or self-certification
• Eviction notice or correspondence from landlord indicating the tenant is in arrears and amount owed
• Fully executed rental/lease agreement and rental addendums
• Most recent utility bill
• Photo ID/identifications for all adult members of household
Eligible applicants must have a valid lease signed by the property owner, must demonstrate lost income
due to COVID-19, and must have been current on rent as of March 31, 2020
