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City of Temple – United Way

CDBG CV Rent, Utility and Mortgage Assistance Program

Participant Guidelines

The City of Temple is receiving a special allocation to the Community Development Block Grant

funds to be used to prevent, prepare for, and respond to the Corona virus (COVID-19). This

allocation was authorized by the Coronavirus Aid, Relief, Economic Security Act (CARES Act),

Public Law 116-136, which was signed by President Trump on March 27, 2020, to respond to the

growing effects of this historic health crisis. Grantees received guidance describing the

immediate availability of waivers uncapped percentage of CDBG funding for public services to

prevent, prepare for, and respond to coronavirus, as well as other flexibilities. This is the first

allocation of this type of funding. HUD is developing a formula to allocate a second round of

CARES Act funding soon.

Program Goals

The purpose of this fund is to help city residents who are enduring financial hardship and are

unable to make their regular rental, utilities, and/or mortgage payments due to COVID-19. The

grant will be for up to three (3) months to aid and alleviate the housing burden for low income

households that have lost employment income as the result to the pandemic. The assistance

amount will depend on household needs.

Eligibility Requirements

COVID-19 Assistance Program will pay missed rent, mortgage, and/or utilities from COVID-19

related loss of wages. Rent, utilities, and/or mortgage arrearages prior to March 31, 2020 are

not eligible. Applications will be reviewed on a first-come, first-serve basis. Only completed

applications that include all required attachments will be reviewed for eligibility.

Therefore, it is very important to submit a COMPLETE application package as soon as

possible.

Payments will be made directly to landlords, mortgage companies, and utility companies.

Property owners/landlords must agree to participate in the program. Landlords/property owners

cannot be part of household.

Applicants who are receiving assistance from another federally funded grant program are not

eligible for an emergency payment through the COVID-19 program. This includes, but not limited

to, other CARES Act programs and Section 8 assistance.

Applicants must reside in the corporate city limits of Temple and must meet the income limits

set by the U.S. Department of Housing and Urban Development for household size not to exceed

80% area median income (see chart below).

2020 HUD Home Income Limits –

Your total annual household income must fall below 80% of City of Temple’s area median

income.

Program Requirements Checklist: ALL DOCUMENTS BELOW MUST BE TURNED IN BEFORE

APPLICATION CAN BE REVIEWED. NO EXCEPTIONS.

All Applicants:

• Complete application and attach the following forms as applicable:

• Copy of Texas Driver’s License or State Identification Card or other Federally issued

Identification Card for all household members over age 18;

• Applicants will be required to provide household income to include copy of the most

recent 3 months of paystubs for all household members over age 18;

• Assets – copy of last continuous six months of bank statements for all checking and one

month for savings account;

• Copy of expenses for the timeframe prior to when the household member (s) suffered

reduction in income;

• Documentation of suffered reduction through lay-off, furlough, reduction in hours, or

termination;

• Documentation of rent, utility, or mortgage owed;

• Documentation of the relief programs applied for including the history of benefits

received or estimated benefits;

• Demonstrated gap between unemployment benefits and regular income;

For Renters:

• Renter must provide documentation from the rental property owner that no evictions

were pending prior to Covid-19;

• A Lease Agreement or a letter/email from the rental property owner the amount of rent

the tenant pays and a statement that the household was in good standing.

• Notification from landlord or property manager that tenant does not qualify for

forbearance or reduction in rent.

For Homeowners:

• Homeowner must provide notification from Lender that the owner does not qualify for

a mortgage forbearance or suspension of mortgage payment;

• Mortgage Statement showing the amount of Principal and Interest

Review and Approval

Submit application and documents by email to: covidrelief@uwct.org

The applications will be reviewed by United Way staff for eligibility and may use a third-party

verification. United Way will use Part 5 Income Determination Method. The application will

either be approved or denied for assistance and you will be notified of the decision. If

approved, you will receive a phone call with further instructions. If denied, you will be notified

by your preferred method of contact.

CDBG Eligibility and National Objective:

This program is eligible for CDBG funding under 570.207(b)(4) and the National Objective is LMI

Limited Clientele 570.208(2)(C).

Environmental Review Requirements:

This program is classified as 24 CFR 58.35(b) (2) a Categorical Exclusion Not Subject to 58.5.

There is no obligation by the City of Temple or United Way to fund a submitted application.

All funding considerations are subject to the availability of funds and program regulatory

and statutory guidance from the U.S. Department of Housing and Urban Development.

COVID-19 Community Relief Fund

Application for Individual/Family Assistance

Assistance requested: Housing____ City Utilities____ Other Utilities____ Other____ Referral for other services ____

How did you hear about the UWCT COVID-19 Fund?____________________________________________________

PERSONAL INFORMATION

Applicant Name: ________________________ Co-Applicant Name: _________________________

Address: _______________________________ Address: __________________________________

City: __________ State: _________ Zip:_______ City: __________ State: _________ Zip: _________

Phone: _________________________________ Phone: ___________________________________

Email: __________________________________ Email: ___________________________________

# of people in household:________ Ages:_________________________________________

Weekly Household Income before COVID-19: $__________ Weekly Household Income today: $____________

HOUSEHOLD MEMBERS:

Name

Relation

Applicant

Date of

Birth

Age

Gender

Ethnicity-

Hispanic

(Y/N)

Race-

select

number

below

Receives

Income

(Y/N)

Type of

Income

Monthly

Amount

Earned

Race—select one (1) and place number in section above.

11 White, 12 Black/African American, 13 Asian, 14 American Indian/Alaska Native, 15 Native Hawaiian/Other Pacific

Islander, 16 American Indian/Alaska Native & White, 17 Asian & White, 18 Black/African American & White,

19 American Indian/Alaska Native & Black/African/American, 20 OTHER MULTI-RACIAL

Employment: Must have employer name & contact information from the job affected by COVID-19.

Applicant Name: ____________________________________________________________________________

Employer Name: ____________________________________________________________________________

Employer Address: __________________________________________________________________________

Company: _________________________________________________________________________________

How long employed: _________________________________________________________________________

Supervisor Contact Name: ____________________________________________________________________

Employer Phone: ________________________________ Employer Email: _______________________________

Impact of COVID-19 to Employment (change in employment status must be the direct result of employer

decisions or government mandates):

Current Job Status: Employed: _____ Reduction of hours: _____ Laid Off: _____ Terminated:____ Other: ______

Effective date of Status Change: _________________________________________________________________

Co-Applicant Name: __________________________________________________________________________

Employer Name: _____________________________________________________________________________

Employer Address: ___________________________________________________________________________

Company: __________________________________________________________________________________

How long employed: __________________________________________________________________________

Supervisor Contact Name: _____________________________________________________________________

Employer Phone: ________________________________ Employer Email: _______________________________

HOUSING ASSISTANCE REQUEST

Landlord/Leasing Agent/Mortgage Company: ______________________________________________________

Phone: _____________________________________________________________________________________

Billing Address: ______________________________________________________________________________

Manger/Landlord Name: _______________________________________ Email: __________________________

Name on Lease or Mortgage: _________________________________ Monthly Payment: __________________

Rent Information:

Do you have a lease?

☐Yes ☐No

How long have you lived there?

Are you behind on your rent/mortgage?

☐Yes ☐No

Monthly Rent $

Due Date:

How much do you owe in back payments?

For which months?

Do you owe late fees?

☐Yes ☐No

Do you receive rent assistance?

(i.e. Section 8)

☐Yes ☐No

Type of assistance?

UTILITY ASSISTANCE REQUEST (includes city water bills):

Utility Company or City Utilities: __________________________________________________________________________

How Much?

Billing Address: ________________________________________________________________________________________

Name on Bill: __________________________________________________________________________________________

Have you missed any payments: Do you have any late fees: _____________________________________________________

Current Bill Amount: ___________________________ Amount Past Due: _________________________________________

Are you able to make a partial payment: If yes, how much: _____________________________________________________

Other Assistance Requested (i.e. Child Care, Car Payment, Prescriptions, Other Household Bills):

Please explain request and amount requested: _______________________________________________________________

Have you received assistance for COVID-19 from another source: ________________________________________________

If yes, from where: How much: ____________________________________________________________________________

COVID-19 has affected my household in the following way: (Describe the need for assistance and how the household has been

affected by the COVID-19 pandemic.)

Warning: Title 18, Section 1001 of the U.S. Code makes it a criminal offense to make willful false

statements or misrepresentations to any Department or Agency in the United States as to any matter within its

jurisdiction. Administered on behalf of the City of Temple Community Development Block Grant - CDBG-CV - U.S.

Department of Housing and Urban Development.

Date: Co-Applicant’s Signature:

Date:

I hereby certify that the information and statements made on this form and al information furnished in support

of the application for assistance are true and correct to the best of my belief and knowledge. I agree to give

United Way of Central Texas any information necessary to prove statement about my eligibility. I furthermore

give United Way of Central Texas permission to contact my employer, benefit provider, or creditors to verify

information I have provided to establish my eligibility. I understand that this application will be considered

without regard to race, color, religion, creed, national origin, or political belief. I understand if granted

assistance, it is a ONE TIME ONLY GRANTED ASSISTIANCE.

The applicant agrees that this application may be electronically signed. The applicant agrees that the electonic

signature appearing on this application is the same as a handwritten signature for the purpose of validity,

enforceability, and admissibility.

Applicant’s Signature: _______________________ __________________________

_____________________ __________________________

UNITED WAY OF CENTRAL TEXAS

COVID-19 Community Relief Fund

Employment Status Verification

Must be completed by employer. A signed letter from the employer can be substituted.

Today’s Date:

______________________

This statement is to confirm that _____________________________ is/was employed at

______________________________. He/She worked full-time hours of _______ per week or part-

time hours of ______ per week at $___________per hour.

The frequency of payment was:

_______weekly _______bi-weekly _______semi-monthly ________monthly

Status of employment due to COVID - 19 as of effective date: ______________

_______ Change in employment was not related to COVID-19

_______ Reduction of Hours

_______ Laid Off or Furloughed - date _____________ to _____________

_______ Terminated

_______ Other

Other explanation: _________________________________________________________________

Company Name: ___________________________________________________________________

Employer Name: ___________________________________________________________________

Signature of Employer:_______________________________________________________________

Title:______________________________________________________________________________

Address: _____________________________________

_____________________________________

Phone: _______________________________

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