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
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
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
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:
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?____________________________________________________
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: $____________
Date of
Type of
Raceselect 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: _______________________________
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:
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
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: _______________________ __________________________
_____________________ __________________________
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:_______________________________________________________________
Address: _____________________________________
Phone: _______________________________