Fillable Delaware Nation EMERGENCY REPAIR PROGRAM (Delaware Nation)

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Delaware Nation EMERGENCY REPAIR PROGRAM (Delaware Nation)

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The Delaware Nation EMERGENCY REPAIR PROGRAM (Delaware Nation) form is 7 pages long and contains:

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  • 13 check-boxes
  • 147 other fields

Country of origin: US
File type: PDF

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Delaware Nation
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Page 1
revised 02/13/2020
EMERGENCY REPAIR PROGRAM
In order to request Emergency Repair Services, participants should contact the DNHD office. We will take a
short description of the repair needed, the tribal member’s name, address, and directions to your home. The
DNHD staff will contact the Delaware Nation Enrollment Office to verify enrollment status and address and
will verify the ownership of the home.
This program is funded by the Delaware Nation Tax Commission through an annual allocation of funds and is
offered as long as funds are available. Damage caused by lack of maintence by the homeowner will not be
eligible for emergency repair assistance.
Please feel free to contact the DNHD office with your housing needs/requests at 405-247-2448.
Emergency Repair Guidelines and Eligibility Requirements
1. Must submit a completed application with ALL required supporting documents. Incomplete applications
will not be processed. (Please see check list on page 3).
2. Applicant must be an enrolled Delaware Nation Elder that is 60 years or older OR must be an enrolled
Delaware Nation citizen who can provide proof of handicap or disability from a medical physician.
3. Must show proof of homeownership of a minimum of three years. Delaware Nation Housing will only
except a deed/title that has the primary applicant listed at the owner. Delaware Nation Housing may
except a title status report from the Bureau of Indian Affairs or court approved probate if the document
shows clear proof that the applicant is the sole owner of the specified property for which repairs are
needed. Delaware Nation Housing may also accept a certified legal document that gives the applicant
lifetime use of the unit.
4. Must reside within the state of Oklahoma. DNHD staff may complete repairs in a 60 mile radius of the
DNHD office. All other repairs shall be contracted out to a Delaware Nation approved vendor.
5. The unit for which assistance is being requested must be the primary residence of the applicant.
6. Eligible applicants who have homeowner insurance and are applying for assistance for repairs that
would normally be insurable (i.e. roofs, flood damage, fire damage, etc.) shall be required to submit a
claim to the insurance company. If the insurance claim is approved, Delaware Nation Housing may pay
the deductible as long as it does not exceed the cap amount. If claim is denied or applicant does not have
homeowner insurance, assistance may be given with the approval of the Executive Committee.
Delaware Nation
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Page 2
revised 02/13/2020
7. Must meet the 80% United States National Median Income Limit Guidelines. Proof of income must be
provided for all household members with submission of application (i.e., pay check stubs, social
security, tax return, etc.).
2019 United States Median Family Income Limits at 80% Published June 21, 2019
FAMILY
SIZE
1
2
3
4
5
6
7
8
MAX
INCOME
$42,280
$48,320
$54,360
$60,400
$65,232
$70,064
$74,896
$79,728
8. Assistance shall be limited to one occurrence per fiscal year, whether or not the repairs required the full
cap amount.
9. Mobile homes, campers and rental units are not eligible for assistance.
10. Delaware Nation Housing shall not pay reimbursement costs to any applicant or vendor for work done
prior to the application process and eligibility determination.
11. Payment shall only be made to a Delaware Nation approved vendor after applicant has been determined
eligible.
12. All selected vendors must meet the Delaware Nation Policy requirements. This includes, but is not
limited to, vendor and all staff performing repairs have approved background checks in compliance with
P.L.101-630, submission of completed W-9, satisfactory rating with the Better Business Bureau and the
System for Award Management.
13. If determined eligible, assistance may be provided in the amount up to but no more than $3,000.00. Any
amounts that exceed the capped amount of $3,000.00 shall be the responsibility of the applicant and
must be paid in full before Delaware Nation Housing will disburse funding.
14. Any application received where the Housing Department staff determines that damage was due to lack
of maintenance by the homeowner, will not be eligible under this program.
*Due to limited funding, this program is a first come, first served basis.
Delaware Nation
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Page 3
revised 02/13/2020
Application Checklist
□ Completed and signed application
□ Tribal enrollment documentation for applicant/homeowner.
□ Valid state identification card.
□ Proof of handicap or disability from a medical physician (if under the age of 60 years).
□ Income verification from all sources of income for all members living in home.
□ Quotes from three licensed and bonded vendors.
□ Pictures (if requested) of needed repairs from applicants who live more than 60 miles from the
Delaware Nation Housing Office located at 31064 US Highway 281 Anadarko, OK 73005.
□ Proof of homeownership of a minimum of three years (see guidelines on pages 1-2).
□ Proof of homeowner insurance (see guidelines on pages 1-2).
Delaware Nation
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Page 4
revised 02/13/2020
Application for Emergency Assistance
Date: Name of Applicant:
Contact Address:
City: State: Zip Code:
Contact Phone: ( ) Alternate Contact #: ( )
List all individuals who reside in the property:
Name
Relationship
to Applicant
Date of Birth
Social Security #
If Delaware Roll #
List Monthly Income of all household members:
Please submit all source of income ~ SS, TANF, Retirement, IIM, unemployment, ect…
Name
WAGES
SALARIES
ETC…
SSI/SSD
PENSION/
RETIREMENT
TANF
DHS
CHILD
SUPPORT/
ALIMONY
OTHER
TOTAL
ANNUAL
INCOME
Explain Other Income Source:
*FOR ALL PERSONS LISTED ABOVE, PLEASE ATTACH COPIES OF TRIBAL ENROLLMENT DOCUMENTS
(if applicable).
Delaware Nation
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Page 5
revised 02/13/2020
Description of Problem:
Physical Address and Mailing Address of the property you are pursuing emergency assistance with:
Mailing Address:
Physical Address:
Have you (or any person listed as a member of the household) received EMERGENCY ASSISTANCE from the
Delaware Nation Housing.
□ No □ Yes If yes, when?
Do you currently have homeowner’s insurance? □ No □ Yes
Delaware Nation
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Page 6
revised 02/13/2020
Certification:
I understand that this is not a contract and does not bind either party. I certify that the information given in this
application is true and correct to the best of my knowledge. I understand that willful, false statements or
information or mis-representations are criminal offenses and could cause me to be ineligible for Emergency
Repair Assistance. I have no objections to inquiries being made of the purpose of verifying the information
given herein.
__________________________________ __________________________________
Signature Date Signature Date
Tribal Member Spouse
_________________________________________________________________________________________________
□APPROVED □DENIED
Comments:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
_____________________________________
HOUSING DIRECTOR
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Delaware Nation
P.O. Box 825
Anadarko, OK 73005
405 / 247-2448
Fax: 405 / 247-4806
Page 7
revised 02/13/2020
CIRCLE TYPE OF INFORMATION REQUEST: RELEASE VIEW DISPUTE
Requested by (Name & Title) ________________________________________________________________
Requestor’s Address _______________________________________________________________________
Requestor’s Primary Phone # ________________________________________________________________
Requestor’s E-mail ________________________________________________________________________
Subject _________________________________________________________________________________
What is specifically requested? ______________________________________________________________
How will it be used? _______________________________________________________________________
Why is it requested? _______________________________________________________________________
Requested on behalf of _____________________________________________________________________
Disclaimer: The information requested provided “as is.”
_______________________________________________________________________________________
(Signature of Requestor)
Date
Form 012 05-26-11
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Delaware Nation EMERGENCY REPAIR PROGRAM (Delaware Nation)

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Completed 20 July 2020

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