Fill - Free fillable DocumentationWaiverBrazoria CountyEmergencyRentalAssistanceProgram(ERAP) Household Email PhoneNumber Name MemberName CurrentWeekly (Department of the Treasury

DocumentationWaiver–Brazoria CountyEmergencyRentalAssistanceProgram(ERAP)

ThedocumentationrequiredfortheERAPapplicationisnotfeasibleformetoobtainorprovidedueto

thefollowingextenuatingcircumstancesrelatedto:(i)thepandemic,(ii)adisability,or(iii)alackof

technologicalaccess. I have checked the box of the applicable category of documentation which I am

not able to provide and I have completed the related information and descriptions in the fields below

in lieu of documentation:

TotalHouseholdIncome:

Pleaselistallsourcesofincomethatyouarenotabletodocument(ifnoincomeforhouseholdmember,

pleaselistnameandwrite“none”):

Household

MemberName

Employer

Name

Employer

PhoneNumber

Employer

Email

CurrentWeekly

GrossPay

Descriptionofwhydocumentationisnotavailable:

SignedLease:

LandlordName

LandlordEmail

LandlordPhone#

MonthlyRent

StartDateofLease

Descriptionofwhydocumentationisnotavailable:

Pleasealsouploadproofofregularpaymentstolandlordorpropertymanagerwithinthelasttwoyears

andofficialmailsenttoyouraddresstoverifyresidency.

EligibilityforUnemployment

Pleasedescribewhenunemploymentbeganandwhydocumentationisnotavailable.Pleaseprovide

thenameandcontactinformationforyourprevious employer.

ReductioninHouseholdIncome

Pleasedescribethereductioninincomeincludingnameofhouseh oldmember,employernameand

contactinformation,andwhydocumentationisnotavailable.Pleaseincludedate(s)thatincome

reductionoccurred.

Household

MemberName

Employer

Name

Employer

PhoneNumber

Employer

Email

CurrentWeekly

GrossPay

Descriptionofwhatthereductionofpaywas,whenitoccurred,andwhydocumentationisnot

available:

Iattestthatthestatementsabovearecorrect

andcomplete.

ApplicantSignature ApplicantName Date

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DocumentationWaiverBrazoria CountyEmergencyRentalAssistanceProgram(ERAP) Household Email PhoneNumber Name MemberName CurrentWeekly (Department of the Treasury - OCIO)

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