Fillable Form 1: APPLICATION FOR HOUSING ASSISTANCE Public Housing

Fill Online, Printable, Fillable, Blank Form 1: APPLICATION FOR HOUSING ASSISTANCE Public Housing Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 1: APPLICATION FOR HOUSING ASSISTANCE Public Housing

On average this form takes 26 minutes to complete

The Form 1: APPLICATION FOR HOUSING ASSISTANCE Public Housing form is 2 pages long and contains:

  • 0 signatures
  • 46 check-boxes
  • 82 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Revised April 2021
RALEIGH HOUSING AUTHORITY APPL # _______
900 Haynes Street, Raleigh, North Carolina 27604
www.rhaonline.com
APPLICATION FOR HOUSING ASSISTANCE
Public Housing and Section 8
***For assistance please call (919) 508-1105 or (919) 508-1201 TDD/TTY 1-800-735-8262***
Si necesita asistencia en Español, llamar al 919.508.1110 o visite nuestra oficina y complete la forma para solicitar el servicio de
traducción. Usted sera contactado para una cita.
2021 HUD Determined Income Limits
SECTION 8 VOUCHER INCOME LIMITS
| | | |
| | | |
PUBLIC HOUSING INCOME LIMITS
| | | |
| | | |
These limits represent the maximum annual income that a household can earn and still qualify for housing assistance.
Your name will be added to the waiting list once a COMPLETE application is received.
Incomplete applications will not be accepted or added to waiting lists (ex. missing SSN, signature, etc.)
Please clearly print the information below for the Head of Household:
Name: ____________________________________ ____________________________________ ____________________________________
FIRST MIDDLE LAST
Address: ____________________________________________________________________________________________________________________
STREET ADDRESS
____________________________________ ____________________________________ ____________________________________
CITY STATE ZIP CODE
Email Address:______________________________________________ Telephone Number: ( )_____________________________
Please place an “X” on the line(s) for all that apply to you:
I wish to apply for: All Programs ________ Public Housing Only ________ Section 8 Voucher Only ________
Please circle your preferred* bedroom size: 1-BR 2-BR 3-BR 4-BR 5-BR *While your preference will be considered, all bedroom sizes are
determined by household size and need in accordance to policies at the time of housing. There is no guarantee that your preferred selection will be approved.
Are you currently homeless? Yes ______ No ______ Are you a veteran? Yes ______ No ______
Have you ever been an RHA resident? Yes ______ No ______ Do you currently live in subsidized housing? Yes ______ No ______
If you answered yes, to the two previous questions: When: ________________________________ Where: _________________________________
Does anyone in your household have a criminal background? Yes ______ No ______ Who: ___________________________________
Please clearly complete all sections below.
LIST ALL HOUSEHOLD MEMBERS --- USE A SEPARATE SHEET FOR ANY ADDITIONAL MEMBERS
NAME
LAST, FIRST, M.I.
RELATIONSHIP
GENDER
DATE OF BIRTH
MM-DD-YY
CITY OR COUNTY AND STATE
WHERE YOU WERE BORN
SOCIAL SECURITY #
LIST ALL INCOME IN THE HOME (LIST ADDITIONAL INCOME ON A SEPARATE SHEET IF NECESSARY)
LIST ALL INCOME IN THE HOME -- LIST ADDITIONAL INCOME ON A SEPARATE SHEET IF NECESSARY.
NAME
START
DATE
MONTHLY
(GROSS)
WEEKLY
(GROSS)
HOURLY
(GROSS)
# of HOURS
WORKED
Please answer all of the questions below by circling your answer. All answers are required to be considered complete.
Does your household need an accessible unit? Yes No What is your race? White Black
If yes, what type of accessible unit do you need? Wheelchair American Indian/Native Alaskan Asian/Pacific Islander
Visually Equipped Hearing Equipped Flat and/or First Floor Declined Other: _________________________________
Other: _______________________________________________
What is your ethnicity? Hispanic Non-Hispanic
Are you a legal resident of the USA? Yes No
What is your primary language? English
Did you file a Federal Income Tax Return for the previous year? Yes No Spanish Other: ________________________________
1 PERSON - $33,500
5 PERSON - $51,700
2
PERSON - $38,300
6 PERSON - $55,550
3
PERSON - $43,100
7 PERSON - $59,350
4 PERSON - $47,850
8 PERSON - $63,200
1
PERSON - $53,600
5 PERSON - $82,700
2
PERSON - $61,250
6 PERSON - $88,800
3
PERSON - $68,900
7 PERSON - $94,950
4 PERSON - $76,550
8 PERSON - $101,050
Revised April 2021
List your Landlord history or where you lived for the last two (2) years. List additional Landlords on a separate sheet if necessary.
Landlord #1 Landlord #2
Name: ______________________________________________________ Name: ________________________________________________
Address: ____________________________________________________ Address: ______________________________________________
Phone Number: ______________________________________________ Phone Number: ________________________________________
How Did You Hear About Applying For Housing Assistance With Raleigh Housing Authority? Check All That Apply:
□Television/Media □Relative □Shelter □Public Housing Brochure
□Church /Place of Worship □Friend □Wake County Human Services (WCHS)
□Internet Search □Other ________________________________________________________
WAITING LIST PREFERENCES
RHA programs have preferences which help determine the order applicants will be processed for housing assistance.
Verification of preference status will be required prior to preferences being applied to active applications.
CHECK ALL OF THE FOLLOWING PREFERENCES FOR WHICH YOU MAY QUALIFY:
Elderly (62 years and older) – Government issued verifications such as photo ID, birth certificate, passport, etc. will be required.
Disabled – Social Security Administration and/or Provider verification will be required.
Wake County Preference – Government issued photo ID or current paystubs showing Wake County residence and/or employment will be
required.
Ready To Rent Graduate – Verification of completion of Wake County’s Ready to Rent program will be required.
Working Family* – Current employment status, number of hours worked and length of employment will be required through recent
paystubs (2 or more) and/or employer letter on company letterhead.
CURRENT EMPLOYER: ________________________________________ TELEPHONE NUMBER: _____________________________
START DATE: __________________________ AVERAGE NUMBER OF HOURS WORKED PER WEEK: ______________________________
*To qualify for the Public Housing Working preference, families must be working at least 35 hours per week and have been employed two (2) years
prior to admission.
*To qualify for the Section 8 Voucher program working preference, families must be working at least 20 hours per week and have been employed for
at least 6 months.
Warning: Section 1001 of the Title 18 of the United States Code states that a person is guilty of a felony for knowingly and willingly making false
or fraudulent statements to any department of the United States Government.
Privacy Act Notice: The collection, maintenance, use and dissemination of SSNs, Employer Identification Numbers (EIN) any information derived
from SSNs and EINs, and income information under this subpart shall be conducted, to the extent applicable, in compliance with the Privacy Act (5
U.S.C. 552a) and all other provision of Federal, State and Local Law.
Violence Against Women Act (VAWA) Notification: VAWA provides protections for victims of domestic violence, dating violence, stalking, or
sexual assaults to prevent them from being denied admissions to or from losing housing solely as a result of being a victim. This protection extends to
all household members listed on a housing assistance application or lease agreement. At any time it is made known to RHA that an applicant, resident
or voucher recipient is a victim of domestic violence, RHA will pause to allow the victim the time needed to provide documentation/verification of the
abuse.
Right to Reasonable Accommodation: Applicants and assisted families have the right to request reasonable accommodations. Please notify staff if
you or anyone in your family is a person with disabilities, and you require a specific accommodation in order to fully utilize our programs and services.
Immigration Notification: Financial assistance is contingent upon the appropriate submission and verification of documentation of citizenship or
eligible immigration status. Proof of citizenship or eligible immigration status is required before an offer of housing assistance to a family. A list of
acceptable submission and verification documentation is available on our website at www.rhaonline.com.
Criminal Background Checks: A criminal background check is conducted on all adult household members. Certain criminal convictions may be
disqualifying, such as but not limited to: sex offenses or violent and/or drug manufacturing and distributing related convictions. At the discretion of
the RHA, on a case-by-case basis, a tenant’s past criminal behavior may not necessarily bar him/her from the program. RHA may, in its discretion,
take into consideration a variety of potential extenuating circumstances including but not limited to: whether violence was involved, whether a
pattern of drug use or sales is evidenced by the record, whether an applicant has gone through a recovery program, the disposition of a case, time
elapsed since the criminal act, etc. The final determination may prevent the family from receiving rental assistance.
I certify all information and answers provided are true and complete to the best of my knowledge. I consent to
the release of necessary information in order to verify my answers and to determine my eligibility. I further
understand providing false statements or information are punishable by law and grounds for denial from all
RHA programs and/or termination of tenancy after occupancy.
Applicant Signature: ________________________________________ Date: ______________________
Revised April 2021
GENERAL INFORMATION
*PLEASE KEEP THIS PAGE*
Please visit our website at www.rhaonline.com for additional information on the Raleigh Housing Authority, the Section 8/Leased
Housing Voucher program, the Public Housing program and communities. For questions and concerns you may call the Leased
Housing at (919) 508-1105 or the Public Housing Administrative Assistant at (919) 508-1201.
Applications are available for printing on our website at www.rhaonline.com. Applicants may apply to be on any or all of the waiting
lists at any time using the appropriate application form. RHA manages each waiting list separately and any status change to an
application on one waiting list has no effect on the applicant’s information or position on any of the other waiting lists.
The waiting list time for Public Housing is typically 2 to 5 years, more or less depending on unit availability. The waiting list time for
Section 8/Leased Housing is typically 3 to 7 years, more or less depending on voucher availability and HUD funding.
BE SURE TO KEEP YOUR CONTACT INFORMATION UP TO DATE.
Applicants will be sent letters to the address provided on this application. Applicants are responsible to provide current and accurate
contact information at all times. Applicants who move from the address listed on the application or have other information that
requires correction or update must provide an update directly to RHA by completing an Applicant Change of Status form for each
housing program to which you applied. Changes will be made once a completed Applicant Change of Status form is received by RHA.
Change of Status Forms should be submitted to the main office at 900 Haynes Street, Raleigh, NC 27604. Additionally, forms may be
downloaded from the RHA website at www.rhaonline.com or picked up in the Leased Housing or main lobby. The Housing
Authority uses the US Postal Service for the delivery of written correspondence, however RHA is not responsible for the delivery of
the mail. Applicants whose mail is returned to RHA as “Undeliverable” or otherwise fail to respond to RHA correspondence will be
withdrawn from the waiting list.
WHAT IS SECTION 8?
Section 8 is a HUD-subsidized rental assistance program for very low-income families, also referred to as “Housing Choice Voucher
Program” or “HAP” (Housing Assistance Payment Program). This is a program that enables you to secure housing in the private
market.
Your application will be placed on a waiting list by DATE and TIME of application and supported PREFERENCE.
A voucher is issued allowing a qualified family to search for affordable housing within program requirements, policies, and
regulations.
At this time, we are estimating our waiting list for Section 8 to be approximately 3-7 years from date of application.
WHAT IS PUBLIC HOUSING?
Public Housing is a multi-family housing program that is owned and managed by the Housing Authority of the City of Raleigh.
Your application will be placed on a waiting list determined by DATE and TIME of application, BEDROOM SIZE and
supported PREFERENCE.
Qualified applicants are paired with a unit that meets their needs at the time their name reaches the top of the waiting list.
RHA is not able to predict which community will have space available at the time of assignment.
Applicants are not able to choose the community in which they prefer to be housed.
A criminal background check is conducted on every adult member of an applicant’s household at the time a potential unit
comes open.
At this time, we are estimating our waiting list for Public Housing to be approximately 2-4 years from date of application.
By applying for Public Housing on this application, you are applying to the following communities:
Kentwood Apartments, The Oaks, Mayview, Heritage Park, Meadowridge, Birchwood, Valleybrook, Eastwood Court,
Stonecrest, Terrace Park, and Berkshire Village.
Glenwood Towers and Carriage House (high rise facilities for elderly and near-elderly households).
DEFINITIONS
ELIGIBILITY: Applicants must qualify as a family and/or as an eligible single person. Annual gross income must be within limits
as established by HUD for this area, with adjustments for smaller and larger families. An eligible family includes but is not limited to
a single person who may be elderly, near-elderly, displaced, disabled, or any other single person; or a group of persons residing
together as a family that may or may not include children regardless of marital status. An elderly family is a family whose head,
spouse, or sole member is at least 62 years of age.
COMPUTATION OF RENT: Rent determinations will be calculated and established at the time that housing assistance is offered
by RHA. Eligible families will have their monthly rent set to one of the following: the greater of 30 percent of their monthly-adjusted
income or 10% of unadjusted monthly income, established welfare rent, or 80 percent of the most current Fair Market rent minus
utility allowance. Rent will not be set to an amount less than RHA’s minimum rent standard of $50. If utilities are not included in the
rent, the family receives a rent credit equal to the RHA’s estimate of the cost of a moderate utility consumption.
WHAT TO BRING TO AN INTAKE INTERVIEW
Please be prepared to bring COPIES of the items listed below for all family members and any other requested information to
your interview once our office has contacted you for an intake orientation:
Verification of current and anticipated income for entire household
Retirement benefits notice
Daycare verification
Unemployment benefits notice
Child Support printout (payment history for at least 1 year)
Four (4) consecutive paycheck stubs
Proof of medical expenses (elderly or disabled persons ONLY)
Copies of Birth Certificates
Award letters for SS/SSI and WFFA/AFDC
Copies of Photo IDs for family member age 18 and older
Copies of Social Security Cards
Revised April 2021
Fraud Warning: Section 1001 of the Title 18 of the United States Code states that a person is guilty of a felony for knowingly and willingly making
false or fraudulent statements to any department of the United States Government.
Privacy Act Notice:
The collection, maintenance, use and dissemination of SSNs, Employer Identification Numbers (EIN) any information derived from SSNs and EINs,
and income information under this subpart shall be conducted, to the extent applicable, in compliance with the Privacy Act (5 U.S.C. 552a) and all
other provision of Federal, State and Local Law.
Violence Against Women Act (VAWA) Notification: VAWA provides protections for victims of domestic violence, dating violence, stalking, or
sexual assaults to prevent them from being denied admissions to or from losing housing solely as a result of being a victim. This protection extends to
all household members listed on a housing assistance application or lease agreement. At any time it is made known to RHA that an applicant, resident
or voucher recipient is a victim of domestic violence, RHA will pause to allow the victim the time needed to provide documentation/verification of the
abuse.
Right to Reasonable Accommodation: Applicants and assisted families have the right to request reasonable accommodations. Please notify staff if
you or anyone in your family is a person with disabilities, and you require a specific accommodation in order to fully utilize our programs and services.
Immigration Notification: Financial assistance is contingent upon the appropriate submission and verification of documentation of citizenship or
eligible immigration status. Proof of citizenship or eligible immigration status is required before an offer of housing assistance to a family. A list of
acceptable submission and verification documentation is available on our website at www.rhaonline.com.
Criminal Background Checks: A criminal background check is conducted on all adult household members. Certain criminal convictions may be
disqualifying, such as but not limited to: sex offenses or violent and/or drug manufacturing and distributing related convictions. At the discretion of
the RHA, on a case-by-case basis, a tenant’s past criminal behavior may not necessarily bar him/her from the program. RHA may, in its discretion,
take into consideration a variety of potential extenuating circumstances including but not limited to: whether violence was involved, whether a
pattern of drug use or sales is evidenced by the record, whether an applicant has gone through a recovery program, the disposition of a case, time
elapsed since the criminal act, etc. The final determination may prevent the family from receiving rental assistance.
***ATTENTION APPLICANTS FOR PUBLIC HOUSING***
In addition to conventional Public Housing, Raleigh Housing Authority (RHA) offers incentive-based public
housing. Each of the four incentive-based housing communities has their own separate application and waitlist.
Incentive-Based Waiting Lists
If you meet the above criteria you may also be qualified for the incentive-based public housing programs offered by RHA.
Incentive-based public housing programs have additional criteria, beyond those found in the conventional public housing
program as specified below. Applicants may apply for one or more of the incentive communities depending on interest
and qualifications. The incentive based public housing communities listed offer applicants a one-time residency with a
10-year cumulative time limit. Residents housed based on the working requirements must maintain employment of at
least 35 hours a week or be relocated to a conventional public housing unit at the resident’s expense.
1. Capitol Park – In order to qualify for public housing at Capitol Park, you must be working full time, elderly
or disabled. One bedroom public housing villas are available for the elderly, the disabled and working persons.
Two and three bedroom units are available for persons who have been working at least 35 hours per week for the
last two years. Applications for this community can be found on RHA’s website and at the Parkview Manor
office located at 911 North Blount Street. The office may be reached by calling 919-508-1217. Note: This
community has a 90-unit tax credit, senior building known as Parkview Manor exclusively for persons 55 years of
age or older which is not public housing. Parkview Manor involves a separate application and has a different rent
structure than public housing.
2. Scattered Site Homes – Scattered Site Homes are single-family homes for working families and are located
around the Raleigh area. In order to qualify for Scattered Sites public housing, you must be working full time at
least 35 hours per week for the last two years, and agree to assume additional responsibilities for the upkeep of the
yards. Applications for this community can be found on RHA’s website and in the main lobby area of 900
Haynes Street.
3. Chavis Heights – In order to qualify for public housing at Chavis Heights, you must be working full time,
elderly or disabled. One bedroom public housing villas are available for the elderly, the disabled and working
persons. Two bedroom units are available for persons who have been working at least 35 hours per week for the
last two years. Applications for this community can be found on RHA’s website and at the Carousel Place office
located at 750 Bright Creek Way. The office may be reached by calling 919-508-1226. Note: This community
has a 55-unit tax credit, senior building known as Carousel Place exclusively for persons 55 years of age or older
which is not public housing. Carousel Place involves a separate application and has a different rent structure than
public housing.
4. Walnut Terrace – Walnut Terrace offers public housing with elderly, disabled, and working preferences. In
order to receive the working preference, the family must have worked 35 hours per week for the last two years.
One bedroom villas, two bedroom townhomes, and three bedroom single family homes are available for those
who qualify. Applications for this community can be found on RHA’s web site and at the Walnut Terrace office
located at 1256 McCauley Street. The office may be reached by calling 919-508-1237.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 1: APPLICATION FOR HOUSING ASSISTANCE Public Housing

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 November 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document