Fillable PRE-APPLICATION FOR PROJECT BASED VOUCHER ASSISTANCE AT RESETAR (Housing Authority of the County of Santa Cruz)

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PRE-APPLICATION FOR PROJECT BASED VOUCHER ASSISTANCE AT RESETAR (Housing Authority of the County of Santa Cruz)

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PLEASE KEEP THIS COVER PAGE FOR YOUR RECORDS
06/2016 050181 JP
PRE-APPLICATION FOR PROJECT BASED VOUCHER ASSISTANCE AT
RESETAR RESIDENTIAL HOTEL
15 WEST LAKE AVENUE WATSONVILLE CA 95076
This pre-application form pertains to the Project Based Voucher (PBV) units at the Resetar Residential
Hotel only. You may also apply for any other programs, such as the Housing Choice Voucher Program
(Section 8) or the Low Income Public Housing (LIPH) Program if the Waiting Lists for such programs are
open. For more information about which programs are accepting applications and how to apply for other
programs administered by the Housing Authority, we invite you to visit our website at www.hacosantacruz.org
or call our Waiting List Call Center at (831) 454-5950.
ABOUT RESETAR RESIDENTIAL HOTEL
The Resetar Residential Hotel is an 89 unit supportive and affordable housing project at the heart of downtown
Watsonville. There are a total of 52 Project Based units at Resetar, of which 5 units are set aside for formerly
homeless veterans participating in the HUD-VASH program. There are 3 one-bedroom units and 49 studio
apartments in the Project Based Voucher program. Residents of Resetar Residential Hotel are required to
establish a service plan and receive case-management provided by Abode Services or other service providers.
ABOUT THE PROJECT BASED VOUCHER PROGRAM
In most ways, the PBV program operates just like the regular Housing Choice Voucher (Section 8) program,
with households paying roughly one third of their income towards housing, and the Housing Authority paying
the remainder of the rent directly to the landlord on the tenant’s behalf. However, there are some key
differences, listed below.
In the PBV program, applicants must have an “extremely low income” (under 30% median income). To
view current income limits, visit our website at: http://www.hacosantacruz.org/income_limits.htm
In the PBV program, tenants do not pay more than 30% of their income on housing.
In the PBV program, assistance is tied to the unit, not the household. Therefore, you must reside at
Resetar Residential Hotel for at least one year before potentially being eligible to transfer your
assistance to another unit.
A waiting list has been established specifically for PBV assistance at Resetar Residential Hotel. The period of
time a household must wait for assistance cannot be estimated. This waiting list does not have any
preferences on the basis of need, age, disability, or any other criteria. If you are interested in residing at Resetar
Residential Hotel, please complete the attached Pre-Application Form and return it to the Housing Authority.
PLEASE KEEP THIS COVER PAGE FOR YOUR RECORDS
06/2016 050181 JP
WHAT TO EXPECT AFTER YOU COMPLETE A PRE-APPLICATION FORM
1. Your name will be placed on the waiting list for Resetar Residential Hotel by the date the Housing
Authority receives your completed pre-application.
2. You will receive a confirmation letter confirming that you have been placed on the waiting list for
Resetar Residential Hotel. It may take several weeks before you receive this confirmation letter. When
you receive your confirmation letter, keep the letter for your records.
3. Your wait for assistance may be long. We cannot predict when your name will reach the top of the waiting
list. Once you have received your confirmation letter, you may not receive anything from the Housing
Authority for a very long time.
4. You must keep us informed, in writing, within thirty (30) days of any changes to your mailing
address. It is your responsibility to make sure the mailing address you give us is a reliable and secure one.
If, at any time, you do not respond to Housing Authority requests for information or appointments by the
due dates established in those letters, or if at any time letters sent to you are returned to the Housing
Authority as undeliverable, no further attempts to contact you will be made and your name will be removed
from the Waiting List.
5. When your name reaches the top of the waiting list we will contact you to confirm your continued
interest in living at Resetar Residential Hotel, and inform you when a unit becomes available. At that
time, you will be given instructions to contact Resetar management, who will screen prospective tenants and
provide the Housing Authority with a referral for the available unit.
6. When Resetar management has referred you for a unit, the Housing Authority will conduct an
income eligibility determination. As part of that eligibility determination, the Department of Housing and
Urban Development requires that we perform a sex offender check on all applicants. Additionally, the
Housing Authority may also perform a criminal background check or credit check. Please see our website
for more information about program eligibility. However, program rules are subject to change at any time,
and your eligibility will not be determined until you have reached the top of the list.
7. How to reach us – you may visit our website at www.hacosantacruz.org or call the Waiting List Call
Center at (831) 454-5950.
The Housing Authority of the County of Santa Cruz
2160 41
st
Avenue, Capitola, CA 95010
Phone (831) 454-9455 TDD (831) 475-1146
www.hacosantacruz.org
If you need assistance completing this form,
please contact the Housing Authority Waiting List Call Center at (831) 454-5950.
PLEASE RETURN THIS PRE-APPLICATION TO THE HOUSING AUTHORITY OF THE COUNTY OF SANTA CRUZ.
MAIL THIS PRE-APPLICATION TO: HOUSING AUTHORITY OF THE COUNTY OF SANTA CRUZ – 2160 41
st
AVENUE - CAPITOLA CA 95010. PRE-APPLICATIONS RECEIVED BY FAX WILL NOT BE ACCEPTED.
06/2016 050181 JP
PRE-APPLICATION FOR PROJECT BASED VOUCHER ASSISTANCE AT
RESETAR RESIDENTIAL HOTEL
15 WEST LAKE AVENUE WATSONVILLE CA 95076
In order to be placed on the Waiting List for Resetar Residential Hotel, please complete the following questions.
Please print your answers neatly in blue or black pen. Incomplete or illegible pre-applications will not be
accepted. Only one Pre-Application form will be accepted per applicant. Duplicate Pre-Application forms will
be rejected.
Applicant Information (If a question is not applicable to you, answer “N/A” or “None”.)
1.
First Name
______________________________________________________________________
2.
Middle Initial
_________
3.
Last Name
______________________________________________________________________
4.
Social Security Number
___________ — ________ — ______________ Not Applicable
5.
Home Telephone Number
6.
Current Resident Address
(Cannot be a PO Box)
Check here if homeless
____________________________________________________________
City_____________________ State _______ Zip Code ___________
7.
Mailing Address
(If different, or if no
resident address provided)
____________________________________________________________
City_____________________ State _______ Zip Code ___________
8.
Total annual household income
$ _______________________
9.
In which language do you prefer to communicate?
English Spanish
TDD Other: ____________________
10.
Date of birth ________________________
11.
Sex
Male Female
12.
Number of members in household
_________
Studios accommodate up to 2 people.
One bedrooms accommodate up to 3 people.
Optional – HUD requires the Housing Authority to request this information.
13. Ethnicity Hispanic or Latino Not Hispanic or Latino
14.
Race
African American / Black
Asian
Native Hawaiian / Pacific Islander
American Indian / Alaska Native
Caucasian / White
PLEASE RETURN THIS PRE-APPLICATION TO THE HOUSING AUTHORITY OF THE COUNTY OF SANTA CRUZ.
MAIL THIS PRE-APPLICATION TO: HOUSING AUTHORITY OF THE COUNTY OF SANTA CRUZ – 2160 41
st
AVENUE - CAPITOLA CA 95010. PRE-APPLICATIONS RECEIVED BY FAX WILL NOT BE ACCEPTED.
06/2016 050181 JP
Optional
15. Do you wish to claim disability status? Yes No
Please note that you are not required to answer this question or to reveal any information about the disability status of any
household member.
Person with disabilities defined as individuals with mental or physical impairments that substantially limit one or more major life
activities. The term mental or physical impairment may include conditions such as blindness, hearing impairment, mobility
impairment, HIV infection, mental retardation, alcoholism, drug addiction, chronic fatigue, learning disability, head injury, and
mental illness. The term major life activity may include seeing, hearing, walking, breathing, performing manual tasks, caring for
one's self, learning, speaking, or working. The definition also includes persons who have a record of such an impairment, or are
regarded as having such an impairment. Current users of illegal controlled substances, persons convicted for illegal manufacture or
distribution of a controlled substance, sex offenders, and juvenile offenders are not considered disabled by virtue of that status.
16.
To help assess special housing needs, please indicate any specific features you would require to
accommodate any family member.
Wheelchair accessibility Unit Adapted for the Hearing Impaired Grab Bars
Ground Floor Unit Adapted for the Visually Impaired Other
Certification
By completing and submitting this form I am requesting that my name be placed on the Waiting List for Project
Based Voucher assistance at the Resetar Residential Hotel in downtown Watsonville. I understand that placing
my name on the Waiting List does not give me any right to be admitted to the program, guarantee my future
eligibility, or assure that subsidy funds will be available. Additionally, by signing below, I give the Housing
Authority my authorization to share my application information with Resetar management so that they may
consider my eligibility for housing.
I understand that I must inform the Housing Authority, in writing, within 30 days of any change to my
name and / or mailing address. I understand that if I do not respond to any information or appointment
request from the Housing Authority, or if any letter sent to me is returned to the Housing Authority as
undeliverable, my name will be removed from the Waiting List.
WARNING – TITLE 18 SECTION 1001 OF THE UNITED STATES CODE STATES THAT ANY PERSON WOULD BE
GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS
TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES.
Printed Name of Applicant _____________________________________________________________
Signature of Applicant _____________________________________________________________
Date ________________________________
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PRE-APPLICATION FOR PROJECT BASED VOUCHER ASSISTANCE AT RESETAR (Housing Authority of the County of Santa Cruz)

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Completed 15 May 2021

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