Fillable Program Application Department of Community Development - Bureau (City of Shreveport)

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Program Application Department of Community Development - Bureau (City of Shreveport)

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Program Application
Neighborhood Revitalization Program
Department of Community Development - Bureau of Housing
REQUEST FOR SERVICES
(Check one or more of the following)
PROPERTY INFORMATION (MUST BE WITHIN CITY LIMITS)
APPLICANT(S) INFORMATION
REQUIRED APPLICATION ATTACHMENTS
✔
✔
✔
✔
✔
REQUIRED APPLICATION ATTACHMENTS
STATISTICAL DATA:
City of Shreveport
CITY OF SHREVEPORT
NEIGBORHOOD REVITALIZATION
PROGRAM
AUTHORIZATION TO RELEASE INFORMATION
To Whom It May Concern
I/We hereby authorize you to release to the City of Shreveport, for verification or re-verification (quality
control) purposes, information necessary to process my/our request for service. This information includes,
but is not limited to, my/our past and present employment status, my/our bank accounts, my/our past and
present consumer credit record, and my/our past and present mortgage and/or rent record.
The information furnished to the City of Shreveport is for their confidential use in processing my/our
mortgage loan/grant request for service.
Your prompt reply to the City of Shreveport will be appreciated.
Applicant's Signature
Date
Co-Applicant's
Signature
Date
PRIVACY NOTICE: This information is to be used by the agency collecting it or its assignees in determining whether you qua1ify as prospective mortgagor under its
program. It
will not be disclosed outside the agency except as required and permitted by law. You do not have to provide this information, but if you do not, your
application for approval as a prospective mortgagor or borrower may be delayed or rejected. The information requested in this form is authorized by Title
38. USC, Chapter 37 (VA); by 12 USC, Section 1701 et.seq. (HUDIFHA); by 42 USC, Section 1452b (HUD/CPD); and Title 42 USC, 1471 ct. Seq. or 7
USC, 1921 el. seq. (USDA/FHA).
LEAD PAINT ACKNOWLEDGMENT
FORM
Date
I, the undersigned, do acknowledge the presence or absence of children under the age of six (6) residing in
my home, or who stay in my home more than six (6) hours each week, by checking the appropriate
statement below.
I DO
have
small
children
residing
in
or
staying
in
my
home.
I DO NOT have any small children residing in or staying in my home.
Homeowner
Date:
CITY OF SHREVEPORT
NEIGBORHOOD REVITALIZATION
PROGRAM
LEAD PAINT
ACKNOWLEDGMENT
WATCH OUT FOR LEAD-BASED PAlNT POISONING
IF THIS PROPERTY WAS CONSTURCTED BEFORE 1978, THERE IS A POSSIBILLITY
IT
CONTAINS LEAD-BASED PAINT. PLEASE READ THE FOLLOWING INFORMATIN
CONCERNING LEAD-BASED PAINT POISONING.
SOURCES OF LEAD BASED PAINT POISONING
The interiors of older homes and apartments often have layers of lead-based paint on the walls, ceilings, window
sills, door and door frames. Lead-based paint and primers may also have been used on outside porches, railings,
garages, fire escapes and lamp posts. When the paint chips, flakes or peels off, there may be a real danger for
babies and young children. Children may eat paint chips or chew on painted railings, window sills or other items
when parents are mot around. Children can also ingest lead even if they do not specifically eat paint chips. For
Example, when children play in an area where there are loose paint chips or dust particles containing lead, they
may get these particles on their hands. Put their hands into their mouths. And ingest a dangerous amount of lead.
HAZARDS OF LEAD BASED PAINT POISONING
Lead poisoning is dangerous-especially to children under the age of sever (7). It can eventually cause mental
retardation, blindness and even death:
SYMPTONS OF LEAD PAINT POISONING
Has your child been especially cranky or irritable? Is he or she eating normally? Does your child have stomach
aches and vomiting? Does he or she complain about headaches? Is your child unwilling to play? These may be
signs of lead poisoning. Many times though, there are no symptoms at all. Because there are no symptoms, does
not mean that you should not be concerned if you believe your child had been exposed to lead-based paint.
ADVISIBILITY AND AVAILIBILITY OF BLOOD LEVEL SCREENING
If you suspect that your child had eaten chips of paint or someone told you this, you should take your child to the
doctor or clinic or testing. If the test shows that your child has an elevated blood level, treatment is available.
Contact your doctor or local health department for help for more information. Lead screening and treatment are
available through the Medicaid Program for those who are eligible, If your child is identified as having an
elevated level, you should immediately notify the Department of Community Development or another agency to
which you or your landlord is applying for rehabilitating assistance so the necessary steps can be taken to test
your unit for lead-based paint hazards, If your unit does have lead-based paint, you may be eligible for
assistance to abate that hazard.
PRECAUTIONS TO TAKE TO PREVENT
LEAD-BASED PAINT POISONING:
You can avoid lead-based paint poisoning by performing some preventive maintenance. Look at your walls, ceilings,
doors, door frames and window sills. Are there places where the paint is peeling, flaking, chipping, or powdering?
If so, there are some things you can do immediately to protect your child:
1. Cover all furniture and appliances
2. Dust containing lead can be a health hazard. DO NOT vacuum loose paint, sweep and damp mop.
3. Sweep up all pieces of paint and plaster and put them in a paper bag or wrap them in newspaper.
Put these packages in the trash can. DO NOT BURN THEM.
4. Do not leave paint chips on the floor or in window sills. Damp mop floors and window sills in and around the
work to remove all dust and paint particles. Keeping these areas clear of paint chips, dust and dirt is easy and
very important.
5. Do not allow loose paint to remain within your children's reach since children may pick loose paint off the
lower part of the walls.
As a homeowner, you should take the necessary steps to keep your home in good shape. Water leaks from faulty
plumbing, defective roofs and exterior holes or breaks may admit rain and dampness into the interior of your home.
These conditions damage walls and ceilings and cause paint to peel, crack or flake. These conditions should be
corrected immediately. Before repainting, all surfaces that are peeling, cracking, chipping or loose should be
thoroughly cleaned by scraping or brushing the loose paint from the surface, and then repainted with two (2) coats of
non-leaded paint. Instead of scraping and repainting, the surface may be covered with other material such as
wallboard, gypsum, or paneling.
Beware that when lead-based paint is removed by scraping or sanding, dust is created, which may be hazardous. The
dust can enter the body either by breathing it or swallowing it. The use of heater paint removers could create a vapor or
fume which may cause poisoning if inhaled over a long period of time.
Whenever possible, the removal of lead-based paint should take place when there are no children or pregnant women
on the premises.
Simply painting over defective lead-based paint surfaces foes not eliminates the hazard.
Remember that you, as an adult, play a major role in the prevention of lead poisoning.
Your actions and awareness about the lead problem can make a big difference.
You should immediately notify the management office or the agency through which you are purchasing your home if
the unit has flaking, chipping, powering or peeling paint, water-leaks from plumbing or a defective roof,
You should cooperate with that office's efforts to repair the unit.
I have received a copy of the Notice entitled "Watch Out for Lead-Based Paint Poisoning"
Homeowners Signature
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Program Application Department of Community Development - Bureau (City of Shreveport)

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Completed 16 July 2020

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