Fillable Program Overview (Texas Coronavirus Relief Bill Rental Assistance Program)

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Program Overview (Texas Coronavirus Relief Bill Rental Assistance Program)

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Updated: May 11, 2021
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Program Overview
Name:
Address:
Program Overview
TEXAS RENT
RELIEF PROGRAM
OVERVIEW
The Texas Rent Relief program provides rental and utility assistance to qualifying applicants to prevent housing
instability, potential eviction, and financial hardships of tenants and landlords as a result of the COVID-19 public health
emergency. Application for assistance may be initiated by either the Tenant or the Landlord so please read carefully and
follow the steps in order to ensure you are filling out the application process correctly.
Program funds may be used to provide up to fifteen (15) months of assistance for the following expenses:
• past due rent,
• current and future rent,
• past due utility and home energy costs, and
• current and future utilities and home energy costs.
While applicants may be assisted for up to 15 total months, the Program will not commit funds for future rent or utility
assistance for more than a 3-month period at a time. We encourage tenants to request 3 future months with the initial
application, if you plan on being in the unit. Applicants must reapply every 3 months and will only be assisted if funds are
still available.
This program has specific eligibility requirements and not all households may be eligible. Application funding is subject
to availability and will remain open until all available funds have been committed. The duration of the Program and the
speed in which a household will be served depends on the number of eligible applicants. Funds may not be available by
the time a household applies or is reviewed for eligibility. Other program limitations may also apply, and policies are
subject to additional guidance and/or requirements provided by the Department of Treasury. For more information or
to view frequently asked questions and program resources, please visit the program's main page at:
https://texasrentrelief.com.
If you need assistance completing an application, our Call Center staff can complete the application with you by phone
at 1-833-989-7368. Call center hours are from 8:00 AM – 6:00 PM Central Time (CT) Monday - Saturday. Help is available
in multiple languages.
Updated: May 11, 2021
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QUALIFICATION CRITERIA
Households must have income at or below 80% of the Area Median Income (AMI).
1. AND One or more of the tenant household members must:
o Attest they have qualified for unemployment benefits since March 13,2020; OR
o Attest in writing that due to or during the pandemic, they:
§ Experienced a reduction in household income,
§ Incurred significant costs, or
§ Experienced financial hardship
2. AND Households must:
o Demonstrate they are at risk of homelessness or housing instability by providing an eviction notice or
past-due utility or rent notice; OR
o Attest that if they do not receive rental and/or utility assistance, they would need to move into an
unsafe or unhealthy living environment, like a shared living situation or emergency shelter
3. AND The unit a household is renting must be their primary residence and be located within the State of Texas.
Beginning on April 21, 2021, Texas Rent Relief may now provide assistance to the following groups:
• Tenants living in Public Housing (the tenant paid-portion of rent and/or utilities)
• Tenant households receiving Project-Based or Tenant-Based Vouchers(the tenant paid-portion of rent and/or
utilities)
• Tenants living in units with rents above the 150% of their Small Area Fair Market Rent (SAFMR)/Fair Market Rent
(FMR). Rent assistance provided may not exceed $4600 per month.
LANDLORD PARTICIPATION
If your application is eligible and there are funds available, the Texas Rent Relief Program will first try to pay your
landlord and/or utility provider. The Texas Rent Relief Program will contact your landlord and/or utility provider for up
to 10 days. If a landlord confirms that they do not want to receive payment directly, or if after that period of time has
passed a landlord has still not responded, the Texas Rent Relief Program will then pay the tenant directly. If you receive
payment directly from the Texas Rent Relief Program, you must use it to pay your landlord and/or utility provider. To not
use the funds for that purpose is a violation of state and federal law.
DOCUMENTS NEEDED TO APPLY
As part of the Program application, all tenant households will be required to submit the following documentation
required to perform the eligibility review:
• Government-issued or personal ID for at least one household member on the lease,
• Copy of rent or lease agreement
o If there is no lease agreement, your landlord will have to submit the rent term and monthly rent amount
and you must provide a rent receipt or other payment documentation for the three most recent
complete months of paid rent to establish a pattern of paying rent.
• Notices of late rent payment or notice to evict, if applicable
• If your landlord has started eviction proceedings, you will need to have ready:
o Court Docket #
o Justice of the Peace Precinct #, and
o County
• Know that you will be asked to sign a certification. To read this ahead of time, you can visit TexasRentRelief.com.
You will be promising that everything you provide is true and that you have not already received assistance for
the same months.
• Copies of past due utility bills, if utility assistance is being requested
Updated: May 11, 2021
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Income
For all household members 18 years of age or above (or head or co-heads of household if all members are under 18),
income documentation must be provided from one of the three options below. Please note that if you follow options 1
or 2, you will only have to provide documentation one time. If you choose option 3 and reapply for additional assistance
after three months, you will need to provide income documentation again. Note that households that are applying in
the eviction diversion set-aside, and have a court docket #, only need to attest that their income is at or below 80% of
Area Median Income; income documentation is not required.
• Option 1: Eligibility Through Other Programs
o Households who receive assistance from other public programs may streamline the application process
by providing proof of participation in any of the following programs to meet the income criteria.
§ A household with 6 or fewer members may provide a letter or other documentation dated on or
after January 1, 2020 showing that the household receives benefits from one of the following
programs:
§ Head Start, LIHEAP/CEAP, or SNAP
§ SSI, TANF, or Tribal TANF, for head or co-head of household
§ Veterans Affairs Disability Pension, Survivor Pension, Enhanced Survivor Benefits, or
Section 306 disability pension (not standard VA pension)
§ A household with 3 or fewer members may provide a letter or other documentation dated on or
after January 1, 2020 showing that the household receives benefits from Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC)
§ If you are living in a rent-restricted property, living in a public housing unit, or receiving tenant-
based rental assistance (such as a Housing Choice Voucher) you or your landlord can provide
evidence of your most recent income certification (as long as it is no older than one year from
when you apply for assistance).
§ If you have either of the items above, the only other information you will have to provide about
income is a signed certification (already a part of the application) that your household income is
still below the limit.
• Option 2: Annual Income Documentation for 2020
o Filed 2020 IRS Form 1040 if you have completed your 2020 federal income taxes. Household income will
be calculated as the adjusted gross income.
o A 2020 IRS Tax Return Transcript will suffice for a 2020 tax return.
o If you have not filed taxes yet, you may use other source documents showing your household’s annual
income (e.g. wage statement, W2s, interest statement, unemployment compensation statement).
o All file types (PDF, screenshot, picture, etc.) are acceptable.
o Unsigned tax returns are accepted as part of the application. They do not need to be signed.
• Option 3: Monthly Income Documentation:
o Check stubs from your employer for the most recent thirty (30) day-period or current letter from your
employer verifying gross wages (pay rate, hours/week, pay date)
o Current Pension/Retirement Benefit letter (if applicable)
o Investment income
o Pension
o Retirement
o Social Security (not SSI)
o Signed certifications (already a part of the application) for any household member who is self-employed,
earns cash income, or does not earn income.
o Unemployment compensation
Updated: May 11, 2021
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FALSE OR FRAUDULENT DOCUMENTS OR STATEMENTS
Falsification of documents or any material falsehoods or omissions in the Application, including knowingly seeking
duplicative benefits, is subject to state and federal criminal penalties. Landlords and tenants are particularly put on
notice that 18 U.S.C. §1001 provides, among other things, that whoever knowingly and willingly makes or uses a
document or writing containing any false, fictitious, or fraudulent statement or entry, in any matter within the
jurisdiction of any department or agency of the United States will be fined not more than $10,000 or imprisoned for not
more than five years, or both.
TO REPORT FRAUD, WASTE, AND ABUSE:
All Texas Department of Housing and Community Affairs (TDHCA) employees and contractor employees have a
responsibility to report waste, fraud and abuse within the agency. The public is also invited to share such concerns. If
you suspect fraud, waste or abuse please call (833) 61-FRAUD or (833) 613-7283.
Suspected Fraud:
TDHCA reserves the right to decline funding or participation if it is determined that fraud has occurred.
For General Program Questions, Contact Us Here:
By phone: 1-833-989-7368
Via email: info@texasrentrelief.com
Reasonable Accommodation
If you or anyone in your household is a person with disabilities and requires a specific accommodation to apply for this
Program, please contact the program call center by phone at 1-833-989-7368 to request an accommodation.
NOTE: Much of the correspondence for this Program is via EMAIL, so please check your Spam email folder if you have
not received any emails from Neighborly Software or from the Texas Rent Relief program.
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A. Eligibility
Name:
Address:
A. Eligibility
The following questions will help determine whether your household meets basic eligibility for the Texas Rent Relief Program.
A.1. Are you seeking assistance for Rent and/or Utilities for your primary residence, located in Texas?
__ Yes __ No
A.2. Is your household income below the program income limit for your county and household size?
• Go to https://texasrentrelief.com/ and click on “Do I Qualify?”
• Answer a few quick questions to see if your household qualifies.
• Under the “ Income Limit Calculator” select the property county, number of household members and hit
“Calculate”.
• If you need any assistance calculating the Income Limit, please contact our call center at: 1-833-989-7368.
__ Yes __ No
A.3. Can you or anyone in your household demonstrate that you are at risk of homelessness by either providing a past
due utility or rent notice or eviction notice, or certifying that unless you receive rental assistance, you would have to
move to an unsafe/unhealthy environment, like a crowded living situation or emergency shelter?
__ Yes __ No
A.4. Has anyone in the household experienced any of these financial impacts related directly or indirectly to COVID-
19: reduction/loss of income, increased expenses, other financial hardship and/or qualified for unemployment
benefits since March 13, 2020?
__ Yes __ No
A.5. Is this the only payment assistance you are requesting or will receive for the months or portion of the rent you
are seeking assistance?
__ Yes __ No
IF YOU ANSWERED NO TO ANY OF QUESTIONS A.1 - A.5, YOU ARE VERY LIKELY TO
BE INELEGIBLE FOR THE TEXAS RENT RELIEF PROGRAM. PLEASE CONTACT OUR CALL
CENTER AT 833-989-7368 IF YOU HAVE ANY QUESTIONS.
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B. Applicant Information
Name:
Address:
B. Applicant Information
Please enter the contact information below for the person(s) seeking rental and/or utility assistance (the person must be on the
lease/rental agreement). If you would like to add additional user(s) to help in the submission of this application, and/or view the
status of this application in the future, you can do so in the VIEW USERS section available in the menu on the left hand side of your
screen.
PRIMARY APPLICANT
B.1. Applicant First Name: ________________________________________________________________________
B.2. Applicant Last Name: ________________________________________________________________________
B.3. Home Address: _____________________________________________________________________________
B.4. County: ___________________________________________
B.5. Mailing Address (Complete If Different from Home Address): ______________________________________
______________________________________________________________________________________________
B.6. Telephone Number: _________________________________
B.7. E-Mail: _________________________________________________________________________________
B.8. Preferred Method of Communication: ________________________________________________________
B.9. Is anyone listed on your lease no longer a member of your household? __ Yes __ No
If yes, please explain below. For example, the individual has moved out, has passed away, or is listed on the lease as a
co-signer.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
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C. Household Members
Name:
Address:
C. Household Members
List all household members, starting with the Head of Household (Primary applicant). Social Security number not required. If you
elect not to share social security numbers, enter 000-00-0000 in SSN field.
Total Household Members: _______
Name
Social Security Number
(not required)
1
2
3
4
5
6
7
8
9
10
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D. Eviction
Name:
Address:
D. Eviction
Some of the rent and utility assistance funding available through the Texas Rent Relief program is dedicated for tenants who have
already been sued for eviction by their landlord.
D.1. Have you been sued for eviction by your landlord? __ Yes __ No
If no, proceed to next section
D.2. Please enter your Court Docket #: _____________
D.3. Please enter the Justice of the Peace Precinct: _____________
D.4. Please select the County of the Court: _____________
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E. Income Verification
Name:
Address:
E. Household Income Verification
You have three options for reporting/entering your household income. Select one of the options below and follow the instructions
for that option. Household income is income earned by everyone within the household over the age of 18. Note that households
that are applying in the eviction diversion set-aside, and have a court docket #, only need to attest that their income is at or below
80% of Area Median Income; income documentation is not required.
Option 1: If you have a 2020 Tax Return that covers all income earned by members of your household, enter the "adjusted gross
income" from your 2020 tax return (IRS Form 1040 Line 11) filed with the IRS. All pages must be included. Unsigned tax returns and
source documents for tax returns are also accepted.
OR
Option 2: If you or your household participate in one of the following programs and can provide a document showing that you
participate in the program, you do not need to prove any additional income documentation.
• If your household has 6 or fewer members, you can include copies of the most recent (no older than January 1, 2020)
benefits letter or program documentation that confirms eligibility from one of these programs:
o Head Start
o Low Income Home Energy Assistance Program (LIHEAP), or the Comprehensive Energy Assistance Program (CEAP)
in Texas
o Supplemental Nutrition Assistance Program (SNAP)
o Supplemental Security Income (SSI), for head or co-head of household
o Temporary Assistance for Needy Families (TANF) or Tribal TANF, for head or co-head of household
o Veterans Affairs Disability Pension, Survivor Pension, Enhanced Survivor Benefits, or Section 306 disability pension
(not standard VA pension)
• If your household has 3 or fewer members, you can include copies of the most recent (no older than January 1, 2020)
benefits letter or program documentation that confirms eligibility from Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC).
• If you live in an affordable housing property, live in a public housing unit, or receive a Housing Choice Voucher, you can
include a copy of a Tenant Income Certification (TIC) form from an affordable housing property dated within the last year.
OR
Option 3: Enter income information for every household member for each type of income following the instructions below. Note:
You will need to include copies of supporting documents for each type of income for each household member. Please use this option
if you are applying to the Eviction Diversion Program and select “Eviction Diversion” for income source to bypass the income
requirements. When selecting “Eviction Diversion” you are not required to submit income documentation.
Follow the instructions below to add at least one source of income for each household member. If a household member has zero
income, then add "Zero Income" as an income source from the Dropdown menu.
1. Using the table below, note the appropriate source of income. If the income source isn’t listed, a written description is required in
the "Additional Information" box.
2. Enter the expected income for the next 12 months specific to the source. If you receive income weekly, bi-weekly, or any other
frequency, please indicate this in the cart below.
3. Upload the appropriate documentation as prompted.
4. Repeat for each source of income for each household member until ALL household income is entered.
Failure to include ALL income information for every household member may prevent assistance from being provided OR you may be
required to REPAY assistance if you are found to be ineligible after assistance is granted.
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Income Sources for this application include:
1. 2020 Federal Tax Return
2. Alimony
3. Cash Income
4. Eviction Diversion
5. Gross Pay
6. Investment Income
7. No Income
8. Other - please provide explanation
9. Pension
10. Retirement
11. Self-Employment Income
12. Social Security
13. Tax Return Source Documents
14. Unemployment Comp
Name
Program
Participation
(Option 2 Only)
Income Source
Income Amount
Income Payment Basis
(Annual, Monthly, Weekly,
Hourly, etc.)
Example:
Joe Brown
SNAP
Other-Child Support
$1,000.00
Monthly
1
2
3
4
5
6
7
8
9
10
Staff Certification
Applicant Signature
Co-Applicant Signature
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F. COVID-19 Impact
Name:
Address:
F. COVID-19 Impact
F.1. Have you or other members of your household qualified for unemployment benefits due to the COVID-19
pandemic since March 13, 2020? __ Yes __ No
F.2. Have you or anyone within your household experienced any of the following hardships due directly, or indirectly,
to COVID-19? (If yes, please check all that apply below)
REDUCTION IN INCOME
Laid off-Receiving unemployment assistance.
Laid off-Not receiving unemployment assistance.
Place of employment has closed.
Reduction in hours of work.
Must stay home to care for child/children due to closure of daycare or school.
Not able to work and/or missed hours due to contracting COVID-19.
Are self-employed, and their business is no longer supplying them with income or such income has been
reduced.
Unwilling or unable to participate in their previous employment due to their high risk of severe illness from
COVID-19.
Reduction or elimination of child or spousal support.
Other reduction in household income: please describe the situation below.
INCURRED SIGNIFICANT COSTS
Child or Adult dependent care expenses increased due to COVID-19.
Other significant costs: please describe the situation below.
OTHER FINANCIAL HARDSHIP EXPERIENCED.
If "Other Hardship Experienced," please describe the situation below.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
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F.3. Has your household received a late rent notice, late utility notice, or eviction notice on or after March 13, 2020?
__ Yes __ No
If yes, please include the late rent notice, late utility notice, or eviction notice with your application.
o Late rent notice, late utility notice, or eviction notice *Required
F.4. If you do not receive rental assistance, would you or anyone in your household need to move into an unsafe or
unhealthy living environment, like a shared living situation or emergency shelter? __ Yes __ No
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G. Rent Assistance Requested
Name:
Address:
G. Rent Assistance Requested
Fill out the amount that you are requesting for each month of housing payments that you require assistance for due to your
household’s COVID-19 impact. For instance, if you are asking for $1,000 of rent missed in November 2020, but only $500 of rent
missed in December 2020, then you would fill out $1,000 in November 2020 and $500 in December 2020. Note that you are allowed
to request all months of past due rent that you may need assistance with (after March 13, 2020) AND YOU ARE ALSO ALLOWED TO
REQUEST UP TO 3 MONTHS OF CURRENT/FUTURE RENT AT THIS TIME.
Please note that for this program, rents assistance may not exceed $4600 per each month. If rent for a given unit is more than $4600
per month, the Texas Rent Relief Program will provide up to $4600 per each month for the months of assistance requested.
We encourage tenants to request 3 future months with the initial application, if you plan on being in the unit.
RENTAL ASSISTANCE REQUESTED
G.1. Are you requesting rent assistance? __ Yes __ No
G.1. What is your current monthly rent? _____________
G.2. How many bedrooms are in your rental unit? _____________
G.3. Rent request by month.
Late fees/penalties should not be included in missed rent, but rather entered in G.4.
Month/Year
Amount Requested
Month/Year
Amount Requested
March 2020
February 2021
April 2020
March 2021
May 2020
April 2021
June 2020
May 2021
July 2020
June 2021
August 2020
July 2021
September 2020
August 2021
October 2020
September 2021
November 2020
October 2021
December 2020
November 2021
January 2021
December 2021
G.4. Total Late Fees: _____________
Total Rent Assistance Request: _____________
G.5. Landlord/Entity Name: ___________________________________________________________________
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G.6. Landlord Address: ______________________________________________________________________
G.7. Landlord Phone Number: ________________________________________________________________
G.8. Landlord Email: ________________________________________________________________________
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H. Water & Gas/Propane
Assistance Requested
Name:
Address:
H. Water & Gas/Propane Assistance Requested
If you are requesting utility assistance, provide the type of utility assistance below for which you are seeking payment. Late fees
should be entered in H.7, H.14. If you have changed utility vendors during the time period for which you are requesting assistance,
enter your current provider under the relevant category and enter your previous provider under the “Other Home Energy” category
in Section J.
WATER ASSISTANCE REQUESTED
H.1. Are you requesting water utility assistance? __ Yes __ No
H.2. If you are requesting water assistance, you must include a copy of your most recent water utility statement with
your application. The amount of past-due assistance requested must match the amount owed shown on your
statement.
o Water Statement *Required
H.3. Water Company Name: ___________________________________________________________________
H.4. Water Company Address: _________________________________________________________________
H.5. Account Number: _______________________________________________________________________
H.6. Water Assistance Request:
Month/Year
Amount Requested
Month/Year
Amount Requested
March 2020
February 2021
April 2020
March 2021
May 2020
April 2021
June 2020
May 2021
July 2020
June 2021
August 2020
July 2021
September 2020
August 2021
October 2020
September 2021
November 2020
October 2021
December 2020
November 2021
January 2021
December 2021
H.7. Water/Sewer Late Fees: _____________
Total Water Request: _____________
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GAS/PROPANE ASSISTANCE REQUESTED
H.8. Are you requesting gas/propane assistance? __ Yes __ No
H.9. If you are requesting gas/propane assistance, you must include a copy of your most recent gas/propane utility
statement with your application. The amount of past-due assistance requested must match the amount owed shown
on your statement.
o Gas/Propane Utility Statement *Required
H.10. Gas/Propane Company Name: ___________________________________________________________________
H.11. Gas/Propane Company Address: _________________________________________________________________
H.12. Gas/Propane Account Number: __________________________________________________________________
H.13. Gas/Propane Assistance Request:
Month/Year
Amount Requested
Month/Year
Amount Requested
March 2020
February 2021
April 2020
March 2021
May 2020
April 2021
June 2020
May 2021
July 2020
June 2021
August 2020
July 2021
September 2020
August 2021
October 2020
September 2021
November 2020
October 2021
December 2020
November 2021
January 2021
December 2021
H.14. Gas/Propane Late Fees: _____________
Total Gas/Propane Request: _____________
click to sign
signature
click to edit
click to sign
signature
click to edit
17 of 26
I. Electric & Sewer Assistance
Name:
Address:
I. Electric & Sewer Assistance
If you are requesting utility assistance, provide the type of utility assistance below for which you are seeking payment. Late fees
should be entered in I.7. If you have changed utility vendors during the time period for which you are requesting assistance, enter
your current provider under the relevant category and enter your previous provider under the “Other Home Energy” category in
Section J.
ELECTRIC ASSISTANCE REQUESTED
I.1. Are you requesting electric utility assistance? __ Yes __ No
I.2. If you are requesting electric assistance, you must include a copy of your most recent electric utility statement
with your application. The amount of past-due assistance requested must match the amount owed shown on your
statement.
o Electric Utility Statement *Required
I.3. Electric Company Name: ___________________________________________________________________
I.4. Electric Company Address: __________________________________________________________________
I.5. Electric Account Number: ___________________________________________________________________
I.6. Electric Assistance Request:
Month/Year
Amount Requested
Month/Year
Amount Requested
March 2020
February 2021
April 2020
March 2021
May 2020
April 2021
June 2020
May 2021
July 2020
June 2021
August 2020
July 2021
September 2020
August 2021
October 2020
September 2021
November 2020
October 2021
December 2020
November 2021
January 2021
December 2021
I.7. Electric Late Fees: _____________
Total Electric Request: _____________
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SEWER ASSISTANCE REQUESTED
I.8. Are you requesting sewer assistance? __ Yes __ No
I.9. If you are requesting sewer assistance, you must include a copy of your most recent sewer utility statement with
your application. The amount of past-due assistance requested must match the amount owed shown on your
statement.
o Sewer Utility Statement *Required
I.10. Sewer Company Name: ______________________________________________________________________
I.11. Sewer Company Address: ____________________________________________________________________
I.12. Account Number: ___________________________________________________________________________
I.13. Sewer Assistance Request
Month/Year
Amount Requested
Month/Year
Amount Requested
March 2020
February 2021
April 2020
March 2021
May 2020
April 2021
June 2020
May 2021
July 2020
June 2021
August 2020
July 2021
September 2020
August 2021
October 2020
September 2021
November 2020
October 2021
December 2020
November 2021
January 2021
December 2021
Total Sewer Assistance Cost: _____________
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J. Trash & Other Utility Assistance
Requested
Name:
Address:
J. Trash & Other Utility Assistance Requested
If you do not have an Other utility request, you may skip the step and mark it "Complete and Continue." If you have changed utility
vendors during the time period for which you are requesting assistance, enter your current provider under the relevant category and
enter your previous provider under the “Other Home Energy” category.
TRASH ASSISTANCE REQUIRED
J.1. Are you requesting trash utility assistance? __ Yes __ No
J.2. If you are requesting trash assistance, you must include a copy of your most recent trash statement with your
application. The amount of past-due assistance requested must match the amount owed shown on your statement.
o Trash Utility Statement *Required
J.3. Trash Company: _______________________________________________________________________________
J.4. Trash Company Address: ________________________________________________________________________
J.5. Account Number: ______________________________________________________________________________
J.6. Trash Assistance Request:
Month/Year
Amount Requested
Month/Year
Amount Requested
March 2020
February 2021
April 2020
March 2021
May 2020
April 2021
June 2020
May 2021
July 2020
June 2021
August 2020
July 2021
September 2020
August 2021
October 2020
September 2021
November 2020
October 2021
December 2020
November 2021
January 2021
December 2021
Total Trash Assistance Cost: _____________
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OTHER HOME ENERGY COST ASSISTANCE REQUESTED
J.7. Are you requesting other energy cost assistance? __ Yes __ No
J.8. If you are requesting other energy cost assistance, you must include a copy of your most recent other energy
utility statement with your application. The amount of past-due assistance requested must match the amount owed
shown on your statement.
o Other Energy Cost Assistance Provider Statement *Required
J.9. Other Company Name: ___________________________________________________________________________
J.10. Other Company Address: ________________________________________________________________________
J.11. Account Number: _______________________________________________________________________________
J.12. Other Assistance Request:
Month/Year
Amount Requested
Month/Year
Amount Requested
March 2020
February 2021
April 2020
March 2021
May 2020
April 2021
June 2020
May 2021
July 2020
June 2021
August 2020
July 2021
September 2020
August 2021
October 2020
September 2021
November 2020
October 2021
December 2020
November 2021
January 2021
December 2021
Total Other Energy Assistance Cost: _____________
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K. Prior Assistance Received
Name:
Address:
K. Prior Assistance Received
Assistance provided under the Texas Rent Relief Program for households economically impacted by COVID-19 may not exceed a
household's monthly unmet housing cost needs. List all other sources of rent or utility assistance received from local governments,
the State, non-profit organizations, faith based organizations, or friends and family for the months for which you are applying for
assistance. Tenants living in a public housing unit, receiving tenant-based or project-based rental assistance, such as the Housing
Choice Voucher or Section 8, do not need to list those sources here.
PRIOR HOUSING ASSISTANCE RECEIVED
K.1. For the months for which you are requesting assistance are/were you receiving a Housing Choice Voucher
(Section 8), living in a unit receiving Project-Based Rental Assistance, or living in a public housing unit?
__ Yes __ No
K.2. Has anyone in your household applied for, or received any rental and/or utility assistance from any source (local,
state, federal, private) FOR THE MONTHS/OR RENT PORTION YOU ARE APPLYING TO TEXAS RENT RELIEF PROGRAM?
If yes, proceed with this section. If no, proceed to the next section.
__ Yes __ No
K.3. List the housing assistance that you have already received each month, where applicable. List all of the sources of
financial and/or housing assistance (the name of the local, state, federal or private organization) FOR ONLY THE
MONTHS YOUR ARE APPLYING TO the Texas Rent Relief Program.
Month/Year
Amount Requested
Assistance Source
March 2020
April 2020
May 2020
June 2020
July 2020
August 2020
September 2020
October 2020
November 2020
December 2020
January 2021
February 2021
March 2021
April 2021
May 2021
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Month/Year
Amount Requested
Assistance Source
June 2021
July 2021
August 2021
September 2021
October 2021
November 2021
December 2021
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L. Required Documents
Name:
Address:
L. Required Documents
Please include a copy of the following documents to complete your application. Submitting an incomplete application will delay
processing times. Applicants with missing documents/information will be notified by email, If non-responsive by email, the applicant
will be contacted by phone. The application will be rejected after three (3) consecutive unsuccessful contact attempts. Once an
application is rejected, the applicant will be notified by email. Rejected applicants are free to re-apply to the TRR Program if funds
remain available.
Documentation
o Government issued identification or other personal ID for at least one household member on the lease and/or
utility bill *Required
o If no lease agreement, the three most recent rent receipts or other proof of rent payment for example: bank
statements, check stubs or document(s) that establish a pattern of paying rent and primary residence. The documents
submitted must show name, address, and rent amount due/paid. *Required
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Submit
Name:
Address:
Submit
Once an application is submitted, it can only be "Re-opened" by an Administrator. Please provide an email address below and
once your application has been received, you will receive an email confirming the submission of your application.
Also note: please check your Spam email folder if you have not received any emails from Neighborly.
By submitting this Application for the Texas Department of Housing and Community Affairs (“TDHCA”) Texas Rent
Relief Program (the "Program), I/we, above named Tenant(s) hereby certify that:
1. I/We are currently occupying the unit for which I/we am seeking assistance as my/our principal residence and have
occupied the unit during the period of time for which the rental or utility arrears assistance, if any, is requested and
will occupy the unit as my/our principal residence throughout the remaining months for which the assistance is
provided.
2. I/We understand that if the Landlord and/or Utility Provider does not elect to participate, assistance payment may
be made directly to me/us as the legally responsible party(ies) for the unpaid bill or future payment, and the payment
must only be used for eligible costs as identified in this application. Use of payment received for any purpose other
than the rent or utility assistance requested is subject to criminal penalty.
3. That if I/We qualified for the program by confirming having qualified for unemployment benefits after March
13,2020, I confirm the information to be true and authorize the Texas Rent Relief Program to provide my information
if needed, to the Texas Workforce Commission to verify my qualification.
4. To my/our knowledge, if the Unit for which I am receiving assistance is receiving Housing Choice Voucher or
Project-Based Rental Assistance or is public housing, I/we are not receiving any other form of government or
charitable assistance for the same expenses for the same month or months for which this assistance is requested. If
I/we am receiving this kind of assistance, I/we have only requested assistance from the Texas Rent Relief program for
the tenant-paid portion of rent and/or utilities.
5. I/We will not seek to obtain rental or utility assistance in the future for the same months of rental arrears, rent,
utility arrears, or utilities covered by this assistance, and if I/we do receive such assistance I will report it to Landlord
and/or Utility Provider using the contact information in my/our lease or utility bill statement, and to the Texas Rent
Relief Program. If I receive an assistance payment directly, I/we will repay any duplicate assistance that I/we receive
to the Texas Department of Housing and Community Affairs within 10 calendar days.
6. I/We will inform the Texas Rent Relief Program within ten calendar days if evicted from the Unit, if disconnected
from Utility services, or if I/we no longer occupy the Unit as my/our principal residence during the period of
assistance by calling the 1-833-989-7368.
7. I/We have provided a current written lease as part of the application, or if I/we have not provided a current written
lease, I/we have provided proof of payment for the three most recent full month that a rent payment was made, and
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that the information I have provided in the Tenant Application regarding the terms of my/our lease, rent amount,
and/or utility arrears are true and accurate.
8. If I/We have requested assistance for any late fees, and I/we certify that those late fees were incurred due to the
impact of the COVID-19 pandemic on my/our household and were not accrued prior to March 13, 2021.
9. I/We understand that if determined to be ineligible, I/We can appeal the decision by following the appeal
instructions at TXRentRelief.com
10. I/We understand and attest that if I/we qualified for this program by providing evidence that we qualify under
another eligible program such as Head Start, SNAP, LIHEAP, TANF, VA benefits, or SSI that my/our household size is
comprised of 6 or fewer members and that my/our household income does not exceed the applicable limit. I/We
understand and attest that if I/we qualified for this program by providing evidence that we qualify under WIC that
my/our household size is comprised of 3 or fewer members and that my/our household income does not exceed the
applicable limit.
I/We understand and attest that if I/we qualified for this program by providing a Tenant Income Certification, my/our
household income does not exceed the applicable limit.
I/we confirm that our household income does not exceed the applicable limit
11. Tenant acknowledges that all information collected, assembled, or maintained by the Texas Rent Relief Program
pertaining to their application, except records made confidential by law or court order, are subject to the Texas Public
Information Act (Chapter 552 of Texas Government Code) and the Texas Rent Relief Program must provide citizens,
public agencies, and other interested parties with reasonable access to all records pertaining to this application
subject to and in accordance with the Texas Public Information Act.
12. I/We shall provide the U.S. Department of the Treasury, the U.S. Inspector General, the U.S. General Accounting
Office, the Texas Comptroller, the Texas State Auditor’s Office, the Office of Court Administration and the Texas
Department of Housing and Community Affairs, or any of their duly authorized representatives, access to and the
right to examine and copy records related to a payment made as a result of this application. If provided funds directly,
I/we agree to keep records of payment to the Landlord for the later of seven years, or such records will be kept for
the longer of seven years, after notice of a monitoring, audit, or litigation, has been provided, the matter has had a
final disposition.
13. I/We have been provided a copy of this certification.
14. I/We may remain responsible for charges presented with my utility bill, such as district assessments, internet, or
cooperative fees, that are presented separately from the charges for utility service.
15. I/We may remain responsible for charges authorized under the lease other than rent going forward, including but
not limited to pet rent or trash pickup fees.
16. The information I/We have provided is true, accurate, and complete, and if requested, I am able to provide
documentation to prove my household’s loss of income or additional expenses. I/We understand that providing false,
incomplete, or inaccurate information on application forms or seeking assistance for months in which assistance has
been or will be provided, may result in termination of participation in the Program, up to 5 years of imprisonment and
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for each occurrence a fine of up to $10,000
SUBMITTING PARTY
Is this application being submitted by the primary applicant/tenant? __ Yes __ No
If no, please select the relationship of the submitting party to the primary applicant/tenant.
Community Advocate
Friend
Relative
Landlord
Texas Rent Relief Call Center
Other
Date: _______________________________________________________________________________
Authorized Signature: _________________________________________________________________
Printed Name: _______________________________________________________________________
Contact Email Address: ________________________________________________________________
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Program Overview (Texas Coronavirus Relief Bill Rental Assistance Program)

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Completed 24 May 2021

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