855.827.3466 Facebook: @PHFA.org
www.PHFA.org Twitter: @PHFAtweets
REMINDER: ALL CARES RENT RELIEF PROGRAM APPLICATION AND SUPPORTING DOCUMENTS MUST BE
SUBMITTED DIRECTLY TO THEIR COUNTY’S DESIGNATED CARES RRP ORGANIZATION. PARTICIPATING
ORGANIZATIONS CAN BE FOUND ON THE PHFA WEBSITE AT HTTPS://WWW.PHFA.ORG/PACARES/.
LANDLORD INFORMATION
Name: _______________________________________________________
Home Address: ________________________________________________
City, State, Zip Code: ___________________________________________
Phone Number: ________________ Email: ________________________
1. Will you accept electronic payment of funds via Direct Deposit?
Yes ____ No ____
2. Are you able to provide the required banking information to receive the disbursement of CARES funds?
Yes ____ No ____
3. Do you agree to wave the right to collect rent from the tenant for the months which CARES assistance
is being applied?
Yes ____ No ____
NAME(S) OF LESSEE (MUST MATCH LESSEE
HOUSEHOLD CERTIFICATION)
MONTHS OF ASSISTANCE
REQUESTED
AMOUNT OF ASSIS-
TANCE REQUESTED
$
$
$
$
$
$
$
$
$
TOTAL AMOUNT OF ASSISTANCE REQUESTED NOT TO EXCEED $4,500 $
4. Have you provided ownership documentation for each rental unit listed below? Acceptable proof of ownership
documents include a copy of the deed, sales contract, most recent property tax receipt, a copy of the mortgage, or
proof of homeowner’s/hazard insurance from the most recent year.
Yes ____ No ____
CARES RENT RELIEF PROGRAM
LANDLORD APPLICATION
855.827.3466 Facebook: @PHFA.org
www.PHFA.org Twitter: @PHFAtweets
5. Do you have either a written or oral lease agreement with your lessee?
Yes ____ No ____
6. Have you and/or your lessee(s) provided a lease agreement (written) and included a third-party document that can
be used to verify residency for each lessee requesting CARES RRP assistance (i.e. utility bill, cancelled check with
address, pay stub or ID showing the current residence address)? Please include third-party supporting documentation
for both written and oral leases.
Yes ____ No ____
7. Do you attest that each lessee requesting CARES RRP assistance occupied the applicable residence between
March 1, 2020, and December 30, 2020?
Yes ____ No ____
8. Do you agree not to begin any eviction proceedings for any other rent within 60 days from the date rent was due
within the last month for which assistance was provided?
Yes ____ No ____
9. Do you attest that all property taxes on buildings associated with lessees listed above are paid and up to date?
Yes ____ No ____
10. Please read the Housing Quality Standards checklist on the Landlord/Property Certification. Do each of the rental
properties for which CARES funds are being requested meet these guidelines?
Yes ____ No ____
NOTE: If approved to receive CARES RRP funds, landlords/property owners will be required to provide a W-9 to the
county’s designated organization.
*IF YES TO ALL OF THE ABOVE, PLEASE COMPLETE THE LANDLORD/PROPERTY CERTIFICATION*
Landlord Name (Print): __________________________________ Date: ____________________
Landlord Signature: _____________________________________ Date: ____________________
CARES RENT RELIEF PROGRAM
LANDLORD APPLICATION
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