Fillable Rent Assistance Application

Fill Online, Printable, Fillable, Blank Rent Assistance Application 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.

Rent Assistance Application

On average this form takes 35 minutes to complete

The Rent Assistance Application form is 3 pages long and contains:

  • 1 signature
  • 8 check-boxes
  • 132 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
 
Rent Assistance – Application
Eligibility:
We need to determine if you qualify for Rent and Utility Assistance. Answer all the question on this application. We will be asking for details about your household,
income, landlord, rent and utilities along with supporting documentation. Submitting this application does not mean you will receive rental assistance. Once we have
verified your income, rent and household information, we will determine your eligibility. The information you provide will be used for determining your eligibility for
assistance under the Rent Assistance Program. We will not provide your information to third parties, except as needed to determine your eligibility for rent relief.
1. Are you renting your primary residence? Yes No
2. Are you receiving Section-8 or Rural Development rental assistance? Yes No
3. Are you currently living in public housing? Yes No
4. Has your household experienced a loss of income due to COVID-19? Yes No
(Total household income decrease could be due to a layoff, reduction in hours or loss of business. The cause must be related to the COVID-19 pandemic)
5. Has your household experienced a financial hardship due to COVID-19? Yes No
(A hardship includes any significant costs or other financial hardship incurred due, directly or indirectly to COVID-19)
6. Is your household experiencing housing instability? Yes No
(Answer yes if you have a past due utility bill, rent statement, eviction notice or can produce other evidence of risk of homelessness.)
7. Do you or any member of your household qualify for unemployment? Yes No
(Does anyone in your household qualify for unemployment benefits?)
8. Number of People in your Household. ______________________
(The number of people in your household in includes all adults listed on your lease, all children living in the rental more than 50% of the time, and any foster children or adults. Do not
include live-in aides. Do not include unborn children.)
9. Current Total Monthly Gross Household Income _____________________
(Enter the total of all household income sources, including but not limited to: wages, business income, social security or pensions, interest on savings accounts, TANF (welfare),
unemployment benefits and any other periodic payments or gifts from any source.)
Contact Information:
Address:____________________________________________ Unit#:___________________City:______________Zip Code:_____________________
Name:________________________________Date of Birth: ___________Social Security Number/ITIN: ______________ Check if you don’t have a SSN/ITIN
Phone Type:_______________Phone Number:________________________________Email:________________________________________________
Demographics:
What is your Gender? ____________________ Are you currently unemployed? Yes No If yes, what is the date of unemployment? __________
Are you Disabled? Yes No Are you Hispanic or Latino: Yes No What is your Race:__________________
Have you served in the US Military? Yes No
Household Member Information:
We need to know about everyone living in the unit except live-in aides. This includes all adults listed on the lease or rental agreement, children living in the unit more
than 50% of the time and any foster children or adults living in the rental. Do not include unborn children.
Name
Date of Birth
Gender
Hispanic or Latino
Race
SSN/ITIN
Check here if no
SSN/ITIN
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Income Information:
Tell us about all sources of income for the household. All amounts should be monthly.
Household Member who receives this income
Source of Income
Gross Monthly Amount
(before taxes)
Rental Information:
# of Bedrooms(for efficiencies, studio, or single room occupancy units, enter zero): _______________Lease Start Date:____________Rent Amount: _____________
Amount of Past Due Rent(only enter past due amounts after 3/13/20): ___________# of Months Past Due(do not count months prior to 3/13/20):________________
Landlord Information:
Name: _______________________________________Email Address:___________________________Phone Number:_______________________________
Mailing Address:______________________________________________City:__________________State:__________________Zip Code:________________
Utility Information:
If you do not pay for utilities check here
Utility Type
Past Due Amount
Months Past due
Date of most
current bill
Additional Services:
Are you interested in additional housing stability services beyond rent payments? Yes No
Required Documents:
Valid government photo ID(expired documents and utility bill with name and address are acceptable alternatives)
Provide a copy of your lease or rental agreement.
If you have one, provide a copy of your most recent Past-Due rent statement.
If you have one, provide a copy of your eviction notice.
Income Verification (provide all that apply)
2020 Income Tax Returns
Last Three Paystubs
Wage Statement from your
employer(s)
Social Security/Disability/Veteran
Benefit Award Letter date within
120 days of application.
Pension Statement
TANF Passport to
services
Workers Compensation
Statement
Alimony and/or Child
Support payments
Annual income derived
from assets to which any
member of the family has
access
Last three military payments
Financial Aid Award
Letter showing amount in
excess of tuition
Unemployment
and/or Disability
Compensation
Statement(s)
Terms and Conditions:
• My household qualifies for unemployment or has experienced a reduction in household income, incurred significant costs, or experienced a
financial hardship due to COVID -19 and is now unable to pay rent.
• My household does not have sufficient savings or liquid assets to pay the rent bills.
• I, or any other persons in my household, will not apply for other rental assistance programs and have not received assistance for the months I am requesting
rent and/or utility assistance.
• If eligible, I understand RH Community Builders may make payments to be applied to my rent. I understand that if have already received the benefit, I am
not eligible for future payment.
I hereby swear and affirm that the above information is true and correct to the best of my knowledge and belief. I authorize RH Community Builders to verify and
investigate such information with my full cooperation at any time. I understand that providing false information on
this Affidavit is a crime, and will subject me to criminal penalties and civil remedies. I am signing this form by electronically entering my name below or
providing a wet signature.
Date: ______________________________ Signature: _______________________________________________________________________
To submit your application, email this form and required documents to erap@rhcbfresno.com. Should you have any questions about your application, or
if you need assistance completing this form, contact us at: 559-515-4700.
click to sign
signature
click to edit
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

Rent Assistance Application

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 11 February 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document