Fillable Rental Assistance - Landlord Application

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Rental Assistance - Landlord Application

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  • 132 other fields

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Rental Assistance - Landlord Application
Follow these steps to complete the application
1. Complete the Landlord Section of this form
2. Have your Tenant Complete the Tenant Section of this
form
3. Provide all required documents
4. Submit complete package to ERAP@rhcbfresno.com
Landlord Section:
Name: _______________________________________Email Address:___________________________Phone Number:_______________________________
Mailing Address:______________________________________________City:__________________State:__________________Zip Code:________________
Mailing Address(list the mailing address of where you would like payments sent, if different from above)
Mailing Address:______________________________________________City:__________________State:__________________Zip Code:________________
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):________________
Required Documents
Valid government photo ID(expired documents and utility bill with name and address are acceptable alternatives)
IRS form W9 Tax bill or Mortgage statement demonstrating proof of ownership
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
Terms and Conditions:
• I, or any other persons in this household, will not apply for other rental assistance programs and have not received assistance for the months I am requesting
rent assistance.
• If eligible, I understand the RH Community Builders may make payments to be applied to the 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: _______________________________________________________________________
Should you have any questions about your application, or if you need assistance completing this form, contact us at: 559-515-4700
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signature
click to edit
Tenant Section:
We need to determine if you qualify for Rent Assistance. Answer all the question on this application. We will be asking for details about your household, income,
landlord, and rent 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)
Required Documents
Valid government photo ID(expired documents and utility bill with name and address are acceptable alternatives)
Income Verification (provide all that apply)
2020 Income Tax Returns
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
Annual income 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
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.
• 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: _______________________________________________________________________
Should you have any questions about your application, or if you need assistance completing this form, contact us at: 559-515-4700.
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Rental Assistance - Landlord Application

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Completed 11 February 2022

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