No action will be taken until you return this form completed to the Housing Authority of the County of Santa Cruz, 2160 41
Avenue, Capitola, CA 95010. If
you have questions, contact the Housing Authority at (831) 454-5955 Monday-Thursday, between 8:00 am4:3 pm, Friday between 8:00 am 12:00 pm.
Section I
1. Voucher Family Member for whom the live-in aide is being requested: __________________________________________
Voucher Head of Household: _________________________________________
The Housing Authority of the County of Santa Cruz may approve a request for a live-in aide as a reasonable accommodation for a person with
disabilities. In order for your request to be considered you must supply the following information:
2. The family member’s doctor, or other health care professional or social worker with medical or professional knowledge of the disability
will be contacted to verify the need for a live-in aide. Please list the name of the qualified professional who can verify the disability and the
need for a live-in aide.
If you include contact information that is incomplete or incorrect, this form will be returned to you to complete and/or
correct, which will delay the processing of your request.
Name of Health Care Professional: _______________________________________ That person’s Phone: ____________________
Name of Hospital, Clinic or Office: _______________________________
Complete Mailing Address of the Professional named above: __________________________________________________________
City: ________________________________ State: __________ Zip Code: ____________ Fax: ______________________
The Housing Authority may contact the health care professional or social worker directly to verify the need for
a live-in aide, if such verification is not already on file.
Authorization to Release Information: I authorize the health care provider or social worker listed above to disclose relevant information to
the Housing Authority of the County of Santa Cruz regarding the need for a reasonable accommodation. I understand the information the
Housing Authority obtains will be kept confidential and used solely to determine if an accommodation should be provided.
You will be informed of the Housing Authority’s granting, denial, or status of this request within thirty (30) days of the receipt of this request.
___________________________________________________ ________________________
Signature of person requesting live-in aide Date
Section II
3. Name of proposed live-in aide:_________________________________________ Date of Birth:_____________
Current street address:______________________________________________ City: ____________________ Phone:__________________
Is the live-in aide related to any family member in the voucher household? If so, describe: ______________________________________
4. Live-in aide’s family members, if any, who will also be living in your unit with the live-in aide:
What is this persons relationship to live-in aide and
member(s) of the voucher household?
060103 092619 BA RA
Request for Live-in Aide AND Request to Change Live-in Aide
- If this is a new request for a live-in aide, complete the entire form, Section I and II.
- If you have already been approved for a live-in aide and are requesting permission to change the live-in aide
currently on your household composition, complete Section II only.
- See the back of this form for general information about live-in aides and the approval process.
060103 092619 BA RA
Information about the Live-in Aide (LIA) Process
For the purposes of the Section 8 program, the definition of a live-in aide (LIA) is as follows:
- A person who is in the home only under an employment arrangement as a caregiver.
- A LIA is not a person who would ordinarily live in the home.
- A LIA must live in the home to provide care during the nighttime (sleeping hours), receive their mail to that home, and
consider that address their own address.
- A LIA is not obligated for the voucher holder’s financial support and cannot be charged rent or required to pay any amount to
the voucher holder in exchange for living in the unit.
A LIA cannot be approved for comfort or companionship only. Their income is not included into the total household income.
The LIA can work outside of the home during the daytime. The LIA has no rights to the voucher or any other housing assistance
at any time.
The household will be provided one additional bedroom for the LIA and any family members that may reside with the LIA. If
the LIA has additional family members they will only be approved if their presence in the unit does not create overcrowding.
Please be aware that the following persons are not permitted to be categorized as a live-in aide:
- A current or prior member of the voucher assisted family.
- A spouse, significant other, life partner, girlfriend/boyfriend, domestic partner, etc., of the person requesting the LIA.
- A person that the landlord will not permit to move into your unit.
- A person that is not authorized by the Housing Authority to move into the unit
- A person under the age of 18.
All LIAs must go through the regular HUD screening process which includes the completion of a criminal background check and
fingerprinting through the FBI Live Scan system.
If the request for a LIA is approved the voucher holder will be notified by mail regarding the next steps in the process to add a
LIA to the voucher. Those steps include:
- Written notification from the voucher holder to the Housing Authority that a suitable LIA has been found.
- Documentation showing that your landlord approves this person to move in.
- Attendance at an appointment scheduled by the Housing Authority for both the voucher holder and the LIA.
At that appointment:
- The LIA will be required to provide identification documentation (photo and social security card) and go
through the HUD screening process (FBI Live Scan system), mentioned above.
- The voucher holder and LIA will be required to sign the Agreement between the Housing Authority the Head
of Household and the Live-in Aide form.
- Any other documentation requested to complete the process will be provided. Typically, this would be
documentation pertaining to other family members of the live-in aide who would be moving in with the live-in
Regardless of the voucher holder’s circumstances, the voucher size will not be adjusted unless and until the process
described above has been completed.
- For voucher holders who are not housed but are searching for housing, the voucher size and subsidy standard will be
adjusted once the LIA has been added to the voucher.
- For voucher holders already living in a unit large enough to provide a bedroom to the live-in aide without transferring
to a larger unit, the voucher will be adjusted the 1
day of the month following completion of the process described
- For voucher holders who transfer to a larger unit so they are able to provide a room for the LIA, the voucher size will
be adjusted once the LIA has been added to the household and the voucher has been transferred to a larger unit.
- For voucher holders who will not be transferring to a larger unit, the LIA will be added and the voucher size and
subsidy standard will remain unchanged. If they then transfer to a larger unit, the voucher size and subsidy standard will
be increased at the time of the transfer.
- For voucher holders who have added a live-in aide, are in a larger unit, have had their live-in aide move-out and do
not hire a new live-in aide, their voucher size and subsidy standard will be adjusted down at the next transfer or annual