Fillable State of Georgia Rental Assistance Program Hardship due (City of Oakland)

Fill Online, Printable, Fillable, Blank State of Georgia Rental Assistance Program Hardship due (City of Oakland) Form

Use Fill to complete blank online CITY OF OAKLAND (CA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

State of Georgia Rental Assistance Program Hardship due (City of Oakland)

On average this form takes 3 minutes to complete

The State of Georgia Rental Assistance Program Hardship due (City of Oakland) form is 1 page long and contains:

  • 0 signatures
  • 15 check-boxes
  • 6 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Oakland

BROWSE CITY OF OAKLAND (CA) 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
 
State of Georgia Rental Assistance Program
Hardship due to COVID-19 - Tenant Attestation
I or a member of my household, as of ____/____/____, am experiencing financial difficulty due to the
COVID-19 pandemic.
My household is experiencing financial difficulty due to:
Qualification for unemployment benefits for at least one household member
Iunderstandthatprovidingfalse,incomplete,orinaccurateinformationonapplication
forms in which assistance has been or will be provided, may result in termination of
participationintheProgram,upto5yearsofimprisonmentandforeachoccurrencea
fineofupto$10,000.
OR
At least one household member has experienced a reduction in household income,
incurred significant costs, or experienced financial hardship (please check applicable
reason(s) and include written attestation to describe the financial hardship):
Experienced a loss or reduction of income due to COVID-19.
Needing to take extended time off work due to COVID-19, either to:
Care for my child(ren) whose school is closed; or
Care for a family member who is sick with COVID-19.
Needing to take extended time off work because I have tested positive for COVID-
19.
Excessive COVID-19 related healthcare related or other expenses.
Penalties, fees, and legal costs associated with rent or utility arears.
Payments for rent or utilities made by credit card to avoid homelessness or
housing instability.
Moving costs for households that moved to avoid homelessness or housing
instability.
Increased internet access and computer equipment costs needed to attend work
and/or school.
Alternate transportation for households unable to use public transportation during
the pandemic.
Purchase of personal protective equipment (PPE).
Please briefly describe the financial hardship experienced due to COVID-19, including the
name of the household member that is experiencing the hardship. (written description
from applicant/effected tenant is REQUIRED):
______________________________________________________________________________________
______________________________________________________________________________________
_______________________________________________________________________________.
I acknowledge that 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. I am
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.
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

State of Georgia Rental Assistance Program Hardship due (City of Oakland)

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 17 May 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document