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COVID EMERGENCY RENTAL ASSISTANCE (CERA)
Owner/Landlord Application
CERA Owner/Landlord Application (03/24/21) Page 1 of 4
Submit completed application
with supporting documents to
your local HARA. A list by
county can be found online at
https://www.michigan.gov/docume
nts/mshda/CERA_Contact_List_7
17582_7.pdf
The COVID Emergency Rental Assistance (CERA) program is
designed to keep Michigan residents who fell behind on their rent
and/or utilities during COVID-19 in their homes.
W
ho is eligible?
H
ouseholds may be eligible for the COVID Emergency Rental
Assistance (CERA) program if they meet the following conditions:
1. Have received a past-due rent or utility notice, notice to quit
or a court ordered summons, complaint or judgment for
unpaid rent after March 13, 2020
2. H
ave a gross household income is below 80% area medi
an
i
ncome (AMI), for the area
3. H
ave experienced an eligible COVID hardship since March
13, 2020.
4. A state ID (or other government issued ID) in the tenant’s
name (with supporting proof of residency if the address
does not match the unit)
5. A
lease agreement in the tenant’s name (if a written leas
e
w
as completed)
For more information on eligibility, please see the COVID
Emergency Rental Assistance (CERA) program FAQ (online at
https://michigan.gov/cera
) or call your local Housing Assessment
and Resource Agency (HARA). A list by county can be found
online at
https://www.michigan.gov/documents/mshda/CERA_Contact_List_
717582_7.pdf
Please:
Print clearly.
Do NOT include original
documents (send photocopies).
Avoid Processing Delays:
Applications must:
• Be complete, signed and
dated.
• Include all supporting
documents as listed in the
attached checklist.
• Be submitted to your local
HARA.
Applications submitted without
required supporting documents
can be held for a maximum of 30
days.
Disclaimer: All applications submitted to MSHDA will be discarded.
All applications must be sent to your local HARA.
COVID Emergency Rental Assistance (CERA) Owner/Landlord Application
CERA Owner/Landlord Application (03/24/21) Page 2 of 4
1. Owner/Landlord Information
Full Name (as shown on your income tax return)
Social Security Number/Employer Identification Number
Address (number, street, and apt. or suite no.)
City
State
Mailing Address (number, street, and apt. or suite no.)
City
State
Phone Number
Contact name and number to leave messages
Email Address
2. Tenant Information
Full Name(s)
County
Contract Unit Address (number, street, and apt. or suite no.)
City
State
Number of Bedrooms in Unit
Move-in date
Tenant Rent amount
Number of Months in Arrears
3. Payment History
Prior to March 13, 2020
Total amount past due or delinquent prior to March 13, 2020
March 13, 2020 to Present
Month / year
Tenant Rent amount
Payment amount (if
applicable)
Payment date (if
applicable)
Amount past due or
delinquent (without late
fees)
Total amount past due or delinquent (without late fees)
Total late fees assessed since March 13, 2020
Clear Form
COVID Emergency Rental Assistance (CERA) Owner/Landlord Application
CERA Owner/Landlord Application (03/24/21) Page 3 of 4
4. Utility and Eviction Information
Are utility payments past due or delinquent on this unit?
Yes – Must complete applicable box/es below
No
Have you filed for eviction?
Yes
No
Utility Type
Electricity
Utility Provider
Amount past due or delinquent
Tenant makes utility payment to
Owner/Landlord
Utility Provider
Utility Type
Gas/Propane/
Other Heat
Source
Utility Provider
Amount past due or delinquent
Tenant makes utility payment to
Owner/Landlord
Utility Provider
Utility Type
Water
Utility Provider
Amount past due or delinquent
Tenant makes utility payment to
Owner/Landlord
Utility Provider
Utility Type
Sewer
Utility Provider
Amount past due or delinquent
Tenant makes utility payment to
Owner/Landlord
Utility Provider
Utility Type
Trash*
Utility Provider
Amount past due or delinquent
Tenant makes utility payment to
Owner/Landlord
Utility Provider
*Trash arrears are allowed only if included with another utility bill
5. Owner/Landlord Certification
Initials
If this application is funded the Owner/Landlord agree that:
1. The settlement amount will be the Tenant’s total obligation for rent, late fees, court costs, and other charges (recognizing that, if
the CERA payment includes prospective rent, that payment might surpass the Tenant’s present financial obligation). The
settlement amount shall not include and the Landlord/Owner waives any late fees assessed after March 13, 2020 in excess of
$400 and any court costs in excess of $150.
2. When the CERA payment will not fully satisfy Tenant’s financial obligation to Owner/Landlord and the settlement includes an
installment repayment plan, if Tenant is performing that plan’s repayment terms, which performance Owner/Landlord will
cooperate with, Owner/Landlord will not take steps to evict Tenant for non-payment of the rent (or any other charges) that plan
covers.
3. It will waive any other present and known grounds for eviction against Tenant other than its nonpayment of rent claim or a claim
based on a serious and continuing violation of the lease or law.
4. Except for grounds permitted by #3 above, or in MCL 600.5714(1)(b), (c)(i), (d), (e), or (f), or MCL 600.5775, Owner/Landlord will
not take steps to terminate a tenancy anytime before 1 month after a CERA payment, or, if a CERA payment covers a period of
prospective rent, until at least 1 month after that period.
5. It has not received any other eviction diversion or rental assistance payments for this same arrearage for this Tenant.
6. Owner/Landlord Signature
I certify that, to the best of my knowledge and belief, all the information presented and attached to this application is true, correct, and complete in every
respect; the undersigned is the person legally entitled to possession of the property described in the Contract Unit Address above, or is an agent of
same with legal authority to enter into agreements on behalf of the person or entity legally entitled to possession of the property, and thereby authorized
to bind the landlord to legal agreements affecting the terms of the lease for the Contract Unit and settlement of any disputes related to said lease.
Owner/Landlord Signature
Date
COVID Emergency Rental Assistance (CERA) Owner/Landlord Application
CERA Owner/Landlord Application (03/24/21) Page 4 of 4
Checklist
Before submitting this application for the COVID Emergency Rental Assistance (CERA) program, please
review the following to make sure that all required information is included with the application.
Copy of past-due rent notice, a notice to quit or a court ordered summons, complaint or judgement
Most current copy of lease agreement in Tenant’s name (if a written lease was completed)
Copy of rental payment history if not provided on Application
Copy of utility statements showing amount past due, if applicable
COVID Emergency Rental Assistance (CERA) Tenant Application (Tenant may also submit
separately)
Copy of a state ID (or other government issued ID) in the Tenant’s name (with supporting proof of
residency if address does not match the unit) (Tenant may also submit separately)
Copy of Tenant household income, if applicable (Tenant may also submit separately)
• Household income for one month, OR
• Copy of submitted 2020 IRS form 1040 (first two pages)
• Food Assistance Program Notice of Case Action form (only applicable for households with 3 or
less people)
Owner/Landlord or Management Agent W-9
Supporting documentation for proof of COVID Hardship (Tenant may also submit separately)
Type of COVID
Hardship
Best Documents to Show
Proof
Alternate Documents to Show
Proof
A member of my
household qualified for
unemployment after
March 13, 2020
Unemployment Monetary
Determination Letter OR
screen shots from
unemployment website
showing payments and
person's name
Signed letter from applicant stating
the time period they received
unemployment benefits
A member of my
household has had a
10% reduction in income
after March 13, 2020
Signed letter from applicant outlining your original hours and pay rate
and reduced hours and pay rate during the COVID outbreak
A member of my
household has incurred
significant costs (over
$500) after March 13,
2020
Signed letter from applicant stating what type and amounts of
increased expenses the household incurred during the COVID
outbreak
A member of my
household experienced
other financial hardship
(over $500) after March
13, 2020
Signed letter from applicant stating what type of financial hardship
they occurred during the COVID outbreak
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Completed 15 November 2021

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