APPLICATION COVER SHEET

APPLICATION COVER SHEET
Thank you for applying with us. We have a waiting list for all of our units and only completed
applications are placed on the waiting list. In order to swiftly process your application, we will need the
following items:
1.
Fully completed application. If a question doesn’t apply to you draw a line through it or write
NA across it. Do not leave anything blank!
2. Credit check fee paid $8 per person or $10 for married couple
3.
Copies of ALL Social Security Cards for all family members.
4.
Age Verification Documents: drivers license, birth certifications or social security benefit
letter
4.
Proof of income-We cannot accept households with no income.
a. 4 paycheck stubs,
b. TANF or TEA statement from DHS,
c. SS and or SSI benefits letter.
d. Unemployment benefit letter
e. Last year tax return with w-2/s
f. Proof of Child Support or Alimony
g. Divorce Decree
5.
Last year’s tax return for student status if you are a college student and under the age of 24.
(Proof you are independent of parents)
Please note that if you do not return these needed items your application cannot be processed for
housing. If you have any questions, or need assistance in filling out your application, we would be happy
to help.
Thank you.
Management
This institution is an equal opportunity provider and employer.
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program
Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any
USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the
information requested in the form. Send your completed complaint form or letter to us by mail at U.S.
Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington,
D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected].
Revised 04/2014
Page 1 of 15
515-2010
Rental Application for :
______________________________________________
Do Not Mark In This Space
(Project Name)
Date Rec’d _____/_____/_____
Time: _____________________
The information collected below will be used to determine if you qualify as a tenant. It will not be disclosed without your consent except to your
employer(s) for verification of income and employment and to financial institutions for verification of assets, and as required and permitted by
law. You do not have to provide the information, but if you do not your application may be delayed or rejected.
Please Print Clearly
Applicant’s Name: ____________________________________________
SSN: __________________________
Mailing Address: _________________________
State: _____ Zip: _____________
City: ___________
Number of years at current address: ___________
Phone: ________________________
Name of Employer: _____________________________
Self Employed: Yes (
Business Phone: _______________________________
Type of Business: _____________
) No (
)
Position/Title: _______________
Co-Applicant’s Name: _________________________________________
SSN: __________________________
Mailing Address: _________________________
State: _____ Zip: _____________
City: ___________
Number of years at current address: ___________
Phone: ________________________
Name of Employer: _____________________________
Self Employed: Yes (
Business Phone: _______________________________
Type of Business: _____________
) No (
)
Position/Title: _______________
Household Composition
List all persons who will reside in the apartment including all members who live there on a part time basis
Member
Number
Full Name
(as it appears on
Social Security Card)
Relationship
to Head
Marital Status:
M - Married
S -Single
L - Legal Separation
Birth
Date
Age
Social Security
Number
Full Time
Student
Y-Yes
N-No
Head
2
3
4
5
6
7
8
This institution is an equal opportunity provider and employer.
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found
online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may
also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S.
Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202)
690-7442 or email at [email protected].
Revised 04/2014
Page 2 of 15
515-2010
Student Status
1.
2.
3.
4.
Are ALL members of your household full-time students?
Will ALL members of your household become full-time students during any 5 months of this year?
Will ALL members of your household be full-time students during any 5 months of next year?
Is ANY ADULT member of your household a part or full-time student of higher education?
Yes (
Yes (
Yes (
Yes (
)
)
)
)
No (
No (
No (
No (
)
)
)
)
If yes, who is enrolled? _________________________ Which school are they enrolled in? _______________________
How do they pay for their education? ___________________ What is the cost of tuition per semester?______________
5. Does ANY ADULT member of your household intend to become a student within the next 12 months? Yes ( ) No (
If yes, who will be enrolling in school? _____________________________________________________
If yes, will they be enrolling as a full-time or part-time student? ________________________________
6. Do you anticipate any additions to the household within the next 12 months?
Yes ( ) No (
If yes, explain: ________________________________________________________________________
7. Does anyone live with you that is not listed above?
Yes ( ) No (
If yes, explain: ________________________________________________________________________
8. Are you or any member of your household currently using an illegal controlled substance or have been convicted
of doing so?
Yes ( ) No (
If yes, explain: ________________________________________________________________________
9. Is ANY household member subject to a lifetime sex offender registration requirement in any state?
Yes ( ) No (
10. In what states has each household member resided? (Please list all states for every household member.)
____________________________________________________________________________________
11. Have you or any member of your household been convicted of a felony?
Yes ( ) No (
If yes, explain: ________________________________________________________________________
12. Have you or any member of your household been evicted or refused housing?
Yes ( ) No (
If yes, when _______________ and for what reason ________________
13. Have you ever filed bankruptcy
Yes ( ) No (
If yes, explain:_________________________________________________________________________
14. Do you or anyone in your household require a caregiver?
Yes ( ) No (
If yes, explain:_________________________________________________________________________
15. Do you have child care expenses for children 12 or under?
Yes ( ) No (
If yes, how much: ______________________________________________________________________
16. Do you own any pets?
Yes ( ) No (
If yes, describe: ________________________________________________________________________
Attention Handicapped / Disabled Applicants
Applicants may be eligible for income adjustments if the tenant or co-tenant has a handicap or disability, as defined by
federal
law. Certain other adjustments to income may be applicable if a household member other than the tenant or
co-tenant has a handicap or disability, as defined by federal law. Additional information will be required to verify
eligibility.
PLEASE CHECK HERE to request adjustments for a tenant or co-tenant who is disabled / handicapped.
PLEASE CHECK HERE to request adjustments for another household member who is disabled/handicapped.
PLEASE CHECK HERE TO REQUEST A WHEELCHAIR ACCESSABLE UNIT: Apartments with special modifications for
accessibility to persons in wheelchairs or other mobility impairments may be available.
Rent on the above apartments is determined by the applicant’s income. Handicap units are available and priority will be given to those who
require special design features. All responsible requests for special accommodations will be reviewd by management and in all cases possible will
be met. Arkansas State Relay Service provides a toll free 24-hour a day service for the hearing impaired. That phone number is 1-800-285-1131.
White River Regional Housing Authority provides equal Housing Opportunities.
Revised 04/2014
Page 3 of 15
515-2010
)
)
)
)
)
)
)
)
)
)
)
Monthly Annual Income
List ALL sources on income as requested below. Do not leave any blanks. Write N/A if a section does
not apply
Source
Applicant
Co-Applicant
Other Household Members
18 or Older
Total
Salary
Overtime
Fees
Tips
Bonuses
Interest and/or
Dividends
Net Income from
Business
Net Rental Income
Social Security
SSI
Pensions, Retirement
Funds
Unemployment
Benefits
Workers
Compensation
Disability
Compensation
Child Support
Welfare Benefits
Other Income
Contributions Family/Group
Food Stamps
Alimony:
Have an entitlement to receive alimony that is not currently being received?
Are you currently going through the courts to collect?
Yes ( ) No ( )
Yes ( ) No ( )
Child Support:
Have an entitlement to receive alimony that is not currently being received?
Are you currently going through the courts to collect?
Yes ( ) No ( )
Yes ( ) No ( )
Total Gross Annual Income based on the monthly amounts listed above X 12 $____________________
Do you anticipate any changes in this income in the next 12 months?
Yes ( ) No ( )
Is yes, Explain_________________________________________________________________________
Revised 04/2014
Page 4 of 15
515-2010
Assets
Please request an additional form if your number of assets exceeds the spaces available on
the page. Do not leave any blank spaces. Write N/A if a section does not apply.
Checking Accounts
No.
No.
No.
Bank:
Bank:
Bank:
Balance $
Balance $
Balance $
Bank:
Bank:
Bank:
Balance $
Balance $
Balance $
Bank:
Bank:
Balance $
Balance $
Bank:
Bank:
Bank:
Balance $
Balance $
Balance $
Bank:
Bank:
Bank:
Balance $
Balance $
Balance $
Bank:
Bank:
Bank:
Balance $
Balance $
Balance $
Bank:
Bank:
Balance $
Balance $
Bank:
Bank:
Bank:
Balance $
Balance $
Balance $
Savings Accounts
No.
No.
No.
Trust Accounts
No.
No.
Certificates of Deposit
No.
No.
No.
Name of Credit Union
No.
No.
No.
Savings Bonds
No.
No.
No.
Life Insurance Policy
No.
No.
Mutual Funds
No.
No.
No.
Revised 04/2014
Page 5 of 15
515-2010
Stocks or Bonds
Name:
Name:
Name:
# Shares
# Shares
# Shares
Dividend Paid $
Dividend Paid $
Dividend Paid $
Value$
Value$
Value$
Investment Property
Appraised Value $
Do you own real estate property? Yes ( ) No ( )
If yes, list type of property:
Location of property:
Appraised or Market Value $
Mortgage or outstanding loan value $
Amount of annual insurance premium $
Most recent tax bill $
Do you have any other assets not listed above (excluding personal property)? Yes ( ) No ( )
If yes, please list:
Have you disposed of any property in the last 2 years? Yes ( ) No ( )
If yes, list type of property:
Market value when sold/disposed $
Amount disposed/sold for $
Date of transaction (mm/dd/yyyy)
Have you disposed of any other assets in the last 2 years? (Example: given money to realatives or set up
Irrevocable Trust Funds? Yes ( ) No ( )
If yes, describe the asset:
Date of disposition (mm/dd/yyyy)
Amount disposed
How did you hear about these apartments?
Driving by Site Road Signs
Web Site
Residents
Newspaper? Name of Newspaper____________________________________________________
Radio?
Name of Station_______________________________________________________
Other? Explain:__________________________________________________________________
Revised 04/2014
Page 6 of 15
515-2010
Reference Information
Current Landlord
Name:
Address:
Home Phone:
Business Phone:
How Long?
Previous Landlord
Name:
Address:
Home Phone:
Business Phone:
How Long?
Personal Reference #1
Name:
Address:
Relationship:
Phone #
Personal Reference #2
Name:
Address:
Relationship:
Phone #
In case of emergency notify:
Name:
Address:
Relationship:
Phone #
Vehicle Information
List any cars, trucks, or other vehicles owned. Parking will be provided for each vehicle. Arrangements with
Manager will be necessary for more than one vehicle.
Type of Vehicle
Year/Make
Type of Vehicle
Year/Make
Revised 04/2014
License Plate #
Color
License Plate #
Color
Page 7 of 15
515-2010
Certification/Consent
I/we hereby certify that I/we do /will not maintain a separate subsidized rental unit in another location. I/we further certify that this will
be my/our permanent residence. I/we understand I/we must pay a security deposit for this apartment prior to occupancy. I /we
understand that my/our eligibility for housing will be based on applicable income limits and by management's selection criteria. I/we
certify that all information in this application is true to the best of my/our knowledge and I/we understand that false statements or
information are punishable by law and will lead to cancellation of this application or termination of tenancy after occupancy. All adult
applicants, 18 or older, must sign this application. I/we consent to the disclosure of income and financial information from my/our
employer and financial references for purposes of income e and asset verification related to my/our application for tenancy.
________________________________________________________________________
Signature
Date
________________________________________________________________________
Signature
Date
________________________________________________________________________
Signature
Date
_______________________________________________________________________
Signature
Date
“The information regarding race, ethnicity, and sex designation solicited on this application is requested in order to assure
the Federal Government, acting through the Rural Housing Service that the Federal laws prohibiting discrimination
against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are
complied with. You are not required to furnish this information, but are encouraged to do so. This information will not
be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish
it, the owner is required to note the race ethnicity, and sex of individual applicants on the basis of visual observation or
surname.
Ethnicity:
( ) Hispanic or Latino
( ) Not Hispanic or Latino
Gender
( ) Male
( ) Female
Race (Mark one or More)
( ) 1. American Indian/Alaska Native
( ) 2. Asian
( ) 3. Black or African American
( ) 4. Native Hawaiian or Other Pacific Islander
( ) 5. White
Revised 04/2014
Page 8 of 15
515-2010
APPLICANT/TENANT AUTHORIZATION FOR RELEASE OF INFORMATION
WHITE RIVER REGIONAL HOUSING AUTHORITY
I authorize the release of any information including documentation and other materials pertinent to eligibility for
participation in any assisted housing program
INFORMATION INQUIRIES ABOUT.
CHILD CARE EXPENSES
CITIZENSHIP
CREDIT HISTORY
CRIMINAL ACTIVITY
FAMILY COMPOSITION
EMPLOYMENT, INCOME PENSION, & ASSETS
FEDERAL, STATE, TRIBAL OR LOCAL BENEFITS
HANDICAPPED ASSISTANCE EXPENSES
IDENTITY AND MARITAL STATUS
MEDICAL EXPENSE
SOCIAL SECURITY NUMBERS AND BIRTH DATES
RESIDENCES AND RENTAL HISTORY
INDIVIDUALS OR ORGANIZATIONS THAT MAY RELEASE INFORMATION:
BANKS & OTHER FINANCIAL INSTITUTIONS
COURTS
LAW ENFORCEMENT AGENCIES
CREDIT BUREAUS
EMPLOYERS, PAST AND PRESENT
LANDLORDS
PENSIONS AND/OR ANNUITIES
SCHOOLSaANDaCOLLEGES
US DEPARTMENT OF VETERANS AFFAIRS
US DEPARTMENT OF IMMIGRATION &
NATURALIZATION
US SOCIAL SECURITY ADMINISTRATION
UTILITY COMPANIES
WELFARE AGENCIES
PROVIDERS OF
ALIMONY
CHILD CARE
CREDIT
HANDICAPPED ASSISTANCE
MEDICAL CARE
CHILD SUPPORT
I agree that photocopies of this authorization may be used for the purpose stated above. If I do not sign
this authorization, I also understand that my housing assistance may be denied or terminated.
Signature
Date
Social Security No.
Signature
Date
Social Security No.
I certify that the above-named individual has read this document fully or that I have read it to him/her and I
have explained its contents and answered any questions to the best of my ability and that he/she
understood the significance of this document at the time of signing.
Housing Authority Representative
Revised 04/2014
Page 9 of 15
Date
515-2010
WHITE RIVER REGIONAL HOUSING AUTHORITY
TENANT SELECTION POLICY
for Rural Development 515/Tax Credit Properties
The White River Regional Housing Authority (referred to as the Agent) shall use this tenant selection policy for
all RD 515/Tax Credit properties under its management. The policy of the Agent is one of equal opportunity and
non-discrimination in compliance with all Civil Rights legislation (1964,1968,1988) Section 504 of the
Rehabilitation Act of 1973 (if applicable) and Affirmative Fair Housing Marketing requirements as set forth
individually for each property. No applicant will be denied on the basis of race, color, religion, sex, handicap or
disability, familial status, or national origin.
1.
Applications must be completed in full. Only completed applications will be processed. Incomplete
applications will be returned for completion, therefore, delaying the possible application approval and movein of an applicant. Applicants with zero income will not be considered for occupancy. Applicants must
demonstrate the ability to pay rent, utilities, and reasonable living expenses.
2.
Maximum household size allowed is two (2) people per bedroom plus an additional person per 50 square feet
of living space (living space excludes closets, stairways, kitchen, dining room, hallways and bathrooms).
Occupancy Guidelines are as follows:
1 bedroom apartment = 1 to 2 persons
2 bedroom apartment = 2 to 4 persons
3 bedroom apartment = 3 to 6 persons
4 Bedroom apartment = 7 to 10 persons
Management retains the authority to grant exceptions to the policy to allow an under-housed or overhoused situation, when a unit meeting the occupancy guidelines is not available. Tenants will be required to
vacate when an eligible applicant is on the waiting list or when an appropriate sized unit becomes available
with a thirty (30) day written notice. It will be the tenant’s financial responsibility when transferring from
a unit to bring the vacated apartment to “rental condition.” This includes all cleaning, painting, carpet
shampooing and anything in excess of normal wear and tear.
In the event the property does not have the appropriate sized unit to make a tenant eligible, the tenant will
be required to vacate at the end of the term of their initial lease, with a thirty (30) day written notice. If
the initial lease term has expired, the tenant will be required to vacate with a thirty (30) day written
notice.
3.
For rental units specially designed for persons with disabilities, an applicant/tenant who does not have a
person with a disability in the household are permitted to occupy the rental unit until management issues a
thirty (30) day notice that a priority applicant is on the waiting list at which time the ineligible tenant must
move to another suitably sized vacant unit. It will be the tenant’s financial responsibility when transferring
from a unit to bring the vacated apartment to “rental condition.” This includes all cleaning, painting, carpet
shampooing and anything in excess of normal wear and tear.
Revised 04/2014
Page 10 of 15
515-2010
4.
Applicants will be required to provide past landlord history for a minimum of three (3) years. Applicant
must provide full names of landlords, addresses, telephone numbers, and dates of occupancy on the Rental
Application or the application will be considered incomplete.
a. If applicant’s past residency has been as a homeowner, Management reserves the right to
request a credit reference from the mortgage holder of the property.
5.
CREDIT HISTORY – A national credit-reporting agency will process the credit application.
6.
CRIMINAL BACKGROUND – A criminal background check will be run on each individual 18 years of age or
older who will be residing in the apartment.
7.
Applicants will be placed on the waiting list according to the date and time completed applications are
received. Applicants who have a need for “special design features” of accessible units will be given first
priority for units designed for persons with disabilities.
8.
Only the applicant may request information on their current status on the waiting list by writing, calling or
appearing in person at the site office. To protect the privacy of all prospective tenants, the waiting list will
not be shown to any prospective tenant.
9.
Applicant must fill out all forms. Each household member must sign his/her own signature as requested on
each form. Forged signatures or someone else signing for the specified household member may be grounds
for ineligibility of an application or eviction of a tenant.
10. All adult household members must be present when Management requests a personal interview and must
show positive identification when requested. Birth certificate or other proof of parental relationship or
guardianship may be requested in order to verify eligibility for deductions for a minor child.
11. All college students will be required to furnish proof whether they are a full-time (12 hours or more)
student. All students must meet the following requirements in order to be eligible:
a. Must be of legal age or otherwise legally able to enter into a binding contract under State Law.
b. Must not be claimed as a dependent on parents’ or legal guardian’s tax return.
c. The applicant must provide a notarized written statement when applicable, stating financial assistance
is being provided by parents, legal guardians or others. Any such assistance will be considered as part
of annual income.
d. Student status has several exceptions. Contact a Management Representative to discuss your specific
situation.
12. Applicants will be required to furnish verification of persons with disability status if they wish to deduct
expenses related to their disability from their income and/or if they wish to be considered eligible for
occupancy in apartments designated as Elderly housing. Management’s policy for verifying an individual’s
disability is as follows:
a. The Rental Application requires the applicant(s) to indicate whether they or anyone in the family would
benefit from special features for persons with disabilities.
b. If yes, the applicant is advised that Management requires a document verifying disability such as a
Social Security Statement or a statement from an independent third person, such as a physician,
clergyman, or other person who has knowledge of the disability.
Revised 04/2014
Page 11 of 15
515-2010
13. Any person wishing to join an existing household must make separate application and must be eligible for
housing in this property as a separate household.
14. The Head of Household and the Co-Tenant (if any) must be legally of age and able to enter into a Lease
Agreement.
15. An applicant will be offered an apartment of appropriate size and type. If more than one such apartment is
vacant, the applicant will be given a choice. If the applicant turns down the vacancy offered, the applicant
will be placed at the bottom of the waiting list. The new eligibility date is the date the applicant turned
down the first offer.
16.
All applicants must require rental assistance. This is a 100% rental assistance program. Rental assistance
will be assigned in accordance with Exhibit 8-2 of HB-2-3560.
17. Applicants may be ineligible if:
a. Application is incomplete.
b. Family composition does not conform to units available on property.
c. Household income exceeds published income limits for the IRS Section 42 program or USDA Rural
Development, whichever is the most restrictive. All applicants must be eligible for rental assistance.
d. Applicant provided false information necessary in the determination of eligibility.
e. Past performance in meeting financial obligations, including past rent and credit history, and past
performance shows inability to fulfill a one (1) year lease or a poor history of job stability (minimum six
(6) months).
f. Applicant has no present guaranteed income.
g. Applicant has a record of disturbance of neighbors, destruction of property, living or housekeeping
habits which adversely affect the health, safety, or welfare of other tenants.
h. Applicant has a history of criminal activity involving crimes of physical violence to persons or property
or other criminal acts which adversely affect the health, safety, or welfare of themselves or other
tenants or the viability of the property. This includes but is not limited to the possession, sale or use
of illegal substances.
i. Applicant is presently on parole or probation for any criminal, civil, domestic action, etc. This is also
valid for up to 24 months from the time parole or probation expires.
18. Management will make reasonable accommodations and allow reasonable modifications for persons with
disabilities, under the Federal Law. In order to provide optimum communications with applicants, tenants
and members of the public that have sight or hearing impairments, the Management Agent will utilize the
state relay service operated by “Arkansas Relay Service.” Assistance will be given for completing the
application. The Management Agent provides handicapped accessible interview rooms.
Any applicant/tenant who thinks his/her rights have been violated under the Fair Housing and Equal Opportunity
laws should contact the HUD Regional Office, Attn.: Fair Housing and Equal Opportunity, PO Box 2778, Little
Rock, AR 72203, or call toll free 1-800-424-8590.
*** All approved applications must be updated every six (6) months to remain on the active waiting list. ***
Revised 04/2014
Page 12 of 15
515-2010
Rural Housing and
Community Programs
Things You Should Know About USDA Rural Rental Housing
Don’t risk losing your chances for federally assisted housing by providing false,
incomplete, or inaccurate information on your application or recertification
Penalties for Committing Fraud
You must provide information about your household status and income when you apply for assisted housing in
apartments financed by the U.S. Department of
Agriculture (USDA). USDA places a high priority on preventing fraud. If you deliberately omit information or give
false information to the management company on your
application or recertification forms, you may be:
Evicted from your apartment;
Required to repay all the extra rental assistance you
received based on faulty information;
Fined;
Put in prison and/or barred from receiving future
assistance.
All Household Members. List the names of all the
people, including adults and children, who will actually live with you in the apartment, whether or not they
are related to you.
Ask for Help if You Need It
If you are having problems understanding any part of
the application, let the landlord know and ask for help
with any questions you may have. The landlord is
trained to help you with the application process.
Before You Sign the Application
Make sure that you read the entire application and
understand everything it says;
Check it carefully to ensure that all the questions
have been answered completely and accurately;
Don’t sign it unless you are sure that there aren’t any
errors or missing information.
Your State and local governments also may have laws that allow them to
impose other penalties for fraud in addition to the ones listed here.
How To Complete Your Application
By signing the application and certification forms, you
are stating that they are complete to the best of your
knowledge and belief. Signing a form when you know it
contains misinformation is considered fraud.
When you meet with the landlord to complete your
application, you must provide information about:
All Household Income. List all sources of money
that you receive. If any other adults will be living with
you in the apartment, you must also list all of their
income. Sources of money include:
–Wages, unemployment and disability compensation,
welfare payments, alimony, Social Security benefits,
pensions, etc.;
–Any money you receive on behalf of your children,
such as child support, children’s Social Security, etc.;
–Income from assets such as interest from a savings
account, credit union, certificate of deposit, stock
dividends, etc.;
–Any income you expect to receive, such as a pay
raise or bonus.
All Household Assets. List all assets that you
have. If any other adults will be living with you, you
must also list all of their assets. Assets include:
Tenant Recertification
Residents in USDA-financed assisted housing must
provide updated information to the management company at least once a year. Ask your landlord when you
must recertify your income.
You must immediately report:
–Bank accounts, savings bonds, certificates of
deposit, stocks, real estate, etc.;
–Any business or asset you sold in the last 2 years
for less than its full value, such as selling your home
to your children.
Revised 04/2014
The management company will verify your information. USDA may conduct computer matches with
other Federal, State or private agencies to verify that
the income you reported is correct;
Ask for a copy of your signed application and keep a
copy of it for your records.
Any changes in income of $100 or more per month;
Any changes in the number of household members.
For your annual recertification, you must report:
Page 13 of 15
All income changes, such as increases in pay or
benefits, job change or job loss, loss of benefits, etc.,
for any adult household member;
515-2010
Any household member who has moved in or out;
All assets that you or your adult housemates own, or
any assets that were sold in the last 2 years for less
than their full value.
Avoid Fraud, Report Abuse
When a Grievance Is Legitimate
Prevent fraudulent schemes through these steps:
The landlord must determine if a grievance is within the
established rules for the program. For example, “I want
to file a complaint because the manager doesn’t speak
to me” is not a legitimate complaint. However, “I want to
file a complaint because the manager isn’t maintaining
the property according to USDA guidelines” is a legitimate complaint. Below are examples of cases in which
tenants may and may not file a complaint.
Don’t pay any money to file your application;
Don’t pay any money to move up on the waiting list;
Don’t pay for anything not covered by your lease;
Get receipts for any money you do pay;
Get a written explanation for any money you are
required to pay besides rent, such as maintenance
charges.
Report Abuse: If you know anyone who has falsified
an application, or who tries to persuade you to make
false statements, report him or her to the manager. If
you cannot report to your manager, call your local or
state USDA office at 1 (800) 670-6553, or write: USDA,
STOP 0782, 1400 Independence Ave., SW,
Washington, DC 20250.
If You Disagree With a Decision
Tenants may file a grievance in writing with the complex
owner in response to the owner’s actions, or failure to
act, that result in a denial, significant reduction, or termination of benefits. Grievances may also be filed when a
tenant disputes the owner’s notice of proposed adverse
action.
Notice of Adverse Action
The complex owner must notify tenants in writing about
any proposed actions that may have adverse consequences, such as denial of occupancy and changes in
the occupancy rules or lease. The written notice must
give specific reasons for the proposed action, and must
also advise tenants of the “right to respond to the notice
within 10 calendar days after the date of the notice” and
of “the right to a hearing.” Housing complexes in areas
with a concentration of non-English-speaking people
must send notices in English and in the majority nonEnglish language.
A complaint may not be filed
with the owner/management
if:
A complaint may be filed
with the owner/management
if:
USDA has authorized a proposed rent change.
There is a modification of the
lease, or changes in the rules or
rent that are not authorized by
USDA.
A tenant believes that he/she
The owner or management fails
has been discriminated against to maintain the property in a
because of race, color, religion, decent, safe, and sanitary mannational origin, sex, age, familial ner.
status, or disability. Discrimination complaints should be
filed with USDA and/or the
Department of U.S. Housing
and Urban Development (HUD),
not with the owner/management.
The complex has formed a ten- The owner violates a lease proant’s association and all parties vision or occupancy rule.
have agreed to use the association to settle grievances.
USDA has required a change in A tenant is denied admission to
the rules and proper notices
the complex.
have been given.
The tenant is in violation of the
lease and the result is termination of tenancy.
There are disputes between
tenants that do not involve the
owner/management.
Tenants are displaced or other
adverse effects occur as a
result of loan prepayment.
PA 1998
December 2008
Grievance Process Overview
USDA believes that the best way to resolve grievances
is through an informal meeting between tenants and
the landlord or owner. Once the owner learns about a
tenant grievance, the process should begin with an
informal meeting between the two parties. Owners
must offer to meet with tenants to discuss the grievance within 10 calendar days of receipt of the complaint. USDA encourages owners and tenants to try to
reach a mutually satisfactory resolution to the problem
at the meeting.
Revised 04/2014
If the grievance is not resolved, the tenant must
request a hearing within 10 days of receipt of the meeting findings. The parties will then select a hearing panel
or hearing officer to govern the hearing. All parties are
notified of the decision 10 days after the hearing.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all
its programs and activities on the basis of race, color, national origin, age,
disability, and where applicable, sex, marital status, familial status, parental
status, religion, sexual orientation, genetic information, political beliefs,
reprisal, or because all or a part of an individual's income is derived from
any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (braille, large print, audiotape, etc.)
should contact USDA's TARGET Center at (202) 720-2600 (voice and
TDD).
To file a complaint of discrimination write to USDA, Director, Office of Civil
Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410
or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal
opportunity provider and employer.
Page 14 of 15
515-2010
Para informacion en espanol, visite www.ftc.gov/credit o
escribe a la FTC Consumer Response Center, Room 130-A 600
Pennsylvania Ave. N.W., Washington, DC 20580.
A Summary of Your Rights Under the Fair
Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the
accuracy, fairness and privacy of information in the files of consumer
reporting agencies. There are many types of consumer reporting
agencies, including credit bureaus and specialty agencies (such as
agencies that sell information about check writing histories, medical
records, and rental history records). Here is a summary of your
major rights under the FCRA. For more information, including
information about additional rights, go to www.ftc.gov/credit or
write to: Consumer Response Center, Room 130-A, Federal
Trade Commission, 600 Pennsylvania Ave. N.W., Washington,
DC 20580.
• You must be told if information in your file has been used
against you. Anyone who uses a credit report or another type of
consumer report to deny your application for credit, insurance, or
employment – or to take another adverse action against you – must
tell you, and must give you the name, address and phone number of
the agency that provided the information.
• You have the right to know what is in your file. You may
request and obtain all the information about you in the files of a
consumer reporting agency (your “file disclosure”). You will be
required to provide proper identification, which may include your
Social Security number. In many cases, the disclosure will be free.
You are entitled to a free file disclosure if:
• A person has taken adverse action against you because of
information in your credit report;
• You are the victim of identify theft and place a fraud alert in your
file;
• Your file contains inaccurate information as a result of fraud;
• You are on public assistance;
• You are unemployed but expect to apply for employment within
60 days.
In addition, by September 2005 all consumers will be entitled to one
free disclosure every 12 months upon request from each nationwide
credit bureau and from nationwide specialty consumer reporting
agencies. See www.ftc.gov/credit for additional information.
• You have the right to ask for a credit score. Credit scores are
numerical summaries of your credit worthiness based on information
from credit bureaus. You may request a credit score from consumer
reporting agencies that create scores or distribute scores used in
residential real property loans, but you will have to pay for it. In
some mortgage transactions, you will receive credit score
information for free from the mortgage lender.
• You have the right to dispute incomplete or inaccurate
information. If you identify information in your file that is incomplete
or inaccurate and report it to the consumer reporting agency, the
agency must investigate unless your dispute is frivolous. See
www.ftc.gov/credit for an explanation of dispute procedures.
• Consumer reporting agencies must correct or delete
inaccurate, incomplete or unverifiable information. Inaccurate,
incomplete or unverifiable information must be removed or
corrected, usually within 30 days. However, a consumer reporting
agency may continue to report information it has verified as
accurate.
• Consumer reporting agencies may not report outdated
negative information. In most cases, a consumer reporting agency
may not report negative information that is more than seven years
old, or bankruptcies that are more than 10 years old.
landlord, or other business. The FCRA specifies those with a valid
need for access.
• You must give your consent for reports to be provided to
employers. A consumer reporting agency may not give out
information about you to your employer, or a potential employer,
without your written consent given to the employer. Written consent
generally is not required in the trucking industry. For more
information, go to www.ftc.gov/credit.
• You may limit “prescreened” offers of credit and insurance
you get based on information in your credit report. Unsolicited
“prescreened” offers for credit and insurance must include a toll-free
phone number you can call if you choose to remove your name and
address from the lists these offers are based on. You may opt-out
with the nationwide credit bureaus at 1-888-567-8688.
• You may seek damages from violators. If a consumer reporting
agency, or, in some cases, a user of consumer reports or a furnisher
of information to a consumer reporting agency violates the FCRA,
you may be able to sue in state or federal court.
• Identity theft victims and active duty military personnel have
additional rights. For more information, visit www.ftc.gov/credit.
States may enforce the FCRA, and many states have their own
consumer reporting laws. In some cases, you may have more
rights under state law. For more information, contact your
state or local consumer protection agency or your state
Attorney General. Federal enforcers are:
TYPE OF BUSINESS:
Consumer reporting agencies,
creditors and others not listed
below
National banks, federal
branches/agencies of foreign
banks (word "National" or initials
"N.A." appear in or after bank's
name)
Federal Reserve System member
banks (except national banks and
federal branches/agencies of
foreign banks)
Savings associations and federally
chartered savings banks (word
"Federal" or initials "F.S.B." appear
in federal institution's name)
Federal credit unions (words
"Federal Credit Union" appear in
institution's name)
State-chartered banks that are not
members of the Federal
Reserve System
Air, surface, or rail common
carriers regulated by former Civil
Aeronautics Board or Interstate
Commerce Commission
Activities subject to the Packers
and Stockyards Act of 1921
• Access to your file is limited. A consumer reporting agency may
Revised
04/2014
Page 15 of 15
provide information
about
you only to people with a valid need usually to consider an application with a creditor, insurer, employer,
CONTACT:
Federal Trade Commission:
Consumer Response Center FCRA
Washington, DC 20580
1-877-382-4357
Office of the Comptroller of
the Currency
Compliance Management
Mail Stop 6-6
Washington, DC 20219
1-800-613-6743
Federal Reserve Board
Division of Consumer &
Community Affairs
Washington, DC 20551
202-452-3693
Office of Thrift Supervision
Consumer Complaints
Washington, DC 20552
800-842-6929
National Credit Union
Administration
1775 Duke Street
Alexandria, VA 22314
703-519-4600
Federal Deposit Insurance
Corporation
Consumer Response Center
2345 Grand Avenue, Suite 100
Kansas City, Missouri 641082638
1-877-275-3342
Department of Transportation
Office of Financial Management
Washington, DC 20590
202-366-1306
Department of Agriculture
Office of Deputy Administrator GIPSA
Washington, DC 20250
202-720-7051
515-2010