HOP Annual Review Form (HOP#7)

Head of Household:
Electronic Signature Agreement. Throughout this process, you will be asked to provide electronic signatures at various points. By selecting the "I Accept" button, you certify that the information provided is true and accurate and all adult members of the household are present for their signatures. You also agree that your electronic signature is the legal equivalent of your manual signature on these forms.  
**Email is not
required, but
entering an email
will speed up the
process.

Adult Family Members: (All persons 18 and older must be listed, head of household first.)

Occupant #1
Occupant #2
Occupant #3
Occupant #4

Children: (List all children under 18 years of age who currently reside in your household permanently.)

Child #1
Child #2
Child #3
Child #4
Child #5

Absent Parent Info:

Students: (List any full time students, 18 years or older, except head of household, spouse, or co-tenant.)

Student #1
Student #2
Student #3

Household Income

Income includes but is not limited to the following sources:
 
                   Employment                          Self-Employment                          Unemployment  
                 TANF/GAU/DSHS                             L&I                                           Alimony
              Security/SSI/SSA/SSD                         VA                                      Child Support       
                       Pensions                             Annuity/Interest                               Gift
                                                                                                                   Financial Aid
            

Do you currently have a source of income?  
Does the total of your assets (property, businesses, stocks, bonds, etc.) exceed $25,000?  
Please List All Income for All Members of Your Household:

Under $25,000 Asset Certification- THA Form #REM-VERI-05

(NOTE: If your assets exceed $25,000, do not sign this form)

Net Household Assets …

Includes:

  • Cash value of real property, savings, stocks, bonds, and other forms of capital investments, after deducting reasonable costs that you would have after disposing of them.
  • Value of any business disposed of for less than fair-market value (including any held in trust, but not in a foreclosure or bankruptcy sale) during the two years before the re-examination, may be counted.

 

Does not include:

  • Furniture and automobiles
  • Interests in Indian trust land and the equity in a housing cooperative unit or in a manufactured home in which you live.
  • A trust fund will not be considered an asset so long as the fund continues to be held in trust.
  • In the case of a separation or divorce settlement, it will not be considered to be for less than fair-market value if the household has received something meaningful other than cash

Please initial below:

I/We do hereby swear under penalty of perjury that each of the following statements is true:

Participant Obligations Form- THA Form #REM-LSNG-150

1. I understand that I am required to report online at www.tacomahousing.net any changes in income and/or household composition within 10 days of the occurrence.

2. I certify that the house or apartment will be my only residence. I will not sublease my assisted residence and will not allow anyone to live in my unit that is not on the lease.

3. I must allow Tacoma Housing Authority (THA) to perform Housing Quality Standard (HQS) inspections with reasonable notice. Federal regulations state I am responsible for all damages caused by my family and guests. Unit abuse, owing rent and unpaid utilities may result in termination of housing assistance.

4. I understand I must receive approval from THA before allowing anyone to move into my unit. I must also receive permission from THA before I move. I must notify THA if I will be away from my unit for more than 30 days. I must make all requests in writing.

5. I understand that I must notify THA online at www.tacomahousing.net if a person moves out of my unit within 10 days of the occurrence. I may be required to provide proof of where the person is now living.

6. I understand it is my family obligation to cooperate in supplying all information needed to determine my eligibility, level of benefits, or verify my true circumstances. I understand I must provide social security cards, birth certificates or other required documents for household members. Cooperation includes attending pre-scheduled meetings, completing and signing all needed forms.

7. I understand I may not make additional payments of any kind to the landlord that are not included in the lease and approved by THA and to do so is considered fraud.

8. I understand I must comply with all provisions of my lease and not commit any serious or repeated violations of the lease. I must pay my family share of the rent and utilities.

9. I understand that my mailing address is for the sole use of authorized household members and may not be used by any other persons.

10. Household members cannot commit fraud, bribery or any other corrupt or criminal act in connection with any federal housing program, including receiving another housing subsidy for my unit or any other unit under any federal, state or local housing assistance program. The household may not own any deed, title or claim to the unit. I understand I may not rent from any person related to any member of my household.

11. Household members my not engage in any drug-related criminal activity, alcohol abuse or violent criminal activity, including threatening, abusive or violent behavior toward THA personnel or other criminal activity that threatens the health, safety, or right to peaceful enjoyment of other residents.

12. I understand that knowingly supplying false, incomplete, or inaccurate information is punishable under Federal or State criminal law. I will also be required to repay assistance overpaid on my behalf and may be terminated from the program. I certify that all the information I provide to THA is true and accurate.

13. I acknowledge that I have received, read, and understand the EIV Guide that was included in the information that was mailed to me. Additionally, by signing below, each of my household members over the age of 18 acknowledge that they have read and understand the EIV Guide.

I have read and I understand the above Participant Obligations. I understand that failure to comply with them may result in denial of admission, an obligation to repay assistance overpaid on my behalf, and /or termination from the housing assistance program. All adults, 18 years and older must sign this form.


Reason for filling out the form  
 

Head of Household: I declare under penalty of perjury that the information provided in this petition is true and correct.

Preparer and/or Tenant: I declare under penalty of perjury that the information provided in this petition is true and correct, and that I have been authorized to file this petition on behalf of the head of household.

Signatures of Additional Tenants:

Third Party Release Form (M-1)

I hereby authorize Tacoma Housing Authority (THA) and the U.S. Department of Housing and Urban Development (HUD) to obtain the information listed below for the purpose of determining my eligibility to receive and continue receiving housing assistance.  THA may use this release to make inquiries or secure information from any source whatsoever, including a person, business, or organization that has, or may have, any information listed below.  If THA makes any negative determination(s) based upon the information obtained, I will have an opportunity to contest such determinations.  If I participate in the Project-based or Mod Rehab program, I also authorize THA and the owner and/or manager of the building in which I reside to share with each other any information needed to verify my continued eligibility and suitability for subsidized housing.  This consent expires 48 months after it is signed.
 
  • Information necessary to authenticate preference claims;
  • Rental history records and references, including but not limited to, information about the ability to pay rent, the ability to abide by the rules of the lease, take care of rental property, and get along well with neighbors;
  • Non-residential references from individuals with whom a professional relationship has been established, and references from neighbors, community, and relatives;
  • References from employers, including wage and salary information, and job performance;
  • Criminal history, including fingerprint submission where necessary to effect positive identification;
  • Information on payment history and balances owed to utility companies including but not limited to TPU, Puget Power, WNG;
  • Credit reports;
  • Services provided by individuals or agencies which are relevant to the ability to pay rent, take care of rental property, and get along well with neighbors and community;
  • (HUD only) U.S. Social Security Administration and U.S. Internal Revenue Service;
  • Income and asset information from any source, including State Wage Information Collection Agencies, for all family members;
  • Immigration status, citizenship status, and legal identity verification;
  • School registration for minor children, and for family members over the age of 18 where required to establish program eligibility;
  • Registration in educational or vocational training programs including information about participation/completion of such programs;
  • Verification of disability or handicap and shelter plus programs, if necessary for program eligibility (not including details of actual disability or handicap);
  • Verification of need for reasonable accommodation, if requested;
  • Credit reports and/or tenant screening reports from private screening contractors;
  • Outstanding debts to other housing agencies.

Head of Household: I declare under penalty of perjury that the information provided in this petition is true and correct.

Preparer and/or Tenant: I declare under penalty of perjury that the information provided in this petition is true and correct, and that I have been authorized to file this petition on behalf of the head of household.

Additional signature(s) required for occupants that are 16 years or older:

Authority: This release of information is in lieu of the HUD-9886 Authorization for the Release of Information/Privacy Act Notice.

 

Who must sign the consent form: Each member of your household who is 16 years of age or older must sign the consent form. Additional signatures must be obtained from new adult members joining the household or whenever members of the household become 16 years of age. Criminal background checks will be run on anyone in the household 16 years of age or older.

 

Failure to sign consent form: Denial of eligibility or termination of benefits is subject to THA’s grievance and Housing Choice Voucher informal hearing/review procedures as well as THA’s Public Housing informal review/grievance process.

 

Privacy Act Notice. Authority: The Department of Housing and Urban Development (HUD) is authorized to collect this information by the U.S. Housing Act of 1937 (42 U.S.C. 1437 et. seq.), Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), and by the Fair Housing Act (42 U.S.C. 3601-19). The Housing and Community Development Act of 1987 (42 U.S.C. 3543) requires applicants and participants to submit the Social Security Number of each household member who is six years old or older. Purpose: Your income and other information are being collected by HUD to determine your eligibility, the appropriate bedroom size, and the amount your family will pay toward rent and utilities. Other Uses: HUD uses your family income and other information to assist in managing and monitoring HUD-assisted housing programs, to protect the Government’s financial interest, and to verify the accuracy of the information you provide. This information may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory investigators and prosecutors. However, the information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law. Penalty: You must provide all of the information requested by the HA, including all Social Security Numbers you, and all other household members age six years and older, have and use. Giving the Social Security Numbers of all household members is mandatory, and not providing the Social Security Numbers will affect your eligibility. Failure to provide any of the requested information may result in a delay or rejection of your eligibility approval.

 

Penalties for misusing this consent: HUD, THA and any owner (or any employee of HUD, THA or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this form is restricted to the purposes cited on the form. Any person, who knowingly or willfully requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, against the officer or employee of HUD, THA or the owner responsible for the unauthorized disclosure or improper use.

Supplement to Application for Federally Assisted Housing

OMB Control#2502-0581, Expires 11/30/2015

Instructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing, the name, address, telephone number, and other relevant information of a family member, friend, or social, health, advocacy, or other organization. This contact information is for the purpose of identifying a person or organization that may be able to help in resolving any issues that may arise during your tenancy or to assist in providing any special care or services you may require. You may update, remove, or change the information you provide on this form at any time. You are not required to provide this contact information, but if you choose to do so, please include the relevant information on this form.

 
Reason for Contact: 
 

Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the issues or in providing any services or special care to you.

Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the applicant or applicable law.

Legal Notification: Section 644 of the Housing and Community Development Act of 1992 (Public Law 102-550, approved October 28, 1992) requires each applicant for federally assisted housing to be offered the option of providing information regarding an additional contact person or organization. By accepting the applicant’s application, the housing provider agrees to comply with the non-discrimination and equal opportunity requirements of 24 CFR section 5.105, including the prohibitions on discrimination in admission to or participation in federally assisted housing programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on age discrimination under the Age Discrimination Act of 1975.

Head of Household: I declare under penalty of perjury that the information provided in this petition is true and correct.

Preparer and/or Tenant: I declare under penalty of perjury that the information provided in this petition is true and correct, and that I have been authorized to file this petition on behalf of the head of household.

The information collection requirements contained in this form were submitted to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The public reporting burden is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers participating in HUD’s assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option to include in the application for occupancy the name, address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such information is to facilitate contact by the housing provider with the person or organization identified by the tenant to assist in providing any delivery of services or special care to the tenant and assist with resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information.

Providing the information is basic to the operations of the HUD Assisted-Housing Program and is voluntary. It supports statutory requirements and program and management controls that prevent fraud, waste and mismanagement. In accordance with the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless the collection displays a currently valid OMB control number.

Privacy Statement: Public Law 102-550, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions.