Homeowner Assistance Program (HoAP) Instructions: Intake Application and Packet

Page 1 of 3 HoAP Instructions: Intake Application and Packet Version 1.0 Dec 2018

PLEASE CAREFULLY REVIEW THESE INSTRUCTIONS BEFORE COMPLETING YOUR HoAP INTAKE APPLICATION AND PACKET

You are receiving this application and attachments because you completed the Harvey Homeowner Assistance Program (HoAP) Survey and based on your responses, were identified as meeting current prioritizations to initiate an application.

Where requested, please be sure to provide information on each person living in the home. Please note, the attached HoAP Intake Application and Packet needs to be filled out completely.

Please note, the City of Houston will not be responsible for any documents being returned to you, regardless of your eligibility and/or acceptance into the Homeowner Assistance Program (HoAP). Please do not provide original documents when submitting any supplemental documentation. Contact your assigned Intake Specialist for assistance scanning any original documents. Please provide LEGIBLE COPIES ONLY.

The following will be included along with your completed HoAP Intake Application: A. Form A: HoAP Application Document Checklist

1. Please submit all applicable documentation outlined in Attachment A.B. Form B: HoAP Communication Designee Form (if applicable)C. Form C: HoAP Insurance, Benefits and Expenditures CertificationD. Form D1: HoAP Household Income Certification (HIC)

1. Please submit all applicable income documentation that verifies each household member’sincome.

2. Note that Form D2 is the HoAP Adjusted Gross Income Worksheet. This Worksheet must becompleted for each household member with Earned or Unearned Income that did NOT file a 2017or 2018 IRS Form 1040, 1040A or 1040 EZ.

3. Note that Form D3 is the HoAP Certification of Zero Income. This Certification must be completed by each adult household member (over age 18), claiming zero income.

E. Form E: HoAP Right-Of-Entry and Release of InformationF. Form F: HoAP Ownership and Signatory Authority AffidavitG. Form G: HoAP Primary Residency and Occupancy Affidavit

1. Please submit applicable documentation outlined in the Affidavit to verify your primary residency.H. Form H1: HoAP Homeowner Mobility Modification ListI. Form I: HoAP Child Support AffidavitJ. Form J: Acknowledgement of Lead Based Paint Notice (only applicable for properties built prior to 1978)K. Form K: Handout – Protect Your Family From Lead In Your Home

For assistance completing this Application Packet, contact the Housing Resource Center in your area, or call the Hurricane Harvey Help Line at (832)-394-6100.

SAMPLE

Page 2 of 3 HoAP Instructions: Intake Application and Packet Version 1.0 Dec 2018

The HoAP Intake Application includes the following information:

1. APPLICANT INFORMATION: Provide your legal name, the address where you receive your mail (may ormay not be the damaged property), email address (if applicable), phone number, date of birth, andmarital status, and other demographic information as requested. The Applicant is considered the Headof Household, for the purpose of this application.

2. CO-APPLICANT INFORMATION (if applicable): List other member(s) of the household who hold as muchresponsibility for the property as the Applicant. This person is often referred to as the co‐owner of theproperty. For example, your spouse may or may NOT be a co‐applicant based on their ownership interestin the property.

3. COMMUNICATION DESIGNEE OR ALTERNATIVE CONTACT(S) (if applicable): This information is beingcollected to assist us in locating you in the event that you move, are living temporarily in anotherlocation or we are unable to reach you. If applicable, also list contact(s) who are helping you throughthis application process. If you assign a Communication Designee or Alternative Contact(s), completeAttachment B, HoAP Communication Designee Form for each designee/alternative contact.

4. HEAD OF HOUSEHOLD RACE AND ETHNICITY: Provide demographic information for the Head ofHousehold. The primary Applicant is considered to be the Head of Household. This information is beingcollected to ensure compliance with federal Housing and Equal Opportunity regulations.

5. HOUSEHOLD COMPOSITION AND CHARACTERISTICS: As of today, list the current Head of Household andall other members of the household. Indicate the relationship of each family member to the Head ofHousehold, gender, date of birth and marital status. Indicate if any of the members listed are disabled andexplain if there are any expected additions to the future household, e.g. birth of a child, adoption, legalcustody ruling resulting in an additional household member.

6. GENERAL INFORMATION: Provide responses to questions in order to determine if the property andapplicant is eligible to receive assistance under this program. Minimum eligibility requirements include:

A. The property must have been damaged as a result of Harvey, owned by the Applicant,and primary residence of the Applicant on August 25, 2017.

B. The Applicant must be current on property taxes for the damaged property, enrolled inan approved payment plan, or exempt;

C. The Applicant and Co‐Applicants must be current on child support payments, if applicable.

7. DAMAGED PROPERTY INFORMATION: Provide basic information concerning the damaged property (i.e.physical address of damaged property, tenancy information, property type, foreclosure/lien status, andother names on the deed).

8. ENVIRONMENTAL INFORMATION: Provide responses to questions in order to determine basicenvironmental conditions of the damaged property.

9. OTHER ASSISTANCE RECEIVED AND EXPENDITURES: Complete Form C, HoAP Insurance, Benefits andExpenditures Certification, regarding all funds received and/or spent as a result of damage to theApplicant’s primary residence from Hurricane Harvey on August 25, 2017.

10. HOUSEHOLD INCOME INFORMATION: Complete Form D1, HoAP Household Income Certification (HIC).Your assigned Intake Specialist can assist you with completing any required income certification formsbased on the income and expense documentation you provide. The HIC requests a listing of everyhousehold member, indicates their relationship to the head of household, their date of birth, thesupporting income documentation they have provided (if any), and summarizes the household AdjustedGross Income (AGI). Submit all requested income documentation and, if applicable, the HoAP AdjustedGross Income Worksheet and/or the HoAP Certification of Zero Income.SAMPLE

Page 3 of 3 HoAP Instructions: Intake Application and Packet Version 1.0 Dec 2018

11. PRIOR FEDERAL ASSISTANCE: Provide all information concerning all property assistance applied for and/or received for disaster related losses due to any federally declared disaster event from September 1994 to the date of the August 24, 2017 Hurricane Harvey disaster event. This information will be verified with the appropriate state and Federal authorized officials/databases to verify prior Federal disaster recovery assistance received by the Applicant(s) and to ensure Applicant(s) compliance with all required covenants, including maintenance of Flood insurance for all properties located within a flood zone.

12. APPLICANT RELEASE AND CERTIFICATION: It is required that the applicant/co‐applicant sign the Release and Certification, which allows the City of Houston, State of Texas and/or its designated Program representatives to request information from third parties concerning eligibility and participation in the Program. The applicant and co‐applicant also certify ownership of the property, acknowledgement of responsibility for completing and returning all required documentation, acknowledgement of the limited availability of program funding, acknowledgement of the potential requirement of obtaining and maintaining hazard insurance, flood and/or windstorm insurance if a benefit is awarded, and certification that all information in the application is true, to the best of your knowledge.

Submitting Your Completed Application Your assigned Intake Specialist is available to provide assistance completing the HoAP Intake Application and Packet, and to collect the documents outlined in Form A, HoAP Application Document Checklist. Submissions will only be accepted if all documents included with this application packet are completed and submitted on or before the deadline for completion (within 90 days of your initial notice to submit an application).

Application Review Process Once a review of your application has been completed, you will be notified of your status and next steps. The City of Houston has the right to ask you to provide certified copies of documents when necessary and may request additional items upon receipt of your application.

For assistance completing this Application Packet, contact the Housing Resource Center in your area, or call the Hurricane Harvey Help Line at (832)-394-6100.

SAMPLE