covid-19 rental assisstance program application · 1 day ago · covid-19 rental assistance –...

COVID-19 RENTAL ASSISSTANCE PROGRAM APPLICATION Applications – paper and online - OPEN August 18, 2020 at 10:00 am and CLOSE August 31, 2020 at

2:00 pm.

ELIGIBILITY To be eligible for assistance you must meet the following qualifications:

1. Be a Montgomery County resident that has resided in Montgomery County for a minimum of six (6) of the past 12 months;

2. You must self-certify that you have had a loss of income or unexpected increase in medical, childcare, or utility expenses due to COVID-19 ;

3. You are not receiving a subsidy (A) as a participant in the Housing Choice Voucher Program (including tenant-based and project-based vouchers), or (B) in a project-based assisted project where you pay no more than thirty percent (30%) of your annual income as rent;

4. You must have documentation from your landlord showing that you are at least one-month delinquent in your rent

5. You must be U.S. citizen or a qualified alien, which includes an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act (as defined by 8 U.S.C. 1641) (applicants can self-certify);

6. You must submit your documentation by the required dates and times; and 7. You must have a gross household income that does not exceed the program limits in the chart below

based on household size. Your household income must remain within the program limits at all times for continued participation.

Area Median Income Chart

Assistance under this program shall be in the form of monthly subsidies only. The maximum monthly subsidy amount is $600 for a maximum of three (3) months, for a total of $1,800 in total assistance. All assistance payments will be made directly to your landlord. One application per household is permitted. All assistance is contingent on the availability of funds.

COVID-19 Rental Assistance – August 2020

INSTRUCTIONS Please note that applications will be reviewed and awards will be made based on a randomized selection system. We strongly encourage you to submit applications online. If you do not have access to a computer or internet-capable device, you may drop off your paper application, date and time-stamped, in the designated drop box outside one of the following locations:

1. 10400 Detrick Avenue, Kensington, Maryland 20895 2. 231 East Deer Park Drive, Gaithersburg, Maryland 20877 3. 101 Lakeforest Boulevard #200, Gaithersburg, Maryland 20877 4. 880 Bonifant Street, Silver Spring, Maryland 20910

Envelopes should be addressed “ATTENTION: COVID-19 RENTAL ASSISTANCE.” Date and time-stamp the envelope and the first page of the application at one of the locations listed above. Seal the envelope before placing in the secure drop box. To apply for assistance, complete the following application and include the required supporting documentation. If you have questions or require assistance, please email [email protected].

*Applications must include all supporting documentation in order to be considered.* If your application is selected in the randomized process, HOC will email you (if you have provided an email address) or send you a letter (via USPS) informing you whether you have been approved or denied. If your application is not selected in the random process, HOC will not contact you.

APPLICATION *You MUST provide answers for all questions below*

Demographic and Household Information Ethnicity: African-American ____ Asian/Pacific Islander ____ Caucasian ____ Native American ____ Other ____ Decline ____ Race: Hispanic ____ Non-Hispanic ____ Decline ____ Gender: Female ____ Male ____ Decline ____ What is the number of members in the household (including yourself)? __________ Do you live, work, or have a notification of work in Montgomery County, Maryland? Yes ____ No ____ Are you the head of household? Yes ____ No ____ Are you the co-head of household? Yes ____ No ____ Is the head or co-head of the household elderly (62+)? Yes ____ No ____

mailto:[email protected]


Have you served in the US Military? Yes ____ No ____ Does any member in the household have a disability? Yes ____ No ____ Do you require any disability-related accommodations in your housing? Yes ____ No ____ Are you or any member of the household homeless? Yes ____ No ____ Is any member of the household at risk of becoming homeless? Yes ____ No ____ Do you have a history of homelessness? Yes ____ No ____ What is your current housing situation? � Currently renting an apartment (my name is listed as head of household or one of the head of household) � Currently buying a home (my name is listed as head of household or one of the head of household) � Currently living with family or friends (do not have my own apartment/home) � Currently living in a shelter, transitional housing or safe haven programs � Currently living in an apartment or home as part of a supportive housing program � Currently living on the streets Are you a victim of domestic violence? Yes ____ No ____ Has any member of the household been approved to receive supportive services under the Medicaid waiver program (money follows the person)? Yes ____ No ____ Does any member of the household currently live or are at risk of being placed in a nursing facility? Yes ____ No ____ Does any member of the household currently live or are at risk of being placed in a segregated housing setting or group home? Yes ____ No ____ Are you or anyone in your household waiting to transition out of an institutional setting or other segregated housing? Yes ____ No ____ Do you have a rep-payee who handles your benefits and financial affairs? Yes ____ No ____ Applicant Information Email Address: ________________________________________ Are you a Montgomery County resident? Yes ____ No ____


Are you a U.S. Citizen or Qualified Alien, which includes an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act (as defined by 8 U.S.C. 1641)? Yes ____ No ____ Applicant First and Last Name: ________________________________________ Applicant Address: Street Address: ________________________________________ Apt. #: ________________________________________ City and Zip Code: ________________________________________ Applicant Phone Number: ________________________________________ Applicant Social Security Number or Alien Registration Number: ________________________________________ Landlord’s First and Last Name: ________________________________________ Landlord’s Address Street Address: ________________________________________ Apt. #: ________________________________________ City and Zip Code: ________________________________________ Landlord’s Phone Number: ________________________________________ Landlord’s Email Address: ________________________________________ *NOTE: If you are submitting a paper application, you MUST provide your landlord with the attached “Landlord Documentation” form. Have your landlord complete the form and provide their W9 form. These items MUST be included in your final application submission.* Resident Verified Needs Assessment Have you experienced a loss in income due to COVID-19? Yes ____ No ____ Do you have an unexpected increase in medical, childcare, or utility expenses related to COVID-19? Yes ____ No ____ Is your rent currently delinquent due to COVID-19? Yes ____ No ____

https://uscode.house.gov/view.xhtml?req=(title:8%20section:1641%20edition:prelim)%20OR%20(granuleid:USC-prelim-title8-section1641)&f=treesort&num=0&edition=prelim


If yes, by how many months? ________________________________________ Are you currently a participant in the Housing Choice Voucher or other rental assistance program? Yes ____ No ____ If yes, list the name of the program if not the Housing Choice Voucher program. ________________________________________

DOCUMENTATION AND AFFIRMATION STATEMENT Required Verification Documentation

*ALL DOCUMENTATION MUST BE INCLUDED AT THE TIME YOU SUBMIT YOUR APPLICATION OR THE APPLICATION WILL NOT BE PROCESSED.*

A. Self-Certification of COVID-19 Impact

1. On the Application, you are required to self-certify that you have had a loss of income (e.g., layoff, furlough, or termination from employment) or unexpected increase in medical, childcare, or utility expenses due to COVID-19. No other documentation of COVID-19 impact required.

B. Income verification

1. Completed “COVID-19 Rental Assistance Self-Certification of Income” form. On the Application, you are required to self-certify that you have a gross household income that does not exceed the program limits in the chart below based on household size. Income includes, but is not limited to, wages, unemployment benefits, SSI, child support, alimony, investment income, retirement income (including pensions), income from assets, etc. No other documentation of income required.

C. Verification of Residency

1. You must submit a copy of pages from your lease or a current lease addendum/renewal that provides the following information: (1) your current address, (2) the unit occupants, (3) the current rent amount, and (4) you and your landlord’s signature.

D. Landlord Documentation

1. You must submit documentation from your landlord showing that you are at least one-month delinquent in your rent.

2. You must provide documentation that shows your landlord’s name, address, and community name (if applicable).

3. You must provide a copy of your landlord’s completed W9 form. a. If you apply for assistance online, you will have the option to have an email generated and

sent to your landlord. The email will contain a link that your landlord may use to upload their completed W9 form and any other required information.


b. If you apply for assistance via a paper application, you should follow the instructions on the paper application.

E. Other Documents

1. Copy of a Maryland’s Driver’s License, Maryland Photo ID, or passport for each adult member. Out-of-State Driver’s Licenses or IDs are not accepted.

*Additional information may be required during processing of application.*

Affirmation Statement

I do hereby affirm and attest, under the penalty of perjury, that all of the information in this application and my supporting documentation is complete, true, and correct. I affirm and attest that I have read and agree to the provisions in this application, including the Required Verification Documentation portion of this application. I understand this information may be shared for referral or management purposes. I understand that failure to provide the required documents will result in my application being denied.

By typing your name and the date in the boxes below, you are hereby signing this application, and in doing so, agree to the affirmation statement.

First and Last Name ________________________________________ Date ________________________________________ Appeals

Applicants who are denied participation or terminated from the program (“Appellant”) may appeal the decision to HOC's Resident Services Director, or his designee. Appeals must be requested in writing and received by HOC within 5 days of the date of HOC’s notice of denial of participation or termination of continued participation. Upon receipt of an appeal request, HOC will contact the Appellant within 10 days of receiving the request. HOC will communicate with the Appellant via phone, email, or virtual meeting to determine if the denial or termination was proper. If specifically requested by Appellant, HOC will schedule a virtual interview for a case review and the Appellant shall be allowed to present their case at the review (including presenting documentation, explanations, and clarifications). HOC’s Resident Services Director, or his designee, will make a decision and notify Appellant within 10 days. The decision of HOC’s Resident Services Director, or his designee, is final and cannot be appealed.


Frequently Asked Questions - COVID- 19 Rental Assistance Program

1. What is the COVID-19 Rental Assistance Program? • Recognizing that the COVID-19 pandemic is causing an unprecedented financial

hardship for many Montgomery County residents, the COVID-19 Rental Assistance Program is a program that provides financial assistance in the form of a rent subsidy payment. This program seeks to fill the gaps for those who have lost income during COVID-19.

2. What are the eligibility criteria? • You must be a Montgomery County resident who has resided in Montgomery County

for a minimum of six (6) of the past twelve (12) months; • You must self-certify that you have had a loss of income or an unexpected increase in

medical, childcare, or utility expenses due to COVID-19; • You are not receiving a subsidy (A) as a participant in the Housing Choice Voucher

Program (including tenant-based and project-based vouchers), or (B) in a project-based assisted project where you pay no more than thirty percent (30%) of your annual income as rent;

• You must have documentation from your landlord showing that you are at least one-month delinquent in your rent;

• You must be a U.S. citizen or a qualified alien, which includes an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act (as defined by 8 U.S.C. 1641) (applicants can self-certify);

• You must submit your application and documentation by the required dates and times; and

• You must have a gross household income that does not exceed the program limits in the chart below based on household size. Your household income must remain within the program limits at all times for continued participation.


3. How much is the payment?

• Each household is eligible for assistance of up to $600 per month for a maximum of three (3) months for a total of $1,800.

• All assistance is contingent on the availability of funds.

4. Will individuals who received COVID-19 Rental Assistance have to pay the money back? • No. This is not a loan; it is a grant and will not have to be paid back. • However, if we discover that a recipient has falsified documents or has somehow

defrauded the program, the money will need to be repaid.

5. Will I have to pay 2020 taxes on this money? • No, the assistance is not income and will not be taxed. • The payment will not affect income for purposes of determining eligibility for other

Federal Government assistance or benefits.

6. How will I get the money? • COVID-19 Rental Assistance will be distributed directly to landlords.

7. Are there preferences for households with children or the elderly?

• No. All households will be treated the same.

8. Is the process of choosing awardees equitable and fair? • Yes. Under the Montgomery County Code, it is illegal to discriminate on the basis of race,

sex, marital status, physical or mental disability, color, religion, national origin, ancestry, presence of children, source of income, sexual orientation, age and family responsibilities.

9. What documentation is needed?

Self-Certification of COVID-19 Impact:

• On the Application, you are required to self-certify that you have had a loss of

income (e.g., layoff, furlough, or termination from employment) or unexpected increase in medical, childcare, or utility expenses due to COVID-19.

• No other documentation of COVID-19 impact required. Income Verification:

• On the Application, you are required to self-certify that you have a gross

household income that does not exceed the program limits in the chart below based on household size. Income includes, but is not limited to, wages,


unemployment benefits, SSI, child support, alimony, investment income, retirement income (including pensions), income from assets, etc.

• No other documentation of income required.

Verification of Residency:

• You must submit a copy of pages from your lease or a current lease addendum/renewal that provides the following information: (1) your current address, (2) the unit occupants, (3) the current rent amount, and (4) you and your landlord’s signature.

Landlord Documentation:

• You must submit documentation from your landlord showing that you are at least one-month delinquent in your rent.

• You must provide documentation that shows your landlord’s name, address, and community name (if applicable).

• You must provide a copy of your landlord’s completed W9 form. o If you apply for assistance online, you will have the option to have an email

generated and sent to your landlord. The email will contain a link that your landlord may use to upload their completed W9 form and any other required information.

o If you apply for assistance via a paper application, you should follow the instructions on the paper application.

Other Documents

• Copy of a Maryland’s Driver’s License, Maryland Photo ID, or passport for each adult member. Out-of-State Driver’s Licenses or IDs are not accepted.

10. When can I submit an application?

• You can submit your complete application between Tuesday, August 18, 2020 at 10:00

am and Monday, August 31, 2020 at 2:00 pm.


11. What is the application review and approval process? Applications received by the submission deadline of 2:00 pm on August 31, 2020 will be included in a randomized selection process. Applicants that are selected through this random process and have submitted all required supporting documentation will be considered for assistance. Applications will be reviewed for completeness of application, submission of required documentation, and eligibility. Selected applicants who have submitted complete applications, submitted all required supporting documentation, and are deemed eligible will be qualified to receive assistance.

• If your application is selected in the randomized process, HOC will email you (if you have provided an email address) or send you a letter (via USPS) informing you whether you have been approved or denied. If your application is not selected in the random process, HOC will not contact you.

12. If I am denied assistance, can I appeal the decision?

• Yes. Applicants who are denied participation or terminated from the program (“Appellant”) may appeal the decision to HOC's Resident Services Director, or his designee. Appeals must be requested in writing and received by HOC within 5 days of the date of HOC’s notice of denial of participation or termination of continued participation. Upon receipt of an appeal request, HOC will contact the Appellant within 10 days of receiving the request. HOC will communicate with the Appellant via phone, email, or virtual meeting to determine if the denial or termination was proper. If specifically requested by Appellant, HOC will schedule a virtual interview for a case review and the Appellant shall be allowed to present their case at the review (including presenting documentation, explanations, and clarifications). HOC’s Resident Services Director, or his designee, will make a decision and notify Appellant within 10 days. The decision of HOC’s Resident Services Director, or his designee, is final and cannot be appealed.

• The appeals process is to be used to dispute denied participation or termination from the program. It is not an opportunity to submit missing documentation that was required to be submitted as part of the initial application.

• If an Appellant is successful in their appeal, their ability to receive assistance will

depend on whether any COVID-19 Rental Assistance Program funds are available on the date of the appeal decision. A successful appeal decision does not guarantee receipt of assistance.


COVID-19 RENTAL ASSISTANCE PROGRAM

Landlord Documentation

Applicant Name: _________________________________

APPLICANT – As part of your application, you are required to submit certain landlord documents. Please complete the applicant information below and have your landlord complete the remainder of the form and attach the documents listed below. Your application must include this information in order to be considered complete and to be eligible for funding consideration.

Applicant Information:

First and Last Name: ________________________________________

Street Address: ________________________________________

Apt. #: ________________________________________

City and Zip Code: ________________________________________

Phone Number: ________________________________________

LANDLORD – The above-named applicant is a tenant at your property and is applying for the COVID-19 Rental Assistance Program. If the applicant is chosen through a random selection process and is eligible for assistance, they could receive $600 per month for a maximum of three (3) months (a total of $1,800) in rental assistance. Rental assistance payments will be made directly to landlords.

In order to be eligible for assistance, the applicant is responsible for submitting certain landlord documentation, which includes:

(1) Rental license number; (2) A copy of landlord’s completed W9 form; and (3) Documentation that provides the above-named applicant is at least one month behind in their rent. Please complete the form on the back side of this document and provide a completed W9 to the applicant. You may either submit separate documentation stating that the applicant is at least one month behind in rent, or you can sign the below statement.

*Applications MUST include the information on this form in order to be considered for assistance.*

Turn over to complete form


LANDLORD AFFIRMATION STATEMENT – TENANT DELINQUENT RENT

I do hereby affirm and attest, under the penalty of perjury, that the above-named applicant is at least one month behind in their rent payments. By entering your name and the date on the lines below, you are hereby signing this application, and in doing so, agree to the affirmation statement.

Landlord First and Last Name: ________________________________________

Date: ________________________________________

Rental License Number: ________________________________________

Please place this form and all required documentation in a windowed letter envelope and fold so that the applicant name at the top of the page is visible in the envelope window. Alternatively, you may label the envelope with the applicant/tenant’s first and last name and “COVID-19 Rental Assistance Program – Landlord Documentation.” Ensure all documentation is inside the envelope and then seal for your security before providing to tenant/applicant.

*APPLICATIONS MUST INCLUDE THE INFORMATION ON THIS FORM IN ORDER TO BE CONSIDERED FOR ASSISTANCE.*


COVID-19 RENTAL ASSISTANCE SELF-CERTIFICATION OF INCOME Self-Certification of Annual Income to Implement COVID-19 Regulatory Waiver

INSTRUCTIONS: Please complete one form and include the requested information for all persons in the household. Complete an additional form if the applicant needs more space. The adult head of household must sign and date the form.

PART I: ELIGIBILITY The CDBG-CV funded Rental Assistance Program is limited to income eligible families whose annual income does not exceed 80% of the area median income, as determined by HUD. Assistance is limited to (a) applicants who have lost employment or income either permanently or temporarily due to the COVID-19 pandemic and to (b) homeless individuals or families.

To comply with CDBG-CV Rental Assistance Program guidelines, the applicant must indicate which eligibility category applies to their household. Do not complete the rest of this form if the household does not meet the program’s income limits and one of the categories below. Check all that apply: Homeless Experiencing financial hardship

If the applicant has experienced financial hardship as a result of the COVID-19 pandemic, the applicant must describe how the household’s financial situation has changed (e.g., lost employment or reduced income either temporarily or permanently).

https://www.hudexchange.info/programs/home/home-income-limits/


PART II: HOUSEHOLD INFORMATION Enter legal address (where the applicant currently lives) and contact information below. If household is experiencing homelessness or is in temporary housing, provide a mailing address (where the applicant currently receives mail).

Legal Address Mailing Address (if different from legal)

Street, Apt./Unit #

State, City, Zip Code

Phone Number(s)

Email(s)

Enter all household information below and indicate if any member is or will be a part-time/full-time student in the next 12 months. Do not include live-in-aides, children of live-in-aides, foster children, or foster adults.

*Note for Applicant: Students do not qualify for the CDBG-CV Rental Assistance Program unless the individual meets one of the exemptions below. Check all that apply:

Over age 24 Veteran of the US Military Married Has dependent child/ren Member is part of a household that is low-income

**Note for Administrator: the “Disabled” column is not required and only provided if deductions under adjusted income at 24 CFR 5.611 will be applied for the CDBG-CV Rental Assistance Program.

PART III: ANNUAL INCOME Report all current income and income expected to be received in the next 12 months including long-term unemployment compensation and all hazard pay. DO NOT INCLUDE: IRS Economic Impact Payments (stimulus checks), Federal Pandemic Unemployment Compensation (the additional $600 per week), income of a live-in-aide, children of live-in-aides, foster children, foster adults, or the income of minors.

Household Member #

Name (Last, First, MI)

Relationship to the

Head of Household

(co-head, spouse, child, etc.)

Birth Date

(mm/dd/ yyyy)

*Student (Part/Full-

time, Neither)

**Disabled (Y/N)

1 Head of Household

2 3 4 5 6


Section A: For each household member (HH Mbr#) below, anticipate annual income for the next 12 months by converting current income to annual figures. Convert wages/income by multiplying it by the frequency in which it is received and factor in amounts that will terminate before the end of the next 12 months. Multiply weekly income by 52; Bi-weekly income (received every other week) by 26; Semi-monthly income (received twice each month) by 24; and Monthly income by 12. A full-time student, 18 years or older (excluding the head of household or spouse) should exclude earnings in excess of $480 for annual income. Leave blank those that do not apply. To determine the total income for the household, add up all columns on the last row of this chart.

Income Sources HH Mbr# 1

HH Mbr# 2

HH Mbr# 3

HH Mbr# 4

HH Mbr# 5

HH Mbr# 6

Unemployment Compensation (include regular unemployment, Pandemic Unemployment Assistance and Pandemic Emergency Unemployment Compensation) (exclude Federal Pandemic Unemployment Compensation)

$ $ $ $ $ $

Wages, salary, overtime, hazard pay, commissions, fees, tips, bonuses (before payroll deductions) $ $ $ $ $ $

Net income from business and self-employment (include income from independent contractors, Gig economy jobs such as Etsy, Amazon, eBay, Uber, Lyft, Instacart, Grubhub, etc.)

$ $ $ $ $ $

Interest, dividends, and other net income of any kind from real or personal property (include rental income) $ $ $ $ $ $

Social Security (include disability/Supplemental; include gross amount prior to any Medicare premiums)

$ $ $ $ $ $

Retirement/Pension/Insurance policy/Annuities $ $ $ $ $ $

Disability or Death Benefits (disability compensation) $ $ $ $ $ $

Worker’s Compensation and Severance pay $ $ $ $ $ $

Welfare Assistance Payments (Temporary Assistance to Needy Families) $ $ $ $ $ $

Regular Pay, special pay, and housing allowance for the Armed Forces (exclude military hazard pay)

$ $ $ $ $ $

Veterans Administration (VA) Benefits (exclude deferred disability benefits) $ $ $ $ $ $

Adoption Assistance Payments (exclude amount in excess of $480) $ $ $ $ $ $

Alimony or Child Support (include only amounts expected) $ $ $ $ $ $

Re-occurring cash gifts from private/nonprofit/charity or friends/family who will not reside in the unit $ $ $ $ $ $

Other (please describe): _______________________________ $ $ $ $ $ $

Total for each HH Member $ $ $ $ $ $

Section A: Total Income for Household $


Section B - Income From Assets: Annual income includes income derived from assets to which household members have access. Interest or dividends earned are counted as income even when the earnings are reinvested. Using the categories below, report the (a) type of asset(s) held by each member of the household, (b) cash value of asset(s), and (c) the income derived from the assets (report annual figures only). If the asset does not generate income, report zero. If the household member does not have assets, leave blank. Calculate the totals on the last row of this chart.

Household Member #

Assets Categories: Checking, Savings, Mutual funds, Money Market Acct. Equity in Rental Property, Retirement and Pensions, 401(K), Stocks, Bonds, Treasury Bills, Certificate of Deposit, Annuities, Revocable Trust, Mortgages or Deed of Trust, Whole Life Insurance policy, Lump sum- inheritance, Lottery Winnings, Insurance Settlements, Personal property held as an investment (e.g., antiques, gems, etc.)

Cash Value of Asset Interest/Dividends Earned on the Assets

1 $ $

2 $ $

3 $ $

4 $ $

5 $ $

6 $ $

Household Member #

Disposed Assets: Assets given away for less than the fair market value in the last 24 months with value greater than $1,000, (e.g. sale of a home)

Cash Value of Disposed

Asset

Income from Disposed Asset

$ $

$ $

$ $

Box (B1) Total Value of Assets

Box (B2) Total Income from Assets

$ $

***To be completed by Program Administrator***

If the amount in Box (B1) is greater than $5000, calculate the imputed value of the assets by multiplying

Box (B1) by the Passbook Savings rate of (.06%)

Box (B3) Value of Imputed Asset

$

Section B: Total Income from Assets (greater of box (B2) or (B3)

$

Total Household Annual Income (Sections A + B) $


PART IV: APPLICANT CERTIFICATION I certify under penalty of perjury that the above information is complete and accurate to the best of my knowledge. I understand that Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government. I agree to provide any additional documentation required by the program administer to document my/our household income.

HEAD OF HOUSEHOLD

Signature Printed Name Date

OTHER ADULT HOUSEHOLD MEMBERS




