HomeMy WebLinkAboutC2018-725 - 7/24/2018 - Approved ACCESSIBLE HOUSING RESOURCES, INC.
FY18 AHRI HOME FUNDING AGREEMENT
STATE OF TEXAS §
§ KNOW ALL BY THESE PRESENTS:
COUNTY OF NUECES §
This Agreement is entered into by and between the City of Corpus Christi (herein referred to
as the "City") and the Accessible Housing Resources, Inc., (herein referred to as "AHRI" or
"Subrecipient").
WHEREAS, the City has received one or more Federal grants to more effectively
carry out the HOME Investment Partnership Program (HOME) funded Tenant-
Based Rental Assistance (TBRA)program; and
WHEREAS, the City is in need of assistance to further this program; and
WHEREAS,it is the desire of the parties hereto that AHRI engage in the performance
of certain activities related to the TBRA program; and
NOW THEREFORE,the parties hereto mutually agree as follows:
Grant: Assistance from HOME Program funds in an amount not to exceed $110,379.00 from
FY 2018 - 2019 HOME funds.
Grant Period: The period beginning on the date of signature by the last Party to sign this
Agreement and ending on the later of:
(a) [, 2019 (being the ending date in the time line contained in
Exhibit "B"), or
(b) the last date to which the Grant Period may be extended pursuant to Section 1.6
City: CITY OF CORPUS CHRISTI, a Texas home rule municipal corporation acting by and
through its duly authorized City Manager, the address of which is 1201 Leopard St.,
P.O. Box 9277, Corpus Christi, Texas 78469-9277
C2018-725
7/24/18
Ord. 031483
Accessible Housing Resources Inc.
SCANNED Page 1 of 20
AHRI: Accessible Housing Resources, Inc, a nonprofit corporation organized under the laws
of the State of Texas,and certified as a Non-Profit Organization,acting by and through
its duly authorized officer(s), the address of which is 1537 Seventh Street Bldg. A.,
P.O. Box 3394, Corpus Christi, Texas 78463-3394
HUD: The United States Department of Housing and Urban Development
Act: The Cranston-Gonzales National Affordable Housing Act, 42 U.S.C. § 12,701 et seq.
Regulations: The HOME Program regulations found in 24 C.F.R. Subtitle A, Part 92
promulgated under the Act, as amended
HOME Program: The HOME Investment Partnerships Program administered by HUD
under the Act and the Regulations
The foregoing terms are thus defined for purposes of this agreement. Other terms shall have
meanings as defined elsewhere in this agreement.
The City and AHRI are the parties to this agreement. Grant monies are available to
the City from HUD through the HOME Program pursuant to the Regulations. AHRI needs
funds to provide rental assistance, rental deposit assistance, and utility deposit assistance to a
minimum of (4) individuals/households with very low and low-income persons with
disabilities, seniors,Veterans, homeless and others at the lowest income levels who may be at
risk of homelessness or institutionalization. The City, a Participating Jurisdiction under the
Regulations,has identified the population to be assisted are persons with disabilities, seniors,
Veterans,homeless and others at the lowest income levels who may be at risk of homelessness
or institutionalization as a specific category of individuals in the City's housing strategy or
consolidated plan as having unmet need, as provided in § 92.209(c)(3)(ii) of the Regulations
(24 CFR Part 92 Home Investment Partnerships Program, Subpart E Program Requirements.).
Giving a preference for financial assistance to such persons is needed to narrow the gap in
benefits and services received by such persons. The City proposes to make part of the City's
HOME grant monies available to AHRI as a"Subrecipient," as defined in the Regulations,
under the terms of this agreement toward fulfilling these mutual needs. AHRI accepts that
proposal.
The accomplishment of these public service objectives is the predominant purpose of
this transaction and the City finds that it will receive adequate consideration in the form of
substantial public benefit. Continuing supervision by the City, statutory and contractual
requirements, and the special expertise,knowledge and experience demonstrated by AHRI in
giving assistance to individuals/households with disabilities, seniors, Veterans, homeless and
others at the lowest income levels who may be at risk of homelessness or institutionalization
provide sufficient assurance that the public purpose will be accomplished.
Therefore, for sufficient value received by each of the parties and in consideration of
the mutual covenants expressed in this agreement, they agree as follows:
FY18 AHRI TBRA Agreement Page 2 of 20
Article 1. The Grant for Tenant-Based Rental Assistance
1.1 The City agrees to provide the Grant to AHRI as a Subrecipient under the
terms of this agreement. Payment of the Grant is subject to payment of the HOME grant funds
to the City by HUD.
1.2 AHRI agrees to use the Grant for the following purposes and none other: to
provide Tenant-Based Rental Assistance ("TBRA"), as defined in the Regulations, to
qualifying persons under the terms of this agreement.
13 A budget for use of the Grant is attached to this agreement as Exhibit "A."
AHRI agrees that the Grant will be expended in accordance with this budget and that no
change in the budget will be made without the prior written approval of the City.
IA A time line for goals and expenditures is attached to this agreement as(Exhibit
"B.")To the maximum extent of its reasonable control, AHRI shall adhere to the time line in
its use of the Grant.
15 For the duration of this agreement, AHRI shall provide written progress
reports,reports of matching contributions,and any additional data the City may request to the
City on or before the 10th(tenth)day of each month,covering the prior month's activity.
AHRI may not request and shall not be entitled to disbursement of the Grant until the funds
are needed for payment of eligible costs and until the reporting requirements of this Section
have been satisfied. The amount of each request must be limited to the amount needed. In
order to have sufficient time to conduct program year close-out procedures,no reimbursement
requests will be submitted to or received by the Housing and Community Development after
December 24, 2019.
L6 The Grant must be fully disbursed during the Grant Period. Upon written
application by AHRI submitted at least 30 days before the end of the Grant Period and
supported with good cause for delay,the City may extend the Grant Period upon receipt
of an extension request to the City. Thereafter, extensions to the time of performance
may be approved only by the City. AHRI shall forfeit any part of the Grant not disbursed
by the end of the Grant Period as it may be extended. In no event shall the City's liability to
pay or reimburse expenses exceed the amount of the Grant.
1.7 Any repayment, refund, interest, or earnings received by AHRI on the Grant
monies advanced to AHRI under this agreement shall be used by AHRI for Tenant-Based
Rental Assistance(TBRA)in the same manner as original Grant monies and must be disbursed
before AHRI requests further disbursement of the Grant. Any excess thereof, together with
any Grant monies and accounts receivable attributable to the use of the Grant monies,
remaining in the hands of AHRI at the end of the Grant Period, shall be returned promptly
to the City.
1.8 Approval by the City of AHRI's use of the Grant, or failure by the City to
disapprove or object to such use, shall not constitute any endorsement of, and the City shall
have no liability for, any aspect of the TBRA administered by AHRI; AHRI shall be solely
FY18 AHRI TBRA Agreement Page 3 of 20
responsible and solely liable for the administration of the Grant monies. Moreover, any such
approval or failure to disapprove or object shall not relieve AHRI of any past, present, or
future obligations to meet the requirements and obligations of the HOME Program,the Act,
the Regulations, or this agreement; shall not constitute a representation by City that AHRI
has complied with those requirements or obligations; and shall not constitute a waiver of any
such requirements or obligations.
Article 2. The AHRI TBRA Program
2.1 AHRI shall disburse the Grant monies through a TBRA program that AHRI
shall design and administer in accordance with this Article, and to the extent not provided
otherwise in this agreement, in compliance with all requirements under § 92.209 of the
Regulations, all other applicable provisions of the Regulations, and any other laws.
2.2 AHRI shall promulgate a written TBRA program (the "TBRA program")
including tenant selection criteria and rental assistance contracts and related administrative
forms or adopt the City's HOME TBRA Administration Plan and TBRA toolkit (See
Attachment A). As appropriate, the written program may adopt pertinent provisions of this
Article by reference to a Section or sub-Section without repeating them verbatim. The City
shall assist AHRI reasonably in developing and writing the program. When the TBRA
program is complete,AHRI shall submit it to the City,which shall approve it in writing before
becoming obligated to provide any of the Grant to AHRI. The rental assistance contracts and
other forms used to implement the TBRA program shall meet the requirements for a"Section
8 Rental Certificate Program" under 24 C.F.R. Part 888 and 24 C.F.R. Part 982. AHRI shall
adhere to its written TBRA program for the duration of this agreement.
23 The TBRA program may include the following requirements and provisions:
(a) The tenants selected for assistance shall meet the income-eligibility
requirements, must be nondiscriminatory on the basis of race, color, national origin, religion,
sex, handicap, or financial status, and must comply with all fair housing and civil rights laws.
(b) In accordance with § 92.216 of the Regulations, the tenants must be
selected such that not less than 90 percent of:
(1) The persons receiving rental assistance are persons whose
annual incomes do not exceed 60 percent of the median family income for the area, as
determined and made available by HUD with adjustments for smaller and larger families
(except that HUD may establish income ceilings higher or lower than 60 percent of the median
for the area on the basis of HUD's findings that such variations are necessary because of
prevailing levels of construction cost or fair market rent, or unusually high or low family
income) at the time of occupancy or at the time funds are invested, whichever is later; or
(2) The dwelling units assisted with Grant monies are occupied by
persons having such incomes; and
The remainder of:
FY18 AHRI TBRA Agreement Page 4 of 20
(3) The persons receiving rental assistance must be households that
qualify as low-income persons (other than persons described in sub-section (b)(1) above) at
the time of occupancy or at the time funds are invested, whichever is later;or
(4) The dwelling units assisted with Grant monies must be
occupied by such households; and
(5) In all cases, AHRI shall determine each applicant's income
eligibility at the time the applicant receives assistance and shall reexamine income at least
annually.
(c) In accordance with § 92.209(c)(2) of the Regulations, the City has
provided for a preference for a specific category of individuals with disabilities, seniors,
Veterans and other who may be at risk of homelessness or institutionalization, in its
Consolidated Plan as having unmet needs and the preference is needed to narrow the gap in
benefits and services received by such persons. The TBRA program shall treat such persons
meeting this preference equally by not limiting the opportunities of such persons on any basis
prohibited by the laws listed under 24 CFR § 5.105(a)
(d) AHRI shall use a waiting list to determine TBRA eligibility whenever
the eligible applicants exceed the number that can be assisted with available funds. The
waiting list shall be designed by AHRI to the satisfaction of the City, and the City shall
approve the design in writing before any Grant monies are disbursed to AHRI.
(e) At all times while receiving TBRA, the tenants selected must reside,
and the assisted lease premises must be located, within the city limits of the City.
(f) The Grant monies may not be used to further subsidize rent of units
already receiving another form of rent subsidy (i.e., public housing or Section 8 Substantial
Rehabilitation).
(g) The TBRA program may include assistance with security deposits as
provided in § 92.209(j) of the Regulations; however, notwithstanding § 92.210(j)(2), any
security deposit funded under the AHRI TBRA program may not exceed the equivalent of
one month's rent for the rental unit. Any refunds of security deposits upon termination of a
lease or at any other time may be paid to the tenant and need not be refunded to AHRI or the
City.
(h) AHRI shall enter into a written rental assistance contract complying
with § 92.209 and § 92.253 of the Regulations with each eligible tenant before disbursing
rental or security deposit assistance funds. The term of each rental assistance contract may not
exceed 24 months, but may be renewed, subject to the availability of Grant monies. The term
of each rental assistance contract must begin on the first day of the term of the tenant's lease
(the "lease") and must terminate on termination of the lease.
n Each lease must not be for less than one year, unless by mutual
agreement of the tenant and the owner. No lease may contain any of the following terms, and
FY18 AHRI TBRA Agreement Page 5 of 20
each lease must affirmatively negate all of these terms either in the body of the lease or by
means of an attached addendum that controls notwithstanding any contrary provisions of the
lease:
(1) Agreement by the tenant to be sued, to admit guilt, or to a
judgment in favor of the owner in a lawsuit brought in connection with the lease;
(2) Agreement by the tenant that the owner may take, hold, or sell
personal property of household members without notice to the tenant and a court decision on
the rights of the parties. This prohibition, however, does not apply to an agreement by the
tenant concerning disposition of personal property remaining in the housing unit after the tenant has
moved out of the unit. The owner may dispose of this personal property in accordance with state law;
(3) Agreement by the tenant not to hold the owner or the owner's
agents legally responsible for any action or failure to act, whether intentional or negligent;
(4) Agreement of the tenant that the owner may institute a lawsuit
without notice to the tenant;
(5) Agreement by the tenant that the owner may evict the tenant or
household members without instituting a civil court proceeding in which the tenant has the
opportunity to present a defense, or before a court decision on the rights of the parties;
(6) Agreement by the tenant to waive any right to a trial by jury;
(7) Agreement by the tenant to waive the tenant's right to appeal,
or to otherwise challenge in court, a court decision in connection with the lease; and
(8) Agreement by the tenant to pay attorney's fees or other legal
costs even if the tenant wins in a court proceeding by the owner against the tenant. The tenant,
however, may be obligated to pay costs if the tenant loses.
6) Each lease must provide that the owner may not terminate the tenancy
or refuse to renew the lease of the tenant except for serious or repeated violation of the terms
and conditions of the lease; for violation of applicable federal, state, or local law; for
completion of the tenancy period, if the tenancy is "transitional housing" as defined in the
Regulations; or for other good cause. Each lease must provide that to terminate or refuse to
renew the tenancy,the owner must serve written notice upon the tenant specifying the grounds
for the action at least 30 days before the termination of the tenancy.
(k) AHRI shall require each owner that is a party to a lease to adopt written
tenant selection criteria that:
(1) Are consistent with the purpose of providing housing for very
low- income and low-income families;
(2) Are reasonably related to TBRA program eligibility and the
FY18 AHRI TBRA Agreement Page 6 of 20
applicants' ability to perform the obligations of the lease;
(3) Give reasonable consideration to the housing needs of families
that would have a federal preference under § 6(c)(4)(A) of the 1937 Act (see § 92.209(c)(2)
of the Regulations);
(4) Provide for the selection of tenants from a written waiting list
in the chronological order of their application, insofar as is practicable; and
(5) Give prompt written notification to any rejected applicant of the
grounds for any rejection.
m Neither the City nor AHRI shall be a party to any lease for which
assistance is given under the TBRA program. The compliance of any lease with the provisions
of this agreement shall not connote approval or endorsement of the lease by the City or by
AHRI, but means only that the lease does not bar the tenant from qualifying for TBRA. The
TBRA program shall provide that the tenant's TBRA will be discontinued if the tenant is
evicted by judicial process for cause under the terms of the lease.
(m) The rent subsidy for any rental unit paid with Grant monies may not
exceed the difference between the rent standard established by the City for the unit size and
30% of the monthly adjusted income of the family of the tenant, in accordance with §
92.209(h)(1) of the Regulations. The City established the HOME rent standard as the City
rent standard in the Request for Proposal. The FY2018 Rents for All Bedroom Sizes for
Corpus Christi, TX HUD Metro FMR Area is attached to this Agreement as Exhibit "C".
Each tenant must contribute the higher of the difference between the gross rent and maximum
subsidy or 10% of the monthly gross income toward rent, with a minimum of$50.00.
(n) The rent to be paid under each lease must be reasonable,based on rents
that are charged for comparable unassisted rental units. The City shall establish rent standards
for various unit sizes in accordance with § 92.209(h)(3) of the Regulations and shall advise
AHRI of the rent standards applicable from time to time.
(o) Housing for which assistance is received under the TBRA program
must meet and be maintained in accordance with the following standards:
(1) The housing quality standards in 24 C.F.R. § 982.401;
(2) Accessibility requirements in the regulations referenced in 24
C.F.R. §5.105(a) which implement the Fair Housing Act and § 504 of the Rehabilitation Act of
1973; and
(3) All applicable state and City housing codes and ordinances.
In accordance with 24 C.F.R. §92.209(h)(3)(iii), the AHRI shall conduct inspections
of each rental unit before approving assistance under the TBRA program and at least annually
thereafter during the term of the rental assistance contract to be sure that these standards are
FY18 AHRI TBRA Agreement Page 7 of 20
met. If any rental unit for which TBRA assistance is being given falls below these standards,
the AHRI shall promptly notify the City, the tenant, and the owner of the specific matters
needing correction and shall give a reasonable time (generally ranging from 24 hours for
violations that are an imminent health or safety threat, to 30 days for other problems) for the
deficiencies to be corrected. If the deficiencies are not corrected within the time allowed, the
TBRA with Grant monies shall be suspended for that rental unit until the deficiencies are
corrected to the satisfaction of the City. This TBRA contract may also be cancelled if the
deficiencies continue unabated.
(p) Each tenant selected to receive assistance must consent in writing for
his or her files to be inspected, copied, and audited by the City, HUD, or any of their agents
or employees, and must waive any confidentiality requirements that may otherwise be
breached as a direct or indirect result of any such inspection, copying, or audit.
(q) AHRI shall verify all factors relating to a family's eligibility for TBRA
that have not already been verified by the City at the time of application. The verification will
be by means of third party verification and review of primary documents provided by the
applicant or applicant certification.
2.4 AHRI shall provide funds of its own from non-federal sources, or qualifying
equivalent matching contributions, for the TBRA program in the amounts and forms required
to satisfy the City's match requirements, if applicable under §§ 92.218-92.222 of the
Regulations, subject to any exceptions that may be granted in writing by HUD. AHRI shall
deliver to City sufficient evidence, in such form as City may require from time to time, that
the match requirements are currently satisfied and will remain satisfied after disbursement,
whenever a disbursement of the Grant is requested.
2.5 Low-income families means families whose annual incomes do not exceed
80% of the median income for the area, as determined by HUD with adjustments for smaller
and larger families. The HUD FY 2018 Income Limits Summary for Corpus Christi TX HUD
Metro FMR Area, which defines "Low Income" as 80%of the median family income for the
area, is attached to this Agreement as Exhibit "D". To determine income eligibility of
applicants, AHRI shall comply with the requirements of 24 C.F.R. § 5.609 which defines
"Annual income" and includes, but is not limited to:
(a) The full amount, before any payroll deductions, of wages and salaries,
overtime pay, commissions, fees, tips and bonuses, and other compensation for personal
services;
(b) The net income from the operation of a business or profession.
Expenses for business expansion or amortization of capital indebtedness shall not be used as
deductions in determining net income, nor shall withdrawals of cash or assets be excluded
from income,except to the extent the withdrawal is a reimbursement of cash or assets invested
in the operation by the family;
(c) Interest, dividends and other net income of any kind from real or
personal property. Where the family has net family assets in excess of$5,000, annual income
shall include the greater of the actual income derived from all net family assets or a percentage
FY18 AHRI TBRA Agreement Page 8 of 20
of the value of such assets based on the current passbook savings rate,as determined by HUD;
(d) The full amount of periodic amounts received from Social Security,
annuities, insurance policies,retirement funds,pensions,disability or death benefits and other
types of periodic receipts, including a lump sum amount or prospective monthly amounts for
the delayed start of a periodic amount (except deferred periodic amounts from supplemental
security income and Social Security benefits that are received in a lump sum amount or in
prospective monthly amounts);
(e) Payments in lieu of earnings, such as unemployment and disability
compensation, worker's compensation and severance pay (except lump sum additions to
family assets, such as inheritances, insurance payments(including payments under health and
accident insurance and worker's compensation), capital gains and settlement for personal or
property losses);
(f) Welfare assistance if the welfare assistance payment includes an
amount specifically designated for shelter and utilities that is subject to adjustment by the
welfare assistance agency in accordance with the actual cost of shelter and utilities. (See
24 C.F.R.
§ 5.609(a)(6)(i) and (ii));
(g) Periodic and determinable allowances, such as alimony and child
support payments, and regular contributions or gifts received from organizations or from
persons not residing in the dwelling;
(h) All regular pay, special pay and allowances of a member of the Armed
Forces (except special pay to a family member serving in the Armed Forces who is exposed
to hostile fire).
Exclusions to the definition of annual income are as follows:
(a) Income from the employment of children under the age of 18;
(b) Payments received for the care of foster children or foster adults;
(c) Lump sum additions to family assets such as inheritances, insurance
payments(including payments under health and accident insurance and
worker's compensation), capital gains and settlement for personal or
property losses;
(d) Amounts received by the family for or in reimbursement of,the cost of
medical expenses for any family member;
(e) Income of a live-in aide;
FY18 AHRI TBRA Agreement Page 9 of 20
(f) All student financial assistance paid directly to the student or to the
educational institution;
(g) The special pay to a family member serving in the Armed Forces who
is exposed to hostile fire;
(h) Amounts received under training programs funded by HUD;
(i) Temporary, nonrecurring or sporadic income (including gifts);
(j) Reparation payments for persons who were persecuted during the Nazi
era;
(k) Earnings in excess of$480 for each full-time student 18 years or older
(excluding the head of household and spouse);
(1) Adoption assistance payments in excess of$480 per adopted child;
(m) Deferred periodic amounts from supplemental security income and
social security benefits that are received in a lump sum amount or in
prospective monthly amounts;
(n) Refunds or rebates under State or local law for property taxes paid on
the dwelling unit;
(o) Amounts paid by a State agency to a family with a member who has a
developmental disability and is living at home to offset the cost of
services and equipment;
(p) Federally mandated income exclusions such as VISTA, Foster
Grandparents, Federal Workstudy, earned income tax credit, etc. (a
complete list can be provided by the Department of Housing and
Economic Development).
Article 3. Duration of Agreement; Default and Enforcement
3.1 This agreement commences on the date of signature by the last Party to sign
this Agreement. Before AHRI receives any part of the Grant, AHRI may terminate this
agreement by written notice to the City if the City does not provide funds as required under
this agreement. After the City makes the first disbursement of the Grant to or on account of
AHRI,this agreement may no longer be terminated by AHRI and it shall remain in effect for
so long as AHRI has any control over Grant monies, unless sooner terminated under the
provisions of this Article.
FY18 AHRI TBRA Agreement Page 10 of 20
3.2 This agreement may be terminated for convenience in accordance with 2
C.F.R. Part 200.
3.3 At any time the City determines or has reason to believe that AHRI has or may
have materially failed to comply with any provision of this agreement or with any of the rules,
regulations, or laws referred to in this agreement, the City may:
(a) Suspend performance of any part or all of its obligations under this
agreement,terminate this agreement entirely with no further obligations or liability on the part
of the City, or exercise other remedies under 2 C.F.R. Part 200;
(b) Declare AHRI ineligible to participate further in City contracts;
(c) Recover damages, obtain specific performance, or exercise any other
remedy available at law or in equity; or
(d) Exercise any one or more of the remedies specified in this Section ,
concurrently or separately.
Article 4. Other Federal Requirements
4.1 For the duration of this agreement and with respect to use of the Grant, AHRI
agrees to comply with all applicable federal laws, regulations, and requirements listed or
described in Subpart H of the Regulations, except for the City's responsibilities for
environmental review under § 92.352 of the Regulations and the intergovernmental review
process under § 92.357. The laws, regulations, and requirements applicable to AHRI under
Subpart H of the Regulations include those mentioned in the remaining Sections of this
Article.
42 Nondiscrimination. No person shall on the grounds of race, color, national
origin,religion, sex, handicap, or financial status be excluded from participation in,be denied
the benefits of, or be subjected to discrimination under any program or activity funded in
whole or in part with the Grant. The Grant is made available subject to all requirements of the
various laws and regulations listed in 24 C.F.R. § 5.105(a).
43 Conflicts of interest. No employee, agent, consultant, officer, or elected or
appointed official of AHRI or of the City who exercises or has exercised any functions or
responsibilities with respect to the Grant or the TBRA program or who is in a position to
participate in a decision making process or gain inside information with regard to the Grant
or the TBRA program may obtain a financial interest or benefit in any lease, contract,
subcontract, or agreement with respect thereto, or the proceeds thereunder, either for himself,
herself, or those with whom he or she has family or business ties, during his or her tenure or
for one year thereafter, subject to the exceptions and other provisions of § 92.356 of the
Regulations.
44 Government Debarment and Suspension and Government Wide Requirements
for a Drug Free Workplace. As a prerequisite for disbursement of funds under this Agreement
FY18 AHRI TBRA Agreement Page 11 of 20
and pursuant to 24 C.F.R. Part 24, et. seq., as part of the AHRI Response to the city of Corpus
Christi Request for Proposal, AHRI, has signed the certifications attached to this Agreement,
as follows:
Exhibit "E" - "Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion- Lower Tier Covered Transaction."
Exhibit"F" - "Drug-Free Workplace Certification."
AHRI may also require owners under leases to be assisted under the TBRA program
to submit the same certification signed by them before receiving TBRA program assistance.
4.5 Religious Organizations. Subrecipients that are religious or faith-based are
eligible, on the same basis as any other organization, to participate in the HOME program
and shall not be discriminated against on the basis of the Subrecipient's religious character or
affiliation;however, Subrecipients that are directly funded under the HOME program may not engage
in inherently religious activities, such as worship, religious instruction, or proselytization, as part of
the programs or services funded hereunder. If a Subrecipient conducts such activities, the activities
must be offered in accordance with the Federal regulations specified in 24 CFR
§ 92.257.
Article 5. Records, Reports, Uniform Administrative Requirements and Monitoring
5.I AHRI shall create and maintain tenant data demonstrating eligibility for its
TBRA program. The data shall include: the tenant's name, address, race or ethnic group, age,
sex, income level, head of household status (gender and whether single or not), confirmation
of chronic mental illness, Social Security number, number of bedrooms, tenant contribution,
monthly gross rent, percentage of median, size of household, type of contract, tenant in
HOME- assisted property, status, contract end date, Federal preferences applicable, any other
basis for determining eligibility, amounts of rent and security deposit subsidies provided and
calculations of the eligible amounts,actions undertaken to comply with equal opportunity and
fair housing requirements, and any other data the City may direct from time to time.
52 AHRI shall also create and maintain current records relating to its TBRA
program that are required of the City, including records supporting the City's certification
under
§ 92.209 of the Regulations;records for income targeting required of the City under§ 92.216
of the Regulations; and records, such as individual project records and a running log,
demonstrating compliance with the matching requirements in § 92.218 through § 92.221 of
the Regulations including the type and amount of contributions.
53 AHRI shall also create and maintain records of compliance with the housing
quality standards, lease terms (including copies of all executed leases), minimum tenant
contributions, actions taken to affirmatively further fair housing, and all other requirements
of the TBRA program.
5.4 AHRI shall comply with any record-keeping format the City may prescribe
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from time to time for the records to be kept under this Article. AHRI shall retain all such
records for the duration of this agreement and for four years thereafter, or after the resolution
of all federal audit findings, whichever occurs later.
55 In the event AHRI is allocated $750,000 or more in Federal awards during its
fiscal year, AHRI shall be required to complete and comply with the U.S. Governmental
federal single audit requirements, including the requirements contained in Uniform
Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards
(also known as the Super Circular) codified at 2 CFR, Part 200 Section C: Subpart F Audit
Requirements. In that event, AHRI is required to submit a data collection form and reporting
package to the Federal Audit Clearinghouse(FAC)within 30 days of receipt of the audit report
or nine months after the end of the audit period, whichever date is earlier. AHRI hereby
agrees to provide to City an annual audit, if applicable, or annual financial statement, if the
annual audit requirement is not applicable, within these same time periods. In addition, a
copy of the agency's Form 990 will be filed with City within thirty(30)days of filing with the Internal
Revenue Service, during the term of this agreement and any extensions.
5.6 All records of AHRI or under its control with respect to any matters covered
by this agreement shall be made available to the City, its designees, or federal agents or
employees, as often as requested during normal business hours, to audit, examine, transcribe,
or copy as any of those parties may deem necessary. Any deficiencies noted in audit reports
must be fully cleared by AHRI within thirty days after notice of the deficiency is given by the
City, its designees, or federal agents or employees.
5.7 AHRI warrants and represents that it now meets and will continue to meet
during the entire term of this agreement, the uniform administrative requirements of 2 CFR
Part 200.
5.8 AHRI agrees to permit and cooperate fully with audits conducted from time
to time as required by 24 C.F.R. parts 44 and 45, as applicable.
59 AHRI will create, maintain and allow inspection of records demonstrating
compliance with the matching requirements, if applicable of 24 C.F.R. § 92.218 through §
92.222 including a running log and documenting the type and amount of match contributions
by project.
5.10 AHRI will create,maintain and allow inspection of records demonstrating that
each family is income eligible in accordance with§ 92.203,using the annual income definition
adopted by the City and set out in Section 2.5 of this Agreement.
5.11 AHRI will create, maintain and allow inspection of records demonstrating
compliance with lead-based paint requirements described in 24 C.F.R. § 92.355.
5.12 AHRI will create, maintain and allow inspection of records demonstrating
compliance with the conflict of interest requirement of 24 C.F.R. § 92.356,as stated in Section
4.3 of this Agreement.
5.13 AHRI will create, maintain and allow inspection of records demonstrating
FY18 AHRI TBRA Agreement Page 13 of 20
compliance with the Government Debarment and Suspension, Ineligibility and Voluntary
Exclusion and the Government Wide Requirements for a Drug Free Workplace, pursuant
to 24
C.F.R. and as set forth in Exhibit"E" and Exhibit "F" and in Section 4.4 of this Agreement.
5.14 AHRI will create, maintain and allow inspection of records demonstrating
compliance with the applicable uniform administrative requirements under Section 5.7 of this
Agreement.
5.15 AHRI will create, maintain and allow inspection of records demonstrating
compliance with all other requirements of this Agreement.
5.16 The CITY shall monitor Subrecipient's files, and program policies and
procedures at least once annually Exhibit "G". The HOME Program Guide for Review of
TBRA projects and other HOME guidance will be used to monitor TBRA file(see Attachment
B & C). In addition to the items and documents specified in the exhibits, Subrecipient's file
must also contain the following fully completed documents as well as any other documents
specified in the HOME TRBA Subrecipient Agreement.
• Subrecipient's Tenant Assessment Form - and application.
• Program Entry Date-the date of HOME Rental Assistance Contract and lease.
• Income Eligibility Form-and proof of income or documentation of no income.
• Adjusted Income Determination Form.
• Tenant Rent Payment Calculation Form - including current FMR for the unit,
with tenant and TBRA assistance determination.
• Rent Reasonableness Determination - the program may only provide rent
assistance if the tenant's proposed rent is reasonable. This is based on rents
that are charged for comparable unassisted rental units using the rent
reasonableness form. The Subrecipient will adopt the approved HUD method
utilized by its organization to determine reasonableness.
• Rent Affordability - verifying the payment standard is within the appropriate
FMR standards.
• Tenant Written Lease - for one year executed by the tenant and landlord.
• Tenant Lease Addendum - signed by the tenant and landlord.
• HOME Rental Assistance Contract - signed by the landlord and the
Subrecipient. This document and the lease should begin and end on the same
day.
• Housing Quality Standards (HQS) - documentation of inspection, completion
and certification, both initially and at recertification.
• Lead-Based Paint Visual Assessment - documentation, both initially and at
recertification.
• Home Rental Assistance Voucher - must be completed and signed by the
Subrecipient and tenant.
• Program Notices - if there is a change in the tenant's share of rent or TBRA
program changes,the Subrecipient must provide written notices to the landlord
and tenant. Copies of those notices must be kept in the client files.
• Re-Assessment Form-annual re-assessment documents for income,HQS,Re-
FY18 AHRI TBRA Agreement Page 14 of 20
calculation of Rent and Rent Reasonableness Determination.
• Documentation of Termination - copy of termination letter specifying the
reason.
Article 6. General Provisions
6.1 AHRI warrants and represents that the following are now true and will remain
true during the entire term of this agreement: that AHRI has and maintains its charter and
organization as a non-profit corporation in good standing under Texas law;that no part of AHRI's net
earnings inure to the benefit of any member, founder, contributor, or individual, and that AHRI's
Articles of Incorporation so provide; and that AHRI has a current ruling by the Internal Revenue
Service recognizing its exemption from income tax under § 501(c)(3) or(4) of the Internal Revenue
Code of 1986.
6.2 For purposes of this Section,the following terms are defined:
(a) To "indemnify" means to protect, defend, hold harmless, pay and be
solely responsible for the indemnified liabilities.
(b) "Liabilities" includes all of the following, whether foreseeable or
unforeseeable: claims, damages (including actual, consequential and punitive), losses, liens,
causes of action, suits,judgments, settlements and expenses (including court costs, litigation
expenses,and attorney fees incurred in defending or settling a claimed liability or in enforcing
this indemnity, costs of investigation, and expert witnesses), of any nature by, through or of
any person or entity including property loss, damage, bodily or personal injury, sickness,
disease, or death, occurring in connection with this agreement or any use of the Grant
hereunder.
(c) To "arise from" includes to occur as a result of or to cause, whether
directly or indirectly, in whole or in part.
(d) "AHRI or its instrumentalities" includes any one or more of: AHRI,
any contractor or subcontractor of AHRI, any employee of AHRI or of any contractor or
subcontractor of AHRI, any person that AHRI controls directly or indirectly to any degree,
any invitee of AHRI,any licensee of AHRI,any tenant or subtenant of AHRI,and any tenant,
landlord, or applicant for assistance under the AHRI TBRA program. It also includes the
following for each of the parties listed in the preceding sentence: partners, partners of their
partners, and any successors, assigns, heirs, personal representatives, devisees, agents,
stockholders, officers, directors, employees, and affiliates.
(e) "Indemnified persons"includes the City, its Council Members,Mayor,
City Manager, agents, guests, consultants, invitees, and employees. It also includes the
following for each of the parties listed in the preceding sentence: partners, partners of their
partners, and any successors, assigns, heirs, personal representatives, devisees, agents,
stockholders, officers, directors, employees, and affiliates.
(f) "Indemnified matters" means (i) bodily or personal injury to, sickness,
FY18 AHRI TBRA Agreement Page 15 of 20
disease, or death, of any person or damage to or loss of property occurring on, in or about the
Housing; (ii) any act, omission, willful misconduct, strict liability, or breach of warranty,
express or implied, of AHRI or its instrumentalities, including negligence in whole or in part
of AHRI or its instrumentalities; (iii) any violation, or nonperformance of any covenant of
AHRI or its instrumentalities under this agreement; or(iv) any violation of any federal, state,
county, or city law, bylaw, ordinance or regulation by AHRI or its instrumentalities.
(g) "Indemnified liabilities" means all liabilities arising from indemnified
matters,except that the indemnified liabilities do not include any liabilities arising solely from
the gross negligence or willful misconduct of an indemnified person.
6.3 AHRI agrees to indemnify the indemnified persons for all indemnified
liabilities arising from,or alleged to have arisen from,any of the indemnified matters.AHRI's
indemnity shall apply to indemnified liabilities EVEN IF ARISING FROM THE
SOLE NEGLIGENCE OR IN PART FROM THE CONCURRENT
NEGLIGENCE OF ANY INDEMNIFIED PERSON, INCLUDING
GROSS NEGLIGENCE, OR IN WHOLE OR IN PART FROM THE
STRICT LIABILITY OF AN INDEMNIFIED PERSON. AHRI shall promptly
advise the City in writing of any action, administrative or legal proceeding or investigation to
which this indemnification may apply.
6.4 AHRI shall carry general liability insurance, with such limits and on such
terms as the City may reasonably require from time to time to protect the interests of the City,
continuously in effect for the duration of this agreement. The insurance policy shall name as
additional insureds the City and its councilpersons, mayor, city manager, agents, guests,
consultants, invitees, and employees. The right of subrogation against the City and any such
additional insureds shall be waived in the insurance policy. The coverage must be maintained
with one or more insurance companies licensed to transact business in Texas.Failure of AHRI
to maintain adequate coverage shall not relieve AHRI of any contractual responsibility or
obligation under this agreement. Prior to receiving any Grant monies under this agreement
and upon renewal of any insurance policy or issuance of a new insurance policy, AHRI shall
furnish to the City a certificate of insurance from the issuing company, providing that the
issuing company shall provide to the City not less than thirty days advance notice in writing
of cancellation, non-renewal, or material changes in the insurance policy. AHRI shall
immediately provide written notice to the City upon receipt of notice of cancellation of an
insurance policy or a decision to terminate or alter any insurance policy. All certificates of
insurance shall clearly state that all applicable requirements have been satisfied. Certificates
of insurance and notices of any cancellations,terminations,or alterations of such policies shall
be mailed to the Office of Risk Management in care of the City at its address for notice
purposes under this agreement. Documentation of the AHRI insurance coverages is attached
hereto as Exhibit"H".
6.5 AHRI shall comply with all applicable federal, state, and local laws,
ordinances, and regulations,whether or not specified in this agreement,in the use of the Grant
and performance under this agreement by AHRI. Any reference in this agreement to a statute
or regulation includes any future amendments thereto, any replacement thereof, and any
FY18 AHRI TBRA Agreement Page 16 of 20
corresponding provision of future laws or regulations. All statutes and regulations referred to
in this agreement are made a part of this agreement for all purposes.
6.6 The provisions of this agreement are severable, and if for any reason a
provision of this agreement is determined to be invalid by a court or federal or state agency,
board or commission having jurisdiction over the subject matter of the invalid provision, the
invalidity shall not affect other provisions that can be given effect without the invalid
provision.
6.7 This written instrument and the exhibits and attachments attached to it, which
are incorporated by reference and made a part of this agreement for all purposes, constitute
the entire agreement by the parties concerning the subject matter of this agreement. Any prior
or contemporaneous oral or written agreement that purports to vary the terms of this agreement
shall be void.
6.8 This agreement may be amended only by written amendment signed by the
City, with approval of its City, and by AHRI, with approval of its board of directors.
6.9 All payments and other obligations under this agreement are to be paid or
performed in Corpus Christi,Nueces County, Texas.
6.10 AHRI is an independent contractor with respect to the City and is not an
officer, agent, servant, partner, or employee of the City. To the extent consistent with the
terms of this agreement, AHRI (and not the City) shall have exclusive control of, and the
exclusive right to control,the details of the work and services performed under this agreement,
and all persons performing same, and shall be solely responsible for the acts and omissions of
its officers, directors, agents, servants, employees, contractors, subcontractors, program
participants, licensees, invitees, and volunteers. The doctrine of respondent superior shall not
apply as between the City and AHRI, its officers, directors, agents, servants, employees,
contractors, subcontractors, program participants, licensees, invitees, and volunteers, and
nothing in this agreement shall be construed as creating a partnership or joint enterprise
between City and AHRI. Neither AHRI nor any of its officers, directors, agents, servants,
employees, contractors, subcontractors, program participants, licensees, invitees, or
volunteers is in the paid service or employment of the City.
6.11 Whenever used in this agreement, to "include" means to "include, without
limitation."
6.12 AHRI shall not assign all or any part of its rights, privileges, or duties under
this agreement without the prior written approval of the City. Any attempted assignment of
same without approval shall be void and shall constitute a breach of this agreement.
6.13 The failure of the City to insist upon the performance of any term or provision
of this agreement or to exercise any right under this agreement shall not be construed as a
waiver or relinquishment to any extent of the City's right to assert, enforce, or rely upon any
such term or right on any future occasion.
6.14 Any notice to be given under this agreement shall be in writing and shall be
deemed delivered when it is deposited in the United States Mail, certified, return receipt
requested, with proper postage prepaid, and addressed to the party to be notified at its address
FY18 AHRI TBRA Agreement Page 17 of 20
given in the first paragraph of this agreement, or to any other address of which that party has
previously notified the other party in writing. All notices directed to the City shall be
addressed to the attention of its Housing and Community Development except as specified
otherwise in this agreement.
6.15 The headings of Articles and Sections in this agreement are for convenience
only and shall be ignored in interpreting this agreement. The use of any gender includes the
other genders, and the use of either singular or plural includes the other. Unless the context
indicates otherwise, a "Section" refers to the provisions of this agreement, including sub-
Sections, beneath and segregated by a number followed by one decimal and another whole number;
and an "Article" refers to all Sections and provisions of this agreement beneath and segregated by a
centered Article number and heading.
6.16 AHRI shall comply with all requirements contained in the city of Corpus
Christi Program Year 2018/2019 HOME TBRA Tenant-Based Rental Assistance Request for
Proposal (RFP) submitted March 16, 2018, as accepted by AHRI.
6.17 AHRI agrees to provide information on client services spreadsheet such as
client name, address, ethnic, race, gender, age, head of household and income level. The
monthly report will be due on the 10th of each month. Information regarding client information
is stated in Exhibit"I".
6.18 AHRI agrees to provide the required information and comply with the
requirements of Exhibit"J",Conflicts of Interest Questionnaire,which is attached hereto and
incorporated herein.
(signature block on next page)
FY18 AHRI TBRA Agreement Page 18 of 20
l'
Executed in duplicate originals this (3? day of LA A _OliAim„i.ig , , 2019.
I
ATTEST: City of Corpus hristj '
,/,114„ ✓�.�i// ii ///,i
'ebecca Huerta, Secretary Samuel"Kei " Se men,"
Interim City Manager
Accessible Housing esources, Inc. fq ( r�'�
Y/Icl 06 v t!..- Fk 1" 1 6
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ACKNOWLEDGMENT
lri
STATE OF TEXAS §
KNOW ALL BY THESE PRESENTS
COUNTY OF NUECES §
This instrument was acknowledged before me ori )4 2001, by Samuel
"Keith" Selman, Interim City Manager of the City of Corpus Christi, lexas.
/0""Y°"•°' : MARTHA VAZQUEZ
_* My Notary b#128028579 TARP PUBLIC, W-Stat
'•?wt, *,- Expires March 5,2022
APPROVED AS TO FORM THIS o?/ DAY OF(:::9 , 2019
Miles Risley, City Attorney
41.0"Art...._
BY: /. /,/`�
ent ci Wc'
Assistant City Attorney
FY18 AHRI TBRA Agreement Page 19 of 20
ACKNOWLEDGMENT
STATE OF TEXAS §
KNOW ALL BY THESE PRESENTS
COUNTY OF NUECES §
•
This instrument was acknowledged before me o
v� � _, r� � ,2019,by Judy Telge,
as Board President of the Accessible Housing Resources, c., a Te .s nonprofit corporation, on
behalf of the corporation.
iyk
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`��ti*pY P4,�i PILAR GONZALES NOTARY zePUBLIC, of Texas
__' �:Notary Public,State of Texas
: 'Q Comm. Expires 08-17-2022
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,,,,,„0 Notary ID 131687307
FY18 AHRI TBRA Agreement Page 20 of 20
ATTACHMENT A
TBRA ADMINISTRATION PLAN
NOTE: This manual outlines the policies pertaining to the HOME TBRA program only.
For additional information please refer to 24 CFR Part 92.
Page 1 of 16
Notice
This manual serves as a reference for the Housing and Community Development's
administration of the HOME Investment Partnerships Program Tenant-Based Rental Assistance
program (TBRA).
To the best of our knowledge,the information in this publication is accurate: however, neither
Housing and Community Development nor its affiliates assume any responsibility or liability for the
accuracy or completeness of,or consequences arising from,such information.Changes,typos,and
technical inaccuracies will be corrected in subsequent publications.This publication is subject to
change without notice.The information and descriptions contained in this manual cannot be copied,
disseminated,or distributed without the express written consent of Housing and Community
Development.This document is intended for informational purposes only.The manual contains
resources and forms used to implement project(s) using HOME TBRA.The manual is not inclusive of all
resources needed to successfully administer a project.
Please contact HCD if you have questions or need additional assistance with materials within this
manual.
Page 2 of 16
Table of Contents
Contents
Program Purpose 4
Application Criteria 4
Eligible Applicants 4
Public Information and Open Records Act Request 5
Minimum Thresholds 5
Maximum Funding Requests 5
Match and Leverage Requirements 6
State Clearinghouse Review 6
Program Requirements and Administration 6
Administration Plan 6
Eligible Costs(Activities) 6
Ineligible Costs(Activities) 7
Income Eligibility for TBRA Beneficiaries(Tenants) 7
Calculating Household Income. 8
Tenant Selection Requirements 8
Eligible TBRA Units and Rent Reasonableness 9
Property and Occupancy Standards 10
Lease Requirements 10
Calculating the Rental Subsidy 11
Minimum Tenant Payment 12
Selecting a Payment(Rent)Standard 12
Length of TBRA Assistance 12
Deposit Assistance 13
Structure and Repayment of HCD Subsidy 13
Recapture of Funds 13
Project Completion 14
Recordkeeping 14
Additional Program Administration 14
Draw Requests 15
Compliance Monitoring 15
Resources 15
Page 3 of 16
HOME Investment Partnerships Program
Tenant-Based Rental Assistance
Policy Manual
NOTE:This manual outlines the policies pertaining to the HOME TBRA program only. It is the
responsibility of HOME TBRA project applicants and grant subrecipients to read,understand,and
comply with the HOME Final Rule,24 CFR Part 92,as well as the documents and notices listed
below.
• 24 CFR Part 92
• HCD's Consolidated and Annual Action Plans
• HCD's HOME TBRA Policy Manual
• HCD's HOME TBRA Application Guidelines
• HCD's HOME TBRA Grant Agreement
• HUD Notices and Updates
• HCD's HOME TBRA Toolkit
• Any other relevant state and federal laws, policies,and regulations not otherwise listed
above.
Program Purpose
The purpose of the HOME Program is to expand the supply of quality,affordable housing for low-
and very low-income households. Created by Congress in 1990,the HOME Investment
Partnerships Program (HOME) provides funding to applicants for various types of affordable
housing production and rehabilitation and to provide Tenant-Based Rental Assistance (TBRA)to
low-and very-low income households throughout the Commonwealth. Housing and Community
Development (HCD)administers and monitors the program for the U.S. Department of Housing
and Urban Development (HUD),awarding funding to eligible applicants, including local
governments, housing authorities, private developers,and nonprofit housing providers.
Application Criteria
Eligible Applicants
Eligible applicants include private developers, nonprofit organizations,Community Housing
Development Organizations (CHDOs),faith-based and community service organizations, and units
of local government in the city of Corpus Christi.
Page 4 of 16
Note:TBRA is not a CHDO set-aside eligible activity;however,CHDOs are not precluded from
applying for TBRA projects.
Applicants that meet the criteria for TBRA established by HUD may apply for funding in the competitive
TBRA funding process.Applicants who are deemed ineligible as a result of HCD's suspension and
debarment policy may not participate in any project that receives HCD resources. Refer to the
Minimum Thresholds section below for additional stipulations.
Any projects located outside of the city limits of Corpus Christi are not eligible to apply for HCD's HOME
TBRA funds.
Public Information and Open Records Act Request
Applicants are advised that materials contained in TBRA applications are subject to the
requirements of the Corpus Christi open records and the application materials may be viewed and
copied by any member of the public.Applicants seeking to claim a statutory exemption to
disclosure from open records requests,which may be made, must place all documents viewed as
confidential in a sealed envelope marked "confidential". Applicants must be aware that if an open
records request is made for any of the application materials, HCD will make an independent
determination of confidentiality and may or may not agree with the applicant's determination
regarding the confidentiality of the materials.
Minimum Thresholds
In addition to meeting basic eligibility criteria,additional minimum thresholds may be set by HCD
during the TBRA competitive funding round. Such thresholds will be outlined in specific TBRA funding
round application guidelines.
Maximum Funding Requests
HCD limits the amount of funds an applicant may request.
HCD reserves the right to award lessor or greater amounts than requested.This determination may
be based on such factors as the capacity of the applicant or administrator, a project's readiness to
proceed,the number of applications received,geographic distribution of funds,and any other factors
that HCD deems appropriate and necessary.
TBRA awards are for a two-year period, unless otherwise stated.
Page 5 of 16
Match and Leverage Requirements
There is no match or leverage requirement for TBRA.
State Clearinghouse Review
The State Clearinghouse review is not applicable to HOME TBRA.
Program Requirements and Administration
Administration Plan
All subrecipients must develop written policies and procedures (Administration Plan) describing how
they will administer their HOME TBRA program.Administration Plans must be in accordance with
the policies included herein, 24 CFR 92, and all other policies and regulations relevant to the
administration of the HOME TBRA program.
Eligible Costs(Activities)
TBRA program funds may be used:
• To provide rental assistance to help pay the cost of monthly rent and utility costs for up to24
months. (Extension of assistance for up to an additional 24 months may be allowed. Refer to
the Length of TBRA Assistance section for more information).
• To pay security and/or utility deposits.
o Security deposit assistance may be provided as long as the procedures in §92.209(j) are
followed and regardless of whether the tenant is receiving on-going tenant-based rental
assistance.
o For those jurisdictions which have adopted the Uniform Residential Landlord Tenant
Act,security deposit is defined as"an escrow payment made to the landlord under
rental agreement for the purpose of securing the landlord against financial loss dueto
damage to the premises occasioned by the tenant's occupancy other than ordinary wear
and tear."
o The amount of a security deposit may not exceed the equivalent of two month's rent for
the unit.
o Utility deposit assistance may be provided only in conjunction with either rental
assistance or a security deposit program.
• To cover related soft costs for a TBRA project which includes unit inspections and income
determinations.
TBRA administrative(admin)funds may be used:
• To pay for reasonable planning and administrative expenses associated with operating a TBRA
program.Administration of TBRA is eligible only under general management oversight and
coordination under§92.207(a).
Page 6 of 16
Ineligible Costs(Activities)
HOME TBRA funds may not be used for the following activities:
• Application fees for housing units.
• Applicant background checks.
• Telephone and cable deposits.
• Landlord vacancy and/or damage claims.
• Down payment and/or closing costs in conjunction with a lease-purchase program.
• To make commitments to specific owners for specific projects.Tenants must be free to use the
assistance in any eligible unit.
• To assist resident owners of cooperative housing that qualifies as homeownership housing.
Cooperative and mutual housing may qualify as either rental or owner-occupied housing,
depending on the provisions of the agreement applying to the unit.
• To prevent displacement of or provide relocation assistance to tenants as a result of activities
other than the HOME Program.
• To provide TBRA to homeless persons for overnight or temporary shelter.Any HOME TBRA
subsidy must be sufficient to enable a homeless person to rent a transitional orpermanent
housing unit that meets Housing Quality Standards(HQS).
• To provide assistance for more than 24 months.The term of rental assistance contract
providing assistance with HOME funds may not exceed 24 month, but may be renewed,subject
to the availability of HOME funds.
• To duplicate existing rental assistance programs that already reduce the tenant's rent payment
to 30 percent of income. For example, if the household is already receiving assistance under the
Section 8 Housing Choice Voucher Program (Section 8),the household may not also receive
assistance under a HOME TBRA program.
• To provide assistance outside of the agency's service area.
Income Eligibility for TBRA Beneficiaries(Tenants)
There are two key rules regarding the income eligibility of households under a HOME TBRA program—
initial income and income at annual recertification:
• Initial Income Eligibility: Income of participating households must be verified before assistance
is provided. Income limits are established by household size and revised annually by HUD. For
initial income eligibility,a household qualifies for TBRA assistance if its annual gross income
does not exceed 60 percent of Area Median Income(AMI) indicated on the HOME Income
Limits. Programs must ensure that 20 percent of all households served have an income that
does not exceed 50 percent AMI.
• Annual Recertification Income Eligibility:The subrecipient must recertify family income,size
and composition at least annually. Income limits are established by household size and revised
annually by HUD.A household may still be served with HOME TBRA so long as its income does
not exceed 80 percent AMI (HUD's Low-Income Limit)after project entry. If at annual
recertification a household's income exceeds 80 percent AMI,the household is no longer eligible
for HOME TBRA and assistance can no longer be provided.The subrecipient must give
reasonable(minimum of 30 days) notice to the tenant and the owner.
Page 7 of 16
Calculating Household Income:
• Household income: Household income under HOME-funded TBRA program must be calculated
using the definition of annual income at 24 CFR Part 5(Section 8).
• The subrecipient must determine annual income by reviewing source documents for at least
two months, evidencing annual income (for example,wage statement, interest statement,
unemployment compensation)for the TBRA-assisted household.
o Income and asset source documentation for new TBRA recipients is good for a six-
month period. If TBRA assistance is not provided before the six months has expired,the
household's income eligibility must be reviewed again before assistance may be
provided.
o Income eligibility criteria must be met regardless of the type of TBRA program operated
by the subrecipient(e.g., rental assistance, utility deposits,security deposits,etc.).
Tenant Selection Requirements
Subrecipients administering HOME-funded TBRA programs must have a written tenant selection policy
that clearly specifies how households will be selected for participation in its TBRA program. There are
two major components of tenant selection—income eligibility(as referenced above)and preferences
established by the subrecipient. Preferences:Subrecipients can use HOME-funded TBRA programs to
support a variety of local goals and initiatives, including the establishment of preferences.
• Residency preference:The subrecipient may opt to establish a residency preference as part of
its community-wide program.A residency preference requires TBRA participants to be residents
of the subrecipient service area, but must adhere to the following:
o Subrecipients may establish a residency preference as long as the application of the
preference does not have the effect of discriminating on the basis of race,color,
religion,sex, nation origin,disability,familial status,age,sexual orientation,gender
identity,or marital status.
o The subrecipient's definition of"resident" must include persons who currently reside in
the service area, and those who are currently working or have a verified job offer in the
service area
o Subrecipients may not establish a requirement for minimum length of residency.
• Preferences for targeted populations:Subrecipients are permitted to design local selection
criteria that meet the housing needs of specific populations.
o Preferences for persons with disabilities:Subrecipients may establish a preference for
individuals with mental or physical disabilities.
• Generally,TBRA and related services may be made available to all persons with
disabilities that can benefit from such services.
• Subrecipients may also provide a preference for a specific category of
individuals with disabilities(e.g., persons with AIDS or severe mental illness) if
the specific category is identified in the Consolidated Plan as having unmet
needs and the preference is needed to narrow the gap in benefits and services
available to such persons. In addition,the provision of assistance must be
Page 8 of 16
necessary to provide housing, aid, benefit,or services that are as effective as
those provided to others.
• Preferences for persons with other special needs:Subrecipients may establish a preference for
individuals with special needs (seniors, homeless persons,etc.).
o TBRA may be provided exclusively to persons with a particular type of special need, if
the specific category of need is identified in the Consolidated Plan as having unmet need
and the preference is necessary to bridge the gap in benefits and services received by
such persons.
o As with the general TBRA program, appropriate non-mandatory social services may be
provided in conjunction with the TBRA.
• Selection for TBRA assistance may be conditioned on successful participation in a self-sufficiency
program.The family's failure to continue participation in the self-sufficiency program is not a
basis for terminating the assistance; however, renewal of the assistance may be conditioned on
participation in the program.
• Tenants on Section 8 waiting list: HOME TBRA Program Participants do not jeopardize their
position on the local Section 8 waiting list while receiving HOME TBRA assistance. If Section 8
assistance becomes available, recipients of TBRA will qualify for tenant selection preferences to
the same extent as when they received HOME TBRA under this subsection.
• Eligibility may NOT be contingent upon participation in medical-or disability-related services,
and cannot be administered in a manner that limits opportunities for persons with disabilities.
Eligible TBRA Units and Rent Reasonableness
The HOME TBRA program offers households great flexibility in selecting a housing unit. Households
must be free to select the unit of their choice.
• Public or private:Units under the TBRA program may be publicly-or privately-owned. Publicly-
owned units include public housing,Section 811,Section 202, HOPE 6,Continuum of Care, and
HOPWA.
• Combining rental assistance with another rental assistance program: HOME TBRA rental
assistance cannot be provided to a program participant who is receiving tenant-based rental
assistance(e.g.Section 8 or Continuum of Care rental assistance)or living in a housing unit
receiving project-based rental assistance or operating assistance through other public sources.
• Combining security and utility deposit assistance with another security or utility deposit
program: HOME TBRA security and utility deposit assistance cannot be provided to a program
participant who is receiving security deposit or utility deposit assistance through other public
sources.
• Rents must be reasonable:Subrecipients must disapprove a lease if the subrecipient
determines the rent is not reasonable, based on rents that are charged for comparable
unassisted rental units.
• HOME-funded units are OK: Households may select units developed or rehabilitated with HOME
assistance. However,the subrecipient may not require the household to select a HOME unit as
a condition of receiving TBRA. Households must be permitted to move out at the end of the
HOME lease term,taking their TBRA assistance with them.
Page 9 of 16
• Portability is an option:Subrecipients may allow eligible TBRA participants to use their TBRA
assistance in units within their service area. HCD does not allow TBRA assistance to be used
outside of the subrecipient's service area.
Property and Occupancy Standards
The Section 8 Housing Quality Standards(HQS) must be used for HOME TBRA activities. Inspection to
verify compliance with HQS and occupancy standards are made both at initial move-in and annually
during the term of the TBRA assistance. If security deposit assistance alone is provided,an inspection is
required only at the time the PJ provides the security deposit assistance.
Occupancy Standards
• The subrecipient must develop local occupancy standards that specify the number of bedrooms
needed by households of various sizes and composition.
• Eligible unit size:The occupancy standards are used to provide consistent criteria for
determining the unit size for which the household is eligible.
• When the household is selected for the HOME TBRA program,the subrecipient should counsel
the household about the unit size for which the household is eligible.
o If the household will be permitted to select a unit that is larger or smaller than the
eligible unit size,the subrecipient should explain the impact of this choice on the
tenant's payment.
o The subrecipient may refer the household to appropriate units, but may not require the
household to select the referral unit.
• Subrecipient must ensure that the property complies with standards and requirements for as
long as the unit is occupied by a TBRA recipient.
o The subrecipient must conduct an annual inspection to ensure that the unit still meets
HQS.
o The subrecipient must also ensure that the unit is the appropriate size for the
household in order to meet the occupancy standard.
Lease Requirements
• TBRA may be provided through an assistance contract with an owner that leases a unit to an
assisted household or directly to the household. In either case, HCD requires subrecipient to
approve the lease between the household and the owner.
• The tenant's lease must comply with the requirements in §92.253(a)and(b).
• Written lease:The lease between the owner and the TBRA recipient must be in writing and
signed by both parties.A written lease is required regardless of what the state considers as a
legal lease.The subrecipient must review the lease.
Page 10 of 16
• Term:The term of the lease between the tenant and the owner must be at least one year,
unless both agree otherwise.
• What the lease may not say:The lease may not contain the following provisions:
o Agreement by the tenant to be sued or to admit guilt,or a judgment in favor of the
owner in a law suit brought in connection with the lease;
o Agreement by the tenant that the owner may take, hold,or sell the personal property of
household members without notice to the tenant and a court decision on the rights of
the parties(this does not apply to personal property left by the tenant after move-out);
o Agreement by the tenant not to hold the owner or its agents legally responsible for any
action or failure to act,whether intentional or negligent;
o Agreement by the tenant that the owner may institute a lawsuit without notice to the
tenant;
o Agreement that the owner may evict the tenant (or other household members)without
a civil court proceeding where the tenant has the right to present a defense,or before a
court decision on the rights of the tenant and the owner;
o Agreement by the tenant to waive a trial by jury;
o Agreement by the tenant to waive the tenant's right to appeal or otherwise challenge a
court decision;
o Agreement by the tenant to pay attorney fees or other legal costs,even if the tenant
wins in court;or
o Agreement by the tenant to participate in any specific supportive services as a term or
condition of the lease.Services may not be mandatory.
• Termination:The subrecipient must establish standards it will use to approve or reject a lease
relating to when a landlord may elect to terminate or refuse to renew the lease of a TBRA
household.These standards must be in writing.They must also be included within the lease
and/or in the contract between the subrecipient and the tenant.
• Rent increases:The subrecipient must review and approve rent increases by the landlord
renting to tenants participating in the TBRA program.Owners may adjust rents as leases are
renewed (generally annually).The subrecipient must disapprove a lease if the rent is not
reasonable.
Calculating the Rental Subsidy
• HCD has elected to utilize the Section 8 Housing Choice Voucher method (24 CFR Part 982)to
calculate subsidy amounts. Subrecipients must utilize the HCD HOME TBRA Subsidy Worksheet
• Maximum TBRA payment(subsidy):The maximum amount that the HOME TBRA program may
pay to assist any given household is the difference between 30 percent of the household's
adjusted monthly income using the requirements in 24 CFR Part 5.611 and the rent limit
established by the subrecipient, known as the payment(rent)standard.This gap is then the
constant amount of the monthly TBRA assistance.The household is free to select an actual unit
Page 11 of 16
that costs more or less than the subrecipient's payment(rent)standard. NOTE:HCD typically
refers to the rent limit as the payment standard. However,the term payment standard means
the same thing as the term rent standard,which is used in 24 CFR Part 92.
• Regardless of whether the unit cost of the actual unit selected is more or less than the payment
(rent)standard,the monthly TBRA to the household remains fixed at the gap between whatthe
household can afford and the subrecipient's payment(rent)standard.
o Unit costing more: If the household selects a unit costing more than the
payment (rent)standard,the household's monthly payment will exceed 30
percent of its monthly adjusted income.Should a household elect a unit that
exceeds the subrecipient's payment (rent)standard,the subrecipient should
obtain documentation signed by the household that it understands the unit is
considered unaffordable to their income level.
o Unit costing less: If the household selects a unit costing less than the payment
(rent)standard,the household's monthly payment will be less than 30 percent
of its monthly adjusted income.
Minimum Tenant Payment
The HOME Program rules require the subrecipient to establish a minimum tenant payment. Minimum
tenant payment:The subrecipient may use its discretion in setting this minimum payment level.The
minimum payment may be established at a dollar figure(such as$50)or at a percentage of income
(such as 10 percent of monthly income). HCD allows the minimum tenant payment to be as low as$0.
Selecting a Payment(Rent)Standard
In establishing a payment (rent)standard,subrecipients may either use the current HUD Fair Market
Rent(FMR)(updated and published annually by HUD)or they may set the standard at 110%of the
FMR1.Whichever method is selected, it must be clearly stated in the agency's HOME TBRA
Administration Plan and must be applied consistently with all assisted households.
Length of TBRA Assistance
• HOME TBRA rental assistance contracts with individual households may not exceed 24 months.
However, contracts can be renewed for up to an additional 24 months and every 24 months
thereafter,subject to availability of HOME funds.
• In circumstances where the payment is made directly to the landlord,the 24 month period
begins on the first day of the lease and ends upon termination of the lease.
• In circumstances where the payment is made directly to the tenant,the TBRA payment ends
when a lease is terminated. However, payments can begin again once the household enters into
a new lease.
Page 12 of 16
• Rental assistance contracts may be shorter than two years. For example, if TBRA is used in
conjunction with a self-sufficiency program,a subrecipient may want to have a shorter contract
term,such as 18 months.
Deposit Assistance
HOME regulations allow the security deposit payment to be made to the tenant or the owner and the
utility deposit payment to be made to the tenant or the appropriate utility company. HCD
recommends that deposit payments be made directly to an owner or utility company.
The amount of security deposit paid should be based upon local market practice. However,the
maximum amount of HOME funds that may be provided for a security deposit is the equivalent of two
months' rent for the unit.Only the prospective tenant, not the owner or landlord, may apply for HOME
security deposit assistance.
Utility deposits may be made only in conjunction with the provision of rental assistance or security
deposit programs,and cannot be operated separately as a "stand alone" program. Utility deposits may
be paid for any of the tenant-paid utility services included on the utility allowance chart provided by the
local public housing authority.Telephone and cable deposits are ineligible.
Note: Funds for assistance for security deposits or utilities must be in the form of a grant to,or
on behalf of,the tenant.
Structure and Repayment of HCD Subsidy
There is no repayment of HOME assistance for HOME TBRA activities by the individual households to
the sponsoring agency.All HOME TBRA to individual households will be in the form of a grant. In the
event of non-compliance by a sponsoring agency, repayment of HOME TBRA funds to HCD will be
required.
Recapture of Funds
HCD reserves the right to:
• Withdraw its conditional funding commitment if items are not submitted by the applicant by
the date referenced in the commitment letter.
• Recapture funds if funds are not committed and/or expended by the dates referenced in the
funding agreement,or if the project substantially changes after the funding commitment.
• Periodically review the applicant's progress toward timely commitment and expenditure of the
HOME allocation. If HCD determines that the project is no longer feasible or is not progressing
timely so that the imposed deadlines will be met,funds may be recaptured.
• HCD will recapture funds for any subrecipient who becomes suspended or debarred
in accordance with the HCD Suspension and Debarment Policy.
Page 13 of 16
Other examples of situations that constitute recapture are included in the funding agreement.
Subrecipients are advised to read those requirements carefully to avoid recapture of HOME funds.
Project Completion
If the project does not meet the commitment and/or expenditure deadlines as noted in the HOME
TBRA grant agreement,any uncommitted or unexpended HOME project funds are subject to
recapture.
Recordkeeping
Recordkeeping and Record Retention requirements must be in compliance with 24 CFR 92.508. For
TBRA projects, records must be retained for five years after the period of rental assistance ends or
from the time the project is closed,whichever is longer.
Documentation of these requirements must be available for review by HCD's compliance monitoring
staff or program staff. Subrecipients are responsible for ensuring that all records are maintained for
the appropriate period of time for all HOME TBRA projects.
Additional Program Administration
Additional requirements include but are not limited to:
• Each applicant must develop and utilize a standard program application form. Each household
must complete the standard application form. If necessary,the agency will provide assistance in
preparing the form;especially to the elderly, handicapped, non-English speaking persons,and
persons who are unable to read and/or write.A Uniform Residential Loan Application is not
considered a program application and cannot be used as such under this program.
• All households deemed ineligible for assistance must be notified in writing of such
determination and the reasons for such determination.The household should also be notified
of other potential resources.
• Applicants should document their efforts to ensure clients are complying with the
requirements.
• Applicants must disclose all real, potential,or perceived conflicts of interest to HCD as
outlined in 2 CFR Part 200,as applicable, regarding the receipt of,assistance provided with,or
expenditure of HCD funds.All conflicts of interest must be disclosed and resolved prior to
providing HOME TBRA assistance to the household. For additional guidance on Conflict of
Interest requirements, refer to HCD.
• HOME applicants must comply with the requirements of the Uniform Relocation Act.
Page 14 of 16
• All funded projects have access to technical assistance through the Contract Administrator
on an as-needed basis.
• The subrecipient is responsible for adhering to Violence Against Women Reauthorization Act of
2013: Implementation in HUD Housing Programs. Additional information can be found at 24
CFR §5.2001-thru §5.2011.
Draw Requests
All draw requests must be submitted at least monthly to the Housing and Community Development.
The final draw request must also include required closeout documentation.
Compliance Monitoring
HCD is responsible for conducting monitoring reviews for all projects. HCD will utilize a risk assessment
tool to determine the relative risk among funded entities and projects. Subrecipients will receive on-
site, desk, or remote monitoring reviews based on the risk assessment. All agencies will be required to
complete the Annual Project Compliance Report (APCR). Each subrecipient of HOME funds is required
to make available, in a timely manner, all documentation required by HCD's Staff.
Resources
HOME Final Rule 24 CFR Part 92
http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title24/24cfr92 main 02.tpl
HUD Exchange
https://www.hudexchange.info/
HOME Tenant-Based Rental Assistance Guidance
https://www.hudexchange.info/home/topics/tenant-based-rental-assistance/
2 CFR Part 200 Uniform Administrative Requirements
http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200 main 02.tpl
Page 15 of 16
HCD HOME Investment Partnerships Program Tenant-Based Rental Assistance Tool Kit
Technical Guide for Determining Income and Allowances for the HOME Program
https://www.hudexchange.info/resource/786/technical-guide-for-determining-income-and-allowances-
for-the-home-program/
This guide book provides information on calculating income of program participants. It reviews general
requirements for determining and calculating income in order to determine program eligibility, provides
an overview of the three allowable definitions of income,and reviews how to determine income using
each of the three definitions.
Section 8 Method of Income Calculation of Annual Income 24 CFR Part 5.609
https://www.gpo.gov/fdsys/gran ule/CFR-2000-title24-voll/CFR-2000-title24-vol1-sec5-609
Section 8 Method of Income Calculation of Adjusted Income 24 CFR Part 5.6.11
https://www.gpo.gov/fdsys/gran u le/CFR-2011-title24-vol1/CFR-2011-title24-vol1-sec5-611/content-
detail.html
HOME Income Limits
https://www.hudexchange.info/home/
HUD Fair Market Rents
https://www.hudusergov/portal/datasets/fmr.html
Housing Quality Standards(HQS)
https://portal.hud.gov/hudportal/HUD?src=/program offices/public indian housing/programs/hcv/hqs
Violence Against Women Act(VAWA)Requirements for HUD Programs
https://www.hudexchange.info/resource/4718/federal-register-notice-proposed-ru le-violence-against-
women-act-2013-vawa-2013/
Page 16 of 16
ATTACHMENT A
TBRA TOOL KIT
Page 1 of 70
HOME TBRA REVISION HISTORY EXPLANATION
Revision Date Affected Pages and Forms Description of Change
10/2018 Forms changed or added: Form 139, Original.
158, HUD Form 5380,HUD Form 5381,
HUD Form 5382, HUD Form 5383,
Conflict of Interest Guidelines, HOME
TBRA Helpful Links.
Form 139 Authorization to Release and Consent:
• The second section of the form contained a typo;the word "employees"was corrected to
"employers". Removed Condition.Added Co-Applicant/Resident. Moved to Sample Forms.
Form 158 Verification of Receipt of Required Documents
• Added non-discrimination language.Added VAWA language.Added Condition.
HUD Form 5380
• Notice of Occupancy Rights Under VAWA
HUD Form 5381
• Model Emergency Transfer Plan for Victims of DV, DV,Sexual Assault,or Stalking
HUD Form 5382
• Certification of DV, DV,Sexual Assault,or Stalking
HUD Form 5383
• Emergency Transfer Request for Certain Victims of DV, DV,Sexual Assault,or Stalking
HOME TBRA Resources and Links:
• added VAWA Implementation Rule
• updated Super Circular, added additional valuable links and removed obsolete links
• deleted Sample Language Access plan link
• updated HUD's TBRA website link
Resources:
Added HUD's Conflict of Interest Guidelines
Page 2 of 70
Notice
This toolkit serves as a reference for the Housing and Community Development's administration of
the HOME Investment Partnership Tenant Based Rental Assistance (HOME TBRA) program.The
purpose of this toolkit is to provide tools and resources to agencies to assist in achieving and
maintaining compliance with applicable laws and program regulations and to administer programs
more effectively and efficiently.
To the best of our knowledge,the information in this publication is accurate; however, neither Housing
and Community Development nor its affiliates assume any responsibility or liability for the accuracy or
completeness of,or consequences arising from,such information. Changes,typos, and technical
inaccuracies will be corrected in subsequent publications.This publication is subject to change without
notice.The toolkit contains resources and forms used to implement the HOME TBRA program.The
toolkit is not inclusive of all resources needed to successfully administer this project.
Please contact HCD if you have questions or need additional assistance with materials within this
toolkit.
Page 3 of 70
•
About HOME TBRA
The HOME TBRA Program provides temporary assistance to individual households to help them afford
the housing costs of market-rate units. HOME TBRA assistance helps the individual households, rather
than subsidizing a particular rental unit.The assistance moves with the client/tenant. If the household
no longer wishes to rent a particular unit,the household may take its HOME TBRA and move to another
rental property.The level of HOME TBRA subsidy varies.The subsidy is based on the income of the
household,the unit the household selects,and the payment standards. HOME TBRA may also be used to
help pay for security deposit and utility deposits.
Basic HOME TBRA Overview
*Refer to 24 CFR Part 92 for all eligible costs and requirements.
The HOME TBRA Program provides funding for:
• Rental Assistance
• Security Deposits
• Utility Deposits(must be in conjunction with Security Deposit or Rental Assistance)
• Project Administration(also known as the Admin Fee)
Page 4 of 70
*Agency to Insert *
g Y
HUD's HOME TBRA Application
Guidelines
(Guidelines are subject to change with every allocation)
Page 5 of 70
*Agency to Insert *
� v
HOME TBRA Funding Agreement
(Funding agreements are subject to change with every allocation)
Page 6of70
HOME TBRA
STEP-BY-STEP
INITIAL LEASE-UP
Step 1—Application Phase
1. Accept Application for Assistance—Should be completed by member of the household and not
agency staff(unless household member requests assistance with completing application).
2. General Authorization to release—Authorizes the agency to verify the necessary information.
3. Verification of Receipt of Required Documents—Documents the client received copies of required
policies.
4. Criminal History—TBRA does NOT require a criminal background check, however if your agency
chooses to make this part of the application you must disclose this to the applicant prior to
application including a description of how criminal history will be managed by your agency.Also,
your agency policy and the procedures used to carry out the policy must be described in your
written policies and procedures (Admin Plan)
5. All applicants must be treated fairly and consistently.
6. Client/tenant files—A client/tenant file should be created for each household per allocation. Use the
Client File Checklist to ensure files are complete.
7. The agency staff member reviewing the Application for Assistance should sign in the "Agency Staff
Review"section.
8. Waiting list—Place all applicants on the waiting list, pending verification of all necessary
information.
Step 2—Determine Eligibility
1. Applicants are selected from the waiting list in the order established by the TBRA administrator's
preference policy.
2. To determine eligibility the TBRA Administrator must verify the following:
a. The household's eligibility for preference status (if applicable, must be done prior to
assistance given)
b. The household's size and composition to determine the unit size for which the household
qualifies
i. Driver's license,state issued ID's,social security cards, birth certificates,and custody
agreements can verify household members
b. The gross household income
Page 7 of 70
i. Income must be verified by two months source documents or the income
verification forms in the HOME TBRA Tool Kit. Under no circumstances should the
applicant deliver a verification form to the source of income.
ii. Calculate income according to the Section 8 method (24 CFR 5.609)
c. Any adjustments for which the household qualifies to arrive at adjusted income (24 CFR
5.611)
i. Elderly adjustment—verify age with source documents such as:driver's license,
state issued ID,or birth certificate
ii. Disability adjustment—verify disability with source documents such as:Social
Security Disability(SSDI)determination/award letter,Supplemental Security Income
(SSI)disability determination/award letter,Verification of Disability Form—
cornpleted by a Physician.
iii. Medical Expenses—If head or co-head of household is elderly or disabled,verify
expenses with source documentation such as: receipts that clearly show eligible
expenses with name,address, and contact information of provider printed on
receipt;statements from providers on letterhead,clearly showing eligible expenses;
(must be paid expenses not just billed expenses);or Verification of Medical Expense
form
iv. Disability Expenses—If the expense allows the disabled household member to
return to work,verify expenses with source documentation such as: receipts that
clearly show eligible expenses with name, address, and contact information of
provider printed on receipt;statements from providers on letterhead, clearly
showing eligible expenses(must be paid expenses not just billed expenses);or
Verification of Disability Expense forms
v. Child Care Expenses—If the expense allows the household member to seek or
maintain employment,verify expenses with source documentation such as:
receipts that clearly show eligible expenses with name, address, and contact
information of provider printed on receipt;statements from providers on
letterhead,clearly showing eligible expenses(must be paid expenses not just billed
expenses);or Verification of Child Care Expense form
9. Applicants determined ineligible after the application process should be notified in writing of this
decision and should be given an opportunity to appeal the decision.
10. Eligible applicants will be issued coupons. (2nd tab of the Subsidy Calculation Worksheet)
Step 3—Issue Coupons
11. The issuance of a HOME TBRA coupon authorizes the household to begin the search for housing.
12. The coupon is issued in person and during a counseling session with the household called "The TBRA
Briefing"
13. The amount determined on the coupon is an ESTIMATE and will not be the final amount of the rent
for the client/tenant.The final amount of the housing assistance payment(HAP)and total tenant
payment(UP)will be determined after the applicant locates a unit to rent and the actual rent and
utilities are known.
14. The TBRA Briefing:The purpose of the briefing is to ensure that the household understands its
responsibilities as well as those of the TBRA administrator and the landlord. It also gives the
household guidance to make an informed choice of housing.The briefing should cover:
Page 8 of 70
a. Roles and responsibilities of the client/tenant, landlord,and TBRA administrator
b. Limitations on the rent the landlord may charge, including how utility allowances are used in
this determination
c. Subsidy calculations
d. Security deposit policy
e. Coupon expiration and extension policies
f. Guidance on selecting a unit
g. HQS requirements
h. Procedures for submitting a Request for Unit Approval. Families should be counseled
against signing a lease until the TBRA administrator has approved the unit.
i. Lead based paint dangers brochure
j. Fair Housing information and how to submit a complaint
15. The TBRA administrator must not steer a household towards a particular unit or require the client to
rent a particular unit
Step 4—Unit/Lease Approval
Once the household has located a unit and the landlord has agreed to participate,the household and
the landlord jointly submit the Request for Unit Approval,which triggers the HQS inspection, rent
reasonableness review and landlord's lease review.
1. HQS Inspection—Each unit must be inspected to confirm that it meets HUD's housing quality
standards (HQS). Units may be inspected by agency staff. It is recommended that staff be trained in
HQS inspections, however, instructions are available on the HQS long form (52580A). If the unit fails
initially,the landlord may be given a reasonable amount of time to correct deficiencies or the
household may elect to look for another unit.Agreements with landlords must not be executed until
the unit passes an HQS inspection.
2. Rent Reasonableness Review—The rent for each unit must be determined to be reasonable when
compared to comparable, UNASSISTED UNITS.
3. Landlord's Lease Review—The TBRA administrator must review the owner's lease to ensure that it
does not include any of the prohibited lease provisions.
Step 5—Final Subsidy Calculation
Once the unit has been approved,a final subsidy calculation is required to determine the HAP,the
client/tenant portion of the rent,and utility assistance payment(UAP), if applicable.
Step 6—Contract/Lease Execution
The TBRA Contract,the Lease Addendum,and the Lease are signed by all parties.The TBRA Contracts
must begin on the first day of the lease.
Step 7—Initiation of Payments
HUD TBRA Program is a reimbursable program.The TBRA administrator will advance funds to the
landlord and then request repayment from HUD.
Page 9 of 70
RECERTIFICATION
Each household must be recertified annually based on the anniversary date of move-in. It is
recommended that you start 90 days prior to ensure client/tenant compliance and that all verifications
are received prior to the anniversary date and you are able to give a 30-day notice of any rent increase
that may begin on the anniversary date.
Step 1—Personal Declaration
The household is asked to update all household information on the Personal Declaration.
Step 2—Determination
Using the information from the Personal Declaration, repeat steps 2,4, 5, &6 listed under Initial Lease-
up. Keep in mind that the HQS inspection and all documentation must be done and dated PRIOR to the
anniversary date. Place all documents from recertification on top of the initial certification in the
client/tenant file, and separate with colored sheets of paper indicating the type of certification (initial or
recert)and the date.
Step 3—Notification
Notify the landlord and client/tenant of the updated rent amounts,whether or not the rent portions
change.The new rent should take effect on the anniversary date, however,YOU MUST GIVE A FULL 30-
DAY NOTICE OF ANY RENT INCREASE,so if you are late getting the recert done,the rent increase may
not take effect until the following month. Keep copies of all correspondence in the client/tenant file.
INTERIM CHANGES
Households are not required to report income changes until the Annual Recertification process,
however, households are encouraged to request Interim Recerts if household income has decreased.
Follow all three steps listed under Recertification. Decreases in the client/tenant portion of rent do not
require a 30-day notice.The decrease will take effect immediately,for example,a change of income is
reported and verified on May 20th,starting June 1,the tenant's portion would be the lesser amount.
OTHER INFORMATION
1. HUD requires that all TBRA households also apply for permanent subsidized housing, (Section 8,
Public Housing Authority,etc.). Written documentation should be kept in the client/tenant file that
shows the household has applied for permanent subsidized housing. HOME TBRA is only temporary
assistance.
2. TBRA administrators should maintain their financial records per OMB regulations(2 CFR 200)
3. TBRA administrators must complete W-9's on landlords and report to the IRS rental amounts paid to
landlords on form 1099.
Page 10 of 70
V HOME TBRA CLIENT FILE CHECKLIST Comments
APPLICATION PHASE
Application for Assistance(HCD Form-201)
Identification for household members(SS cards, driver's license, birth certificates,etc.)
Authorization to Release(HCD Form- 139)
Verification of Receipt of Required Documents (HCD Form- 158)
GROSS INCOME AND ADJUSTED INCOME DETERMINATION
Two months source documents verifying income(or appropriate HCD form)
Source documents verifying Assets(or HCD form- 160)
Source documents verifying Disability(or HCD form- 123)
Source documents verifying Medical Expenses, if applicable(or HCD form- 155)
Source documents verifying Disability Expenses, if applicable (or HCD forms- 153 or 154)
Source documents verifying Child Care Expenses, if applicable(or HCDform- 150)
Earned Income Disallowance documentation if applicable
SUBSIDY DETERMINATION
Income limits
Occupancy standards
Payment standards
Request for Unit Approval
Utility Allowance Chart
Subsidy Calculation Worksheet
UNIT DETERMINATION AND CONTRACTUAL AGREEMENTS
Rent Reasonableness(HCD Form-202)
HQS Inspection
Lead Visual Assessment and Worksheets
Lease
TBRA Lease Addendum
TBRA Contract
HUD Form 5380-Notice of Occupancy Rights Under VAWA
HUD Form 5381-Model Emergency Transfer Plan for Victims of DV,DV,Sexual Assault,or Stalking
HUD Form 5382-Certification of DV,DV,Sexual Assault,or Stalking
HUD Form 5383-Emergency Transfer Request for Certain Victims of DV,DV,Sexual Assault,or Stalking
RECERTIFICATION
Personal Declaration- if additional members, client identification
Updated Authorization to Release
Updated gross income and adjusted income determination(all steps from income above)
Updated unit determination and contractual agreements
CORRESPNDENCE,MOVEOUT INFO,ASSISTANCE PAYMENTS
Copies of all written correspondence between agency, client and landlord
Termination letter, if applicable
Move out documentation
Complaints& investigations
Copies of Payments made on client's/tenant's behalf and supporting documentation
Page l lH$CTPForm—200
Conflict of Interest Guidance
Organizational Conflicts
1) The provision of any type or amount of assistance may not be conditioned on the client's
acceptance or occupancy of housing owned by the sub-recipient agency,or a parent or
subsidiary of the subrecipient agency.
2) Agencies should not administer assistance for clients that are occupying housing owned by the
subrecipient agency,or a parent or subsidiary of the subrecipient agency without an exception
from HUD.
Individual(personal)Conflicts
1) For the procurement of goods and services,the subrecipient agency must comply with codes of
conduct and conflict of interest requirements under 24 CFR 85.36 or 24 CFR 84.42.
2) No person (employee, agent,consultant,contractor,officer,or elected or appointed official)of
the subrecipient may obtain a financial interest or benefit from an assisted activity(including
contracts, subcontracts, agreements and any proceeds derived from an activity)for either
themselves or for family members or business partners, unless an exception has been requested
and approved by HUD. For example:
a. Agencies must not serve employees (or a member of an employee's family)without
receiving an exception from HUD allowing that employee to be served. Please see the
regulation at 24 CFR 404(b)and (c), and how to request an exception at 24 CFR
404(b)(3).
b. Agencies must not pay a CPA with program funds (or program matching funds) if that
CPA or one of the partners in the CPA's firm is on the board of directors for the agency
without receiving an exception from HUD.
c. Agencies must not pay a landlord with program funds(or program matching funds) if
that landlord has family or business ties with someone at the agency without receiving
an exception from HUD.
Recordkeeping Requirements for Conflict of Interest
1) Subrecipient agencies must keep records to show compliance with conflicts of interest.
2) Subrecipient agencies must keep records of the personal conflicts of interest policy or codes of
conduct developed and implemented.
3) Subrecipient agencies must keep records supporting exceptions to personal conflict.
14
Page 12 of 70
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Housing Contract Administration
Conflict of Interest
GUIDELINES
Housing and Community
Development
1201 Leopard St.
Corpus Christi, TX 78469
(361) 826-3010
A
OPPORTUNITY
Housing and Community Development prohibits discrimination based on race; color; religion;
sex; national origin;sexual orientation; gender identity; ancestry; age; disability; or marital,
familial or veteran status.
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Notice
Housing and Community Development(HUD) provides this guidance as a resource for conflicts of
interest that may arise through the administration of the following federal and state funding sources
administered by HUD's Housing Contract Administration Department:
• HOME Single Family Production
• AHTF Single Family Production
• GAP Single Family Production
• HouseWorks Single Family Repairs
• HOME Tenant Based Rental Assistance(HOME TBRA)
• Housing Opportunities for Persons with AIDS(HOPWA)
• Emergency Solutions Grant(ESG)
• Continuum of Care (COC)
To the best of our knowledge,the information in this publication is accurate: however, neither Housing
and Community Development nor its affiliates assume any responsibility or liability for the accuracy or
completeness of,or consequences arising from,such information. Changes,typos,and technical
inaccuracies will be corrected in subsequent publications.This publication is subject to change without
notice.The information and descriptions contained in this guide cannot be copied, disseminated,or
distributed without the express written consent of Housing and Community Development.This
document is intended for informational purposes only.This guide addresses conflicts of interest only
and is not inclusive of all resources needed to successfully administer a project.
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Contents
Section I—Conflict of Interest Policy 4
Types of Conflict of Interest Transactions 4
Due Diligence Documentation 4
Section II—Conflict of Interest Procedures 5
Step 1-Determine if potential conflict exists 5
Step 2—Notify HUD 5
Step 3—Complete and submit waiver request 6
Step 4—Decision 6
Section III—Conflict of Interest Resources 7
Conflict of Interest Definitions 7
Conflict of Interest Decision Tree 8
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Section I - Conflict of Interest Policy
Housing and Community Development Conflict of Interest Policy: All recipients are
responsible for identifying situations in which a conflict of interest, whether real or perceived,
may exist. If a conflict of interest is identified, the agency must request an exemption.
Applicants must disclose all real, potential, or perceived conflicts of interest to HUD, regarding
the receipt of, assistance provided with, or expenditure of HUD funds. All conflicts of interest
must be disclosed and resolved prior to providing HUD assistance.
Types of Conflict of Interest transactions: This list is not all-inclusive.
• Non-Procurement Conflict of Interest transactions: In general, all HUD Community
Planning and Development Program regulations (HOME, ESG, COC, & HOPWA)
prohibit grant-assisted activity benefiting subrecipient agency employees, board
members, or relatives of employees and board members.
• Procurement Conflict of Interest transactions: In general, 2-CFR 200 prohibits
procurement of goods or services from organizations with an organizational orindividual
conflict of interest.
• Texas Non-Profit Conflict of Interest Transaction: (1) A conflict of interest
transaction is a transaction with the nonprofit corporation in which a director of such
corporation has a direct or indirect interest...(2) For the purposes of this section, a
director of a nonprofit corporation shall be considered to have an indirect interest in a
transaction if: (a) Another entity in which he has a material financial interest or in which
he is a general partner is a party to the transaction; or (b) Another entity of which he is a
director, officer, or trustee is a party to the transaction and the transaction is or should be
considered by the board of directors of the corporation.
Due Diligence Documentation: The recipient agency should obtain and maintain evidence
that the following groups have been asked to identify potential conflicts of interests:
• Employees/volunteers— Employees and volunteers should be asked if they are:
o Related to applicants and/or clients
o Related to contractors, vendors, and landlords
• Board members — Board members should be asked if they are:
o Related to applicants and/or clients
o Related to contractors, vendors, and landlords
• ContractorsNendors (including landlords) — Contractors, vendors, and landlords should
be asked if they are:
o Related to employees and/or board members
o Related to the applicant and/or client being assisted*
• Applicants/Clients —Applicants and clients should be asked if they are:
o An employee or related to an employee
o A board member or related to a board member
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Section II - Conflict of Interest Procedures
Step 1: Determine if a potential conflict of interest exist
Potential conflicts of interest may arise from many situations. Use the decision tree located at the end of
this publication to determine if the situation is or has the appearance of a potential conflict of interest.
Some common examples of potential conflicts of interest are, but not limited to:
• A client presents for assistance and/or services and this client is related to someone who works
at the agency or who is a board member of the agency
• A vendor or contractor hired by the agency is related to someone who works at the agency or
who is a board member of the agency
• A landlord for an assisted unit is related to someone who works at the agency or who is a board
member of the agency
• A board member works for a company that has been hired to perform work for the agency
• A landlord for an assisted unit is related to the client being assisted*
• An affiliated, subsidiary, or related agency is receiving or being paid with grant funds for a
product or service
• A volunteer or employee at the agency applies for assistance
• A family member of a volunteer or employee applies for assistance
• A vendor or contractor used by the agency for grant related expenditures is asked to donate
money,goods, or services to an agency fund-raising event
It is the subrecipient agency's responsibility to identify, disclose, and document potential conflicts of
interest. Not doing so can result in findings;frozen,forfeiture or repayment of funds; suspension,
debarment, and potential prosecution. Conflicts of interest are situations and not allegations. Even the
appearance of a conflict is a potential conflict of interest. If you have questions on whether something
constitutes a conflict of interest, you must contact HUD prior to the transaction.
Step 2: Notify HUD
Send written communication to HCD indicating you have a potential conflict of interest. A
technical assistance representative will assist you through the rest of the process.
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Step 3:Complete&submit a waiver request
Your technical assistance representative will email you a Modification/Waiver Request form.
You will complete the form and attach/upload the following documents and then submit the
request:
A. A written narrative that includes specific information about the potential conflict of interest
transaction and any information you have relevant to whether it is,or is not an actual conflict of
interest.
B. A letter from the agency's legal counsel stating that there are no laws,statutes,or local
ordinances which would be violated,should an exception be granted.
C. Evidence of public disclosure of the potential conflict of interest. Example:A copy of the
newspaper advertisement with the dates of publication, or a copy of minutes from a board of
director's meeting(that is open to the public) in which the potential conflict of interest was
disclosed and discussed.
PLEASE NOTE:Submission of a waiver request does not authorize a subrecipient agency to engage in
any activity related to the transaction that involves the potential conflict of interest.A waiver or
exception is not granted until the subrecipient agency receives such determination in writing.
Step 4: Decision
Upon receipt of the waiver request documentation, HUD will submit the request to the federal agency
(e.g. HUD)for consideration,except when the conflict involves state funds, in which case, HUD legal
counsel will consider those requests.With federal funding,the federal agency determines whether the
threshold requirements are met and whether the circumstances fall within the exception criteria
permitted by the regulations. HUD and/or the federal agency may request additional information, if
necessary.The subrecipient agency will receive a decision in writing. Until the written decision is
received,the subrecipient agency is not authorized to engage in any activity related to the transaction.
* HOPWA allows for a possible exception to the potential conflict of interest created between a landlord and the assisted client
by means of a"reasonable accommodation."For more information please see the HOPWA rule.
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Section III - Resources
Conflict of Interest Definitions
Employee: For the purpose of conflict of interest, the term employee includes both paid and
unpaid (volunteers), as well as those persons paid on a contract basis, and those persons
acting as agent or consultant.
Exception: The mechanism by which HUD waives the conflict of interest provisions.
Family ties (i.e., what does "related to" encompass?): The spouse, parent, child, brother,
sister, grandparent, grandchild, including steps, and in-laws; and any person cohabitating with a
covered person, as well as any immediate family member related by blood, marriage, or
adoption, but not distant relations such as cousins, aunts, uncles, who do not reside with the
covered person.
Example # 1: A cousin living with the covered person is a potential conflict. A cousin not
living with the covered person would not be a potential conflict.
Example # 2:A brother or step-brother living with the covered person is a potential
conflict. A brother or step-brother not living with the covered person is still a potential
conflict.
Individual Conflict of Interest: An employee, agent, consultant, officer, elected official, or
appointed official of the sub-grantee or subrecipient:
1. Who exercises or has exercised any function, or responsibility with respect to activities
assisted under the funded program, or
2. Who is in a position to participate in a decision making process, or
3. Who gains inside information with regard to activities assisted under the program...
...For either him or herself, or for those with whom he or she has family or business ties, during
his or her tenure or during the one-year period following his or her tenure.
Non-Procurement: Transactions that do not involve the procurement of goods, or services.
Organizational Conflict of Interest: Because of relationships with a parent company, affiliate,
or subsidiary organization, the recipient/subrecipient entity is unable or appears to be unable to
be impartial in conducting a procurement action involving a related organization.
Procurement: Procurement is the process of obtaining any property (purchase or lease),
supplies, equipment or services. Some common services include employment, construction,
engineering or architecture services, legal services, accounting services, etc.
Vendor: Any person or company you purchase goods or services from, including goods or
services purchased on behalf of clients. Some examples are: a building contractor, a landlord,
an office supply store, a consultant, a Certified Public Accountant, etc.
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FAIR HOUSING GUIDANCE
HUD&HUD Protected Classes
In 2012 HUD published a rule and HUD adopted the rule that added new protected classes.There are 11
current protected classes as follows:
Race, Color, National Origin,Sex, Religion, Disability, Familial Status,Age,Sexual Orientation,
Gender Identity, Marital Status
Fair Housing Laws:
• Title VIII of the Civil Rights Act of 1968(Fair Housing Act)
• Title VI of the Civil Rights Act of 1964
• Section 504 of the Rehabilitation Act of 1973
• Section 109 of Title I of the Housing and Community Development Act of 1974
• Title II of the Americans with Disabilities Act of 1990
• Architectural Barriers Act of 1968
• Age Discrimination Act of 1975
• Title IX of the Education Amendments Act of 1972
Fair Housing-Related Presidential Executive Orders:
• Executive Order 11063-Prohibits discrimination in the sale, leasing, rental,or other disposition of
properties and facilities owned or operated by the federal government or provided with federal
funds.
• Executive Order 11246-As amended, bars discrimination in federal employment because of race,
color, religion,sex,or national origin.
• Executive Order 12892-As amended, requires federal agencies to affirmatively further fair housing
in their programs and activities.The Order also establishes the President's Fair Housing Council,
which will be chaired by the Secretary of HUD.
• Executive Order 12898-Requires that each federal agency conduct its program, policies,and
activities that substantially affect human health or the environment in a manner that does not
exclude persons based on race,color,or national origin.
• Executive Order 13166-Eliminates,to the extent possible, limited English proficiency as a barrier to
full and meaningful participation by beneficiaries in all federally-assisted and federally conducted
programs and activities.
• Executive Order 13217-Requires federal agencies to evaluate their policies and programs to
determine if any can be revised or modified to improve the availability of community-based living
arrangements for persons with disabilities.
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List of Relevant Regulations
HOME Rule—24 CFR 92
Uniform Administrative Requirements for State and local governments—24 CFR 85
Uniform Administrative Requirements for nonprofit organizations—24 CFR 84
Section 8 method of Income Calculation of Annual Income—24 CFR 5.609
Section 8 method of Income Calculation of Adjusted income—24 CFR 5.6.11
Housing Quality Standards—24 CFR 982.401
Other Federal Regulations
OMB regulations—2 CFR 200
Lead based paint—24 CFR 35
Section 3—24 CFR 135
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HOME TBRA Helpful Links
1. HUD's HOME TBRA webpage—https://www.hudexchange.info/home/topics/tenant-based-rental-
assistance
2. HQS Checklist (52580) - http://portal.hud.gov/hudportal/documents/huddoc?id=DOC 11775.pdf
3. HQS Checklist with instructions (52580A) -
http://portal.hud.gov/hudportal/documents/huddoc?id=52580-a.pdf
4. HUD's Fair Housing and Equal Opportunity webpage-
http://portal.hud.gov/hudportal/HUD?src=/program offices/fair housing equal opp
5. HUD's Lead Based Paint webpage-
http://portal.hud.gov/hudportal/HUD?src=/program offices/healthy homes/healthyhomes/lead
6. OMB Requirements—http://www.ecfr.gov/cqi-
bin/retrieveECFR?qp=&SID=e9d04b6379450bca991 cbebf947507e6&n=pt2.1.200&r=PART
&ty=HTML
7. HUD's requirement for Financial Management-http://www.gpo.gov/fdsys/pkg/CFR-2012-title24-
voll/xml/CFR-2012-title24-voll-sec84-21.xmI
8. VAWA Implementation
Rule: https://www.federalregister.gov/documents/2016/11/16/2016-25888/violence-against-
women-reauthorization-act-of-2013-implementation-in-hud-housing-programs
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HUD Publishes New Proposed Rule Violence Against Women Reauthorization Act of 2013:
Implementation in HUD Housing Programs
On April 1,2015,the Department of Housing and Urban Development issued a proposed rule amending
HUD's regulations to fully implement the requirements of the Violence Against Women Act(VAWA)as
reauthorized in 2013 under the Violence Against Women Reauthorization Act of 2013 (VAWA 2013).VAWA
2013 provides enhanced statutory protections for victims of domestic violence,dating violence,sexual assault,
and stalking.VAWA 2013 also expands VAWA protections to HUD programs beyond HUD's public housing
and Section 8 programs,which were covered by the reauthorization of VAWA in 2005 (VAWA 2005).In
addition to proposing regulatory amendments to fully implement VAWA 2013,HUD has also created two
documents concerning tenant protections required by VAWA 2013—a notice of occupancy rights and an
emergency transfer plan.
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NOTICE OF OCCUPANCY RIGHTS UNDER U.S. Department of Housing and Urban Development
THE VIOLENCE AGAINST WOMEN ACT OMB Approval No.2577-0286
Expires 06/30/2017
Notice of Occupancy Rights under the Violence Against Women Act'
To all Tenants and Applicants
The Violence Against Women Act(VAWA)provides protections for victims of domestic
violence, dating violence, sexual assault, or stalking. VAWA protections are not only available
to women, but are available equally to all individuals regardless of sex, gender identity, or sexual
orientation.2 The U.S. Department of Housing and Urban Development(HUD) is the Federal
agency that oversees that is in compliance with VAWA. This
notice explains your rights under VAWA. A HUD-approved certification form is attached to
this notice. You can fill out this form to show that you are or have been a victim of domestic
violence, dating violence, sexual assault, or stalking, and that you wish to use your rights under
VAWA."
Protections for Applicants
If you otherwise qualify for assistance under , you cannot be denied
admission or denied assistance because you are or have been a victim of domestic violence,
dating violence, sexual assault, or stalking.
Protections for Tenants
If you are receiving assistance under ,you may not be denied
assistance, terminated from participation, or be evicted from your rental housing
Despite the name of this law,VAWA protection is available regardless of sex,gender identity,or sexual
orientation.
2 Housing providers cannot discriminate on the basis of any protected characteristic,including race,color,national
origin,religion,sex,familial status,disability,or age.HUD-assisted and HUD-insured housing must be made
available to all otherwise eligible individuals regardless of actual or perceived sexual orientation,gender identity,or
marital status.
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because you are or have been a victim of domestic violence, dating violence, sexual assault, or
stalking.
Also, if you or an affiliated individual of yours is or has been the victim of domestic violence,
dating violence, sexual assault, or stalking by a member of your household or any guest, you
may not be denied rental assistance or occupancy rights under solely
on the basis of criminal activity directly relating to that domestic violence, dating violence,
sexual assault, or stalking.
Affiliated individual means your spouse,parent, brother, sister, or child, or a person to whom you
stand in the place of a parent or guardian (for example, the affiliated individual is in your care,
custody, or control); or any individual, tenant, or lawful occupant living in your household.
Removing the Abuser or Perpetrator from the Household
HP may divide (bifurcate)your lease in order to evict the individual or terminate the assistance
of the individual who has engaged in criminal activity(the abuser or perpetrator)directlyrelating
to domestic violence, dating violence, sexual assault, or stalking.
If HP chooses to remove the abuser or perpetrator, HP may not take away the rights of eligible
tenants to the unit or otherwise punish the remaining tenants. If the evicted abuser or perpetrator
was the sole tenant to have established eligibility for assistance under the program, HP must
allow the tenant who is or has been a victim and other household members to remain in the unit
for a period of time, in order to establish eligibility under the program or under another HUD
housing program covered by VAWA, or, find alternative housing.
In removing the abuser or perpetrator from the household, HP must follow Federal, State, and
local eviction procedures. In order to divide a lease, HP may, but is not required to, ask you for
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documentation or certification of the incidences of domestic violence, dating violence, sexual
assault, or stalking.
Moving to Another Unit
Upon your request, HP may permit you to move to another unit, subject to the availability of
other units, and still keep your assistance. In order to approve a request, HP may ask you to
provide documentation that you are requesting to move because of an incidence of domestic
violence, dating violence, sexual assault, or stalking. If the request is a request for emergency
transfer,the housing provider may ask you to submit a written request or fill out a form where
you certify that you meet the criteria for an emergency transfer under VAWA. The criteria are:
(1) You are a victim of domestic violence, dating violence, sexual assault, or
stalking. If your housing provider does not already have documentation that you
are a victim of domestic violence, dating violence, sexual assault, or stalking, your
housing provider may ask you for such documentation, as described in the
documentation section below.
(2) You expressly request the emergency transfer. Your housing provider may
choose to require that you submit a form, or may accept another written or oral
request.
(3) You reasonably believe you are threatened with imminent harm from
further violence if you remain in your current unit. This means you have a
reason to fear that if you do not receive a transfer you would suffer violence in the
very near future.
OR
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You are a victim of sexual assault and the assault occurred on the premises
during the 90-calendar-day period before you request a transfer. If you are a
victim of sexual assault, then in addition to qualifying for an emergency transfer
because you reasonably believe you are threatened with imminent harm from
further violence if you remain in your unit, you may qualify for an emergency
transfer if the sexual assault occurred on the premises of the property from which
you are seeking your transfer, and that assault happened within the 90-calendar-
day period before you expressly request the transfer.
HP will keep confidential requests for emergency transfers by victims of domestic violence,
dating violence, sexual assault, or stalking, and the location of any move by such victims and
their families.
HP's emergency transfer plan provides further information on emergency transfers, and HP must
make a copy of its emergency transfer plan available to you if you ask to see it.
Documenting You Are or Have Been a Victim of Domestic Violence, Dating Violence,
Sexual Assault or Stalking
HP can, but is not required to, ask you to provide documentation to "certify"that you are or have
been a victim of domestic violence, dating violence, sexual assault, or stalking. Such request
from HP must be in writing, and HP must give you at least 14 business days (Saturdays,
Sundays, and Federal holidays do not count) from the day you receive the request to provide the
documentation. HP may, but does not have to, extend the deadline for the submission of
documentation upon your request.
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You can provide one of the following to HP as documentation. It is your choice which of the
following to submit if HP asks you to provide documentation that you are or have been a victim
of domestic violence, dating violence, sexual assault, or stalking.
• A complete HUD-approved certification form given to you by HP with this notice, that
documents an incident of domestic violence, dating violence, sexual assault, or stalking.
The form will ask for your name,the date, time, and location of the incident of domestic
violence, dating violence, sexual assault, or stalking, and a description of the incident.
The certification form provides for including the name of the abuser or perpetrator if the
name of the abuser or perpetrator is known and is safe to provide.
• A record of a Federal, State, tribal, territorial, or local law enforcement agency, court, or
administrative agency that documents the incident of domestic violence, dating violence,
sexual assault, or stalking. Examples of such records include police reports, protective
orders, and restraining orders, among others.
• A statement, which you must sign, along with the signature of an employee, agent, or
volunteer of a victim service provider, an attorney, a medical professional or a mental
health professional (collectively, "professional") from whom you sought assistance in
addressing domestic violence, dating violence, sexual assault, or stalking, or the effects of
abuse, and with the professional selected by you attesting under penalty of perjury that he
or she believes that the incident or incidents of domestic violence, dating violence, sexual
assault, or stalking are grounds for protection.
• Any other statement or evidence that HP has agreed to accept.
If you fail or refuse to provide one of these documents within the 14 business days, HP does not
have to provide you with the protections contained in this notice.
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If HP receives conflicting evidence that an incident of domestic violence, dating violence, sexual
assault, or stalking has been committed (such as certification forms from two or more members
of a household each claiming to be a victim and naming one or more of the other petitioning
household members as the abuser or perpetrator), HP has the right to request that you provide
third-party documentation within thirty 30 calendar days in order to resolve the conflict. If you
fail or refuse to provide third-party documentation where there is conflicting evidence, HP does
not have to provide you with the protections contained in this notice.
Confidentiality
HP must keep confidential any information you provide related to the exercise of your rights
under VAWA, including the fact that you are exercising your rights under VAWA.
HP must not allow any individual administering assistance or other services on behalf of HP (for
example, employees and contractors)to have access to confidential information unless for
reasons that specifically call for these individuals to have access to this information under
applicable Federal, State, or local law.
HP must not enter your information into any shared database or disclose your information to any
other entity or individual. HP, however, may disclose the information provided if:
• You give written permission to HP to release the information on a time limited basis.
• HP needs to use the information in an eviction or termination proceeding, such as to evict
your abuser or perpetrator or terminate your abuser or perpetrator from assistance under
this program.
• A law requires HP or your landlord to release the information.
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VAWA does not limit HP's duty to honor court orders about access to or control of the property.
This includes orders issued to protect a victim and orders dividing property among household
members in cases where a family breaks up.
Reasons a Tenant Eligible for Occupancy Rights under VAWA May Be Evicted or
Assistance May Be Terminated
You can be evicted and your assistance can be terminated for serious or repeated lease violations
that are not related to domestic violence, dating violence, sexual assault, or stalking committed
against you. However, HP cannot hold tenants who have been victims of domestic violence,
dating violence, sexual assault, or stalking to a more demanding set of rules than it applies to
tenants who have not been victims of domestic violence, dating violence, sexual assault, or
stalking.
The protections described in this notice might not apply, and you could be evicted and your
assistance terminated, if HP can demonstrate that not evicting you or terminating your assistance
would present a real physical danger that:
1) Would occur within an immediate time frame, and
2) Could result in death or serious bodily harm to other tenants or those who work on the
property.
If HP can demonstrate the above, HP should only terminate your assistance or evict you if there
are no other actions that could be taken to reduce or eliminate the threat.
Other Laws
VAWA does not replace any Federal, State, or local law that provides greater protection for
victims of domestic violence, dating violence, sexual assault, or stalking. You may be entitled to
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additional housing protections for victims of domestic violence, dating violence, sexual assault,
or stalking under other Federal laws, as well as under State and local laws.
Non-Compliance with The Requirements of This Notice
You may report a covered housing provider's violations of these rights and seek additional
assistance, if needed, by contacting or filing a complaint with
or .
For Additional Information
You may view a copy of HUD's final VAWA rule at [insert Federal Register link].
Additionally, HP must make a copy of HUD's VAWA regulations available to you if you ask to
see them.
For questions regarding VAWA, please contact
For help regarding an abusive relationship, you may call the National Domestic Violence Hotline
at 1-800-799-7233 or, for persons with hearing impairments, 1-800-787-3224 (TTY). You may
also contact .
For tenants who are or have been victims of stalking seeking help may visit the National Center
for Victims of Crime's Stalking Resource Center at https://www.victimsofcrime.org/our-
programs/stalking-resource-center.
For help regarding sexual assault, you may contact
Victims of stalking seeking help may contact .
Attachment: Certification form HUD-5382 [form approved for this program to be included]
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MODEL EMERGENCY TRANSFER PLAN FOR U.S.Department of Housing and Urban Development
VICTIMS OF DOMESTIC VIOLENCE,DATING OMB Approval No.2577-0286
VIOLECE,SEXUAL ASSAULT,OR STALKING Expires 06/30/2017
Model Emergency Transfer Plan for Victims of Domestic Violence,Dating Violence,
Sexual Assault, or Stalking
Emergency Transfers
(acronym HP for purposes of this model
plan) is concerned about the safety of its tenants, and such concern extends to tenants who are
victims of domestic violence, dating violence, sexual assault, or stalking. In accordance with the
Violence Against Women Act(VAWA),' HP allows tenants who are victims of domestic
violence, dating violence, sexual assault, or stalking to request an emergency transfer from the
tenant's current unit to another unit. The ability to request a transfer is available regardless of
sex, gender identity, or sexual orientation.2 The ability of HP to honor such request for tenants
currently receiving assistance, however, may depend upon a preliminary determination that the
tenant is or has been a victim of domestic violence, dating violence, sexual assault, or stalking,
and on whether HP has another dwelling unit that is available and is safe to offer the tenant for
temporary or more permanent occupancy.
This plan identifies tenants who are eligible for an emergency transfer,the documentation needed
to request an emergency transfer, confidentiality protections, how an emergency transfer may
occur, and guidance to tenants on safety and security. This plan is based on a model
'Despite the name of this law,VAWA protection is available to all victims of domestic violence,dating violence,
sexual assault,and stalking,regardless of sex,gender identity,or sexual orientation.
2 Housing providers cannot discriminate on the basis of any protected characteristic,including race,color,national
origin,religion,sex,familial status,disability,or age.HUD-assisted and HUD-insured housing must be made
available to all otherwise eligible individuals regardless of actual or perceived sexual orientation,gender identity,or
marital status.
Form HUD-5381
(12/2016)
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emergency transfer plan published by the U.S. Department of Housing and Urban Development
(HUD),the Federal agency that oversees that is in
compliance with VAWA.
Eligibility for Emergency Transfers
A tenant who is a victim of domestic violence, dating violence, sexual assault, or stalking, as
provided in HUD's regulations at 24 CFR part 5, subpart L is eligible for an emergency transfer,
if: the tenant reasonably believes that there is a threat of imminent harm from further violence if
the tenant remains within the same unit. If the tenant is a victim of sexual assault,the tenant may
also be eligible to transfer if the sexual assault occurred on the premises within the 90-calendar-
day period preceding a request for an emergency transfer.
A tenant requesting an emergency transfer must expressly request the transfer in accordance with
the procedures described in this plan.
Tenants who are not in good standing may still request an emergency transfer if they meet the
eligibility requirements in this section.
Emergency Transfer Request Documentation
To request an emergency transfer,the tenant shall notify HP's management office and submit a
written request for a transfer to . HP will provide reasonable
accommodations to this policy for individuals with disabilities. The tenant's written request for
an emergency transfer should include either:
1. A statement expressing that the tenant reasonably believes that there is a threat of
imminent harm from further violence if the tenant were to remain in the same dwelling
unit assisted under HP's program; OR
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2. A statement that the tenant was a sexual assault victim and that the sexual assault
occurred on the premises during the 90-calendar-day period preceding the tenant's
request for an emergency transfer.
Confidentiality
HP will keep confidential any information that the tenant submits in requesting an emergency
transfer, and information about the emergency transfer, unless the tenant gives HP written
permission to release the information on a time limited basis, or disclosure of the information is
required by law or required for use in an eviction proceeding or hearing regarding termination of
assistance from the covered program. This includes keeping confidential the new location of the
dwelling unit of the tenant, if one is provided, from the person(s)that committed an act(s) of
domestic violence, dating violence, sexual assault, or stalking against the tenant. See the Notice
of Occupancy Rights under the Violence Against Women Act For All Tenants for more
information about HP's responsibility to maintain the confidentiality of information related to
incidents of domestic violence, dating violence, sexual assault, or stalking.
Emergency Transfer Timing and Availability
HP cannot guarantee that a transfer request will be approved or how long it will take to process a
transfer request. HP will, however, act as quickly as possible to move a tenant who is a victim of
domestic violence, dating violence, sexual assault, or stalking to another unit, subject to
availability and safety of a unit. If a tenant reasonably believes a proposed transfer would not be
safe,the tenant may request a transfer to a different unit. If a unit is available,the transferred
tenant must agree to abide by the terms and conditions that govern occupancy in the unit to
which the tenant has been transferred. HP may be unable to transfer a tenant to a particular unit
if the tenant has not or cannot establish eligibility for that unit.
Page 34 of 70
4
If HP has no safe and available units for which a tenant who needs an emergency is eligible, HP
will assist the tenant in identifying other housing providers who may have safe and available
units to which the tenant could move. At the tenant's request, HP will also assist tenants in
contacting the local organizations offering assistance to victims of domestic violence, dating
violence, sexual assault, or stalking that are attached to this plan.
Safety and Security of Tenants
Pending processing of the transfer and the actual transfer, if it is approved and occurs, the tenant
is urged to take all reasonable precautions to be safe.
Tenants who are or have been victims of domestic violence are encouraged to contact the
National Domestic Violence Hotline at 1-800-799-7233, or a local domestic violence shelter, for
assistance in creating a safety plan. For persons with hearing impairments,that hotline can be
accessed by calling 1-800-787-3224 (TTY).
Tenants who have been victims of sexual assault may call the Rape,Abuse& Incest National
Network's National Sexual Assault Hotline at 800-656-HOPE, or visit the online hotline at
https://ohl.rainn.org/online/.
Tenants who are or have been victims of stalking seeking help may visit the National Center for
Victims of Crime's Stalking Resource Center at https://www.victimsofcrime.org/our-
programs/stalking-resource-center.
Attachment: Local organizations offering assistance to victims of domestic violence, dating
violence, sexual assault, or stalking.
Page 35 of 70
CERTIFICATION OF U.S.Department of Housing OMB Approval No.2577-0286
DOMESTIC VIOLENCE, and Urban Development Exp.06/30/2017
DATING VIOLENCE,
SEXUAL ASSAULT,OR STALKING,
AND ALTERNATE DOCUMENTATION
Purpose of Form: The Violence Against Women Act("VAWA")protects applicants,tenants, and
program participants in certain HUD programs from being evicted,denied housing assistance,or
terminated from housing assistance based on acts of domestic violence,dating violence,sexual assault, or
stalking against them. Despite the name of this law,VAWA protection is available to victims of domestic
violence,dating violence,sexual assault, and stalking,regardless of sex,gender identity,or sexual
orientation.
Use of This Optional Form: If you are seeking VAWA protections from your housing provider,your
housing provider may give you a written request that asks you to submit documentation about the incident
or incidents of domestic violence, dating violence,sexual assault,or stalking.
In response to this request,you or someone on your behalf may complete this optional form and submit it
to your housing provider, or you may submit one of the following types of third-party documentation:
(1)A document signed by you and an employee,agent, or volunteer of a victim service provider, an
attorney,or medical professional,or a mental health professional(collectively,"professional")from
whom you have sought assistance relating to domestic violence,dating violence,sexual assault, or
stalking,or the effects of abuse. The document must specify, under penalty of perjury,that the
professional believes the incident or incidents of domestic violence,dating violence, sexual assault,or
stalking occurred and meet the definition of"domestic violence,""dating violence,""sexual assault,"or
"stalking" in HUD's regulations at 24 CFR 5.2003.
(2)A record of a Federal, State,tribal,territorial or local law enforcement agency, court, or
administrative agency; or
(3)At the discretion of the housing provider, a statement or other evidence provided by the applicant or
tenant.
Submission of Documentation: The time period to submit documentation is 14 business days from the
date that you receive a written request from your housing provider asking that you provide documentation
of the occurrence of domestic violence,dating violence, sexual assault,or stalking. Your housing
provider may,but is not required to,extend the time period to submit the documentation,if you request an
extension of the time period. If the requested information is not received within 14 business days of when
you received the request for the documentation,or any extension of the date provided by your housing
provider,your housing provider does not need to grant you any of the VAWA protections. Distribution or
issuance of this form does not serve as a written request for certification.
Confidentiality: All information provided to your housing provider concerning the incident(s)of
domestic violence, dating violence,sexual assault,or stalking shall be kept confidential and such details
shall not be entered into any shared database. Employees of your housing provider are not to have access
to these details unless to grant or deny VAWA protections to you,and such employees may not disclose
this information to any other entity or individual, except to the extent that disclosure is: (i)consented to
by you in writing in a time-limited release;(ii)required for use in an eviction proceeding or hearing
regarding termination of assistance; or(iii)otherwise required by applicable law.
Page 36 of 70
2
TO BE COMPLETED BY OR ON BEHALF OF THE VICTIM OF DOMESTIC VIOLENCE,
DATING VIOLENCE.SEXUALASSAULT. OR STALKING
1. Date the written request is received by victim:
2. Name of victim:
3. Your name(if different from victim's):
4. Name(s)of other family member(s)listed on the lease:
5. Residence of victim:
6. Name of the accused perpetrator(if known and can be safely disclosed):
7. Relationship of the accused perpetrator to the victim:
8. Date(s)and times(s)of incident(s)(if known):
10. Location of incident(s):
In your own words,briefly describe the incident(s):
This is to certify that the information provided on this form is true and correct to the best of my knowledge
and recollection,and that the individual named above in Item 2 is or has been a victim of domestic violence,
dating violence, sexual assault, or stalking. I acknowledge that submission of false information could
jeopardize program eligibility and could be the basis for denial of admission,termination of assistance, or
eviction.
Signature Signed on(Date)
Public Reporting Burden: The public reporting burden for this collection of information is estimated to
average 1 hour per response. This includes the time for collecting,reviewing,and reporting the data. The
information provided is to be used by the housing provider to request certification that the applicant or
tenant is a victim of domestic violence,dating violence, sexual assault,or stalking. The information is
subject to the confidentiality requirements of VAWA. This agency may not collect this information,and
you are not required to complete this form,unless it displays a currently valid Office of Management and
Budget control number.
Page 37 of 70
EMERGENCY TRANSFER U.S.Department of Housing OMB Approval No.2577-0286
REQUEST FOR CERTAIN and Urban Development Exp.06/30/2017
VICTIMS OF DOMESTIC
VIOLENCE,DATING VIOLENCE,
SEXUAL ASSAULT,OR STALKING
Purpose of Form: If you are a victim of domestic violence, dating violence,sexual assault,or stalking,
and you are seeking an emergency transfer,you may use this form to request an emergency transfer and
certify that you meet the requirements of eligibility for an emergency transfer under the Violence Against
Women Act(VAWA).Although the statutory name references women,VAWA rights and protections
apply to all victims of domestic violence, dating violence,sexual assault or stalking. Using this form does
not necessarily mean that you will receive an emergency transfer. See your housing provider's
emergency transfer plan for more information about the availability of emergency transfers.
The requirements you must meet are:
(1)You are a victim of domestic violence,dating violence,sexual assault,or stalking.
If your housing provider does not already have documentation that you are a victim of
domestic violence,dating violence,sexual assault,or stalking,your housing provider may
ask you for such documentation. In response, you may submit Form HUD-5382, or any
one of the other types of documentation listed on that Form.
(2) You expressly request the emergency transfer. Submission of this form confirms
that you have expressly requested a transfer. Your housing provider may choose to require
that you submit this form, or may accept another written or oral request. Please see your
housing provider's emergency transfer plan for more details.
(3) You reasonably believe you are threatened with imminent harm from further
violence if you remain in your current unit.This means you have a reason to fear that if
you do not receive a transfer you would suffer violence in the very near future.
OR
You are a victim of sexual assault and the assault occurred on the premises during
the 90-calendar-day period before you request a transfer.If you are a victim of sexual
assault, then in addition to qualifying for an emergency transfer because you reasonably
believe you are threatened with imminent harm from further violence if you remain in your
unit, you may qualify for an emergency transfer if the sexual assault occurred on the
premises of the property from which you are seeking your transfer, and that assault
happened within the 90-calendar-day period before you submit this form or otherwise
expressly request the transfer.
Submission of Documentation: If you have third-party documentation that demonstrates why you are
eligible for an emergency transfer,you should submit that documentation to your housing provider if it is
safe for you to do so. Examples of third party documentation include,but are not limited to: a letter or
other documentation from a victim service provider,social worker, legal assistance provider,pastoral
counselor,mental health provider,or other professional from whom you have sought assistance; a current
restraining order;a recent court order or other court records; a law enforcement report or records;
communication records from the perpetrator of the violence or family members or friends of the
perpetrator of the violence,including emails,voicemails,text messages,and social media posts.
Form HUD-5383
(12/2016)
Page 38 of 70
2
Confidentiality: All information provided to your housing provider concerning the incident(s)of
domestic violence,dating violence,sexual assault, or stalking, and concerning your request for an
emergency transfer shall be kept confidential. Such details shall not be entered into any shared database.
Employees of your housing provider are not to have access to these details unless to grant or deny VAWA
protections or an emergency transfer to you. Such employees may not disclose this information to any
other entity or individual,except to the extent that disclosure is: (i)consented to by you in writing in a
time-limited release;(ii)required for use in an eviction proceeding or hearing regarding termination of
assistance; or(iii)otherwise required by applicable law.
TO BE COMPLETED BY OR ON BEHALF OF THE PERSON REOUESTING A TRANSFER
1. Name of victim requesting an emergency transfer:
2. Your name(if different from victim's)
3. Name(s)of other family member(s)listed on the lease:
4. Name(s)of other family member(s)who would transfer with the victim:_
5. Address of location from which the victim seeks to transfer:
6. Address or phone number for contacting the victim:
7. Name of the accused perpetrator(if known and can be safely disclosed):
8. Relationship of the accused perpetrator to the victim:
9. Date(s),Time(s)and location(s)of incident(s):
10. Is the person requesting the transfer a victim of a sexual assault that occurred in the past 90
days on the premises of the property from which the victim is seeking a transfer? If yes,skip
question 11. If no,fill out question 11.
11. Describe why the victim believes they are threatened with imminent harm from further
violence if they remain in their current unit.
12. If voluntarily provided,list any third-party documentation you are providing along with this
notice:
This is to certify that the information provided on this form is true and correct to the best of my knowledge,
and that the individual named above in Item 1 meets the requirement laid out on this form for an emergency
transfer.I acknowledge that submission of false information could jeopardize program eligibility and could
be the basis for denial of admission,termination of assistance, or eviction.
Signature Signed on(Date)
Form HUD-5383
(12/2016)
Page 39 of 70
Page 1
APPLICATION FOR ASSISTANCE
Please complete all information requested in ink.Do not leave blanks,if the question does not apply,enter N/A,if you do not
understand a question,or if you need help to complete this form,please ask.This agency may be unable to process your application if
it is incomplete.If information submitted on this application,changes,please contact the office to update as soon as possible.
Please print clearly.
Date of Application
L Applicant Information
Applicant Name Date of Birth Age
Address(where you live now) Social Security No.
City., State Zip Code Telephone
Mailing Address(if different) City State Zip Code
II.Household Member Information:Please list all persons who will live in the assisted unit beginning with the applicant.
PLEASE PROVIDE TWO FORMS OF INDENTIFICATION FOR EACH HOUSEHOLD MEMBER(SUCH AS:DRIVER'S
LICENSE,STATE ISSUED ID,SOCIAL SECURITY CARDS,BIRTH CERTIFICATES,ETC.).IF APPLICABLE,PLEASE
PROVIDE CUSTODY COURT ORDERS.IF YOU DO NOT HAVE THIS INFORMAITON,PLEASE MAKE AGENCY STAFF
AWARE,SO THEY MAY ASSIST YOU IN OBTIANING PROPER DOCUMENTATION.
Relationship Date of Place of Social Security
Name Sex to Applicant Birth Birth Number *Race
*Race:White,Black,American Indian/Alaska Native,Asian or Pacific Islander,Hispanic,Other
You are not required to report if someone in your household has a disability,however,if a household member has a disability you may
qualify for additional deductions in your rent amount. Does any household member have a disability? Yes No If yes,list n ame(s)
Is there any specific accommodation you would like to request that would allow you to fully utilize our programs? -Yes—No
If yes,please explain:
You can voluntarily provide information on an alternate contact person.If we are unable to contact you,we will try to contact the
alternate person on your behalf. NAME: TELEPHONE NUMBER:
ADDRESS:
III.Household Income
Please provide all income/earnings information below for all household members.This income may include but is not limited to:
Employment Income,Self-Employment Income,Unemployment Compensation,Social Security,K-TAP,Disability Income,Child
Support,Pensions,Baby-Sitting Income,etc.If you have no income,write NONE below.
Name of Employment or Weekly Social Security/ K-TAP Child Other Income
Household Self-Employment Unemployment SSI Monthly Monthly Support List-Type and
Member Gross Weekly Benefits Benefits Income Monthly Monthly Amount
Receiving Income and Income
Income Employer Name
Does anyone in your household have any other eamings/income or receive any money not listed above? Yes No
If yes,list type and amount monthly:
Does anyone help you pay your bills? Yes No If yes,list name and monthly amount:
Cr
Page 40 of 70
PAGE 2
N.Housing Assets:
Do you have a checking account? Yes No Balance Bank Name:
Do you have a savings account? Yes No Balance Bank Name:
Do you own any real estate/property? Yes No Type Value Address
Do you have any of the following: Money Market Account?-Yes-No Certificate of Deposit?nYes-No IRA Account?-Yes
-No Stocks?nYes nNo Bonds Yes-No Other(list)
Have you disposed of any assets for less than Fair Market Value during the preceding two years? -Yes nNo
If yes,please list
V.Preferences: gives a preference to households that are,
•
Does your household qualify for this preference?nYes -No
VI.General Information
Do you currently live in federally assisted housing? Yes No If yes,give name of agency or complex?
Have you previously lived in federally assisted housing? nYes -No Approximate date,address and agency name of each instance.
Do you owe money to any Housing Agency? Yes nNo If yes,list agency and amount owed.
VII.Conflict of Interest
Are you an employee or board member of this agency? 'Yes I No
Are you related to an employee or board member of this agency? Yes nNo
If yes to either question above,please give details:
VIII.Signatures/Certification of True and Correct Information
Upon the return of this completed application,this agency will begin processing your application for assistance.Some programs may
have a waiting list,and if so,you will be placed on that list.If you do not qualify,you will be notified in writing.
I/We hereby certify all information given on this application is true and correct,and that Uwe have not knowingly withheld any fact or
circumstances which would,if disclosed,affect this application unfavorably.UWe hereby authorize inquiries to be made to verify the
information given in this application.
(Applicant Signature) (Date)
(Spouse Signature) (Date)
WARNING:Section 1001,of Title 18 of the U.S.code,makes it a criminal offense to make willful false statements or
misrepresentation to any department or agency of the United States as to any matter within its jurisdiction
Page 42 of 70
Verification of Receipt of Required Documents
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
It is required that the client be provided with the information listed below. The client's signature
on this document when maintained in the client file will serve as proof of delivery to the client.
Check all applicable actions below. The client must initial after each checked box.
Notification of Rights to Fair Housing information provided and reviewed
Anti-Discrimination Policy provided and reviewed
Personal Privacy Protection Policy information provided and reviewed
Confidentiality Agreement provided and reviewed
Grievance Policy and Appeals Process provided and reviewed
Termination Policy provided and reviewed
Program Policies and Rules provided and reviewed
Dangers of Lead Based Paint information provided and reviewed
u VAWA Notice of Occupancy Rights (Form HUD-5380)
VAWA Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking,
and Alternative Documentation (Form HUD-5382)
I certify that I have provided the client with the information and policies noted above. I have reviewed all
documents/publications indicated and allowed the client opportunity to ask questions regarding these
documents to ensure a thorough understanding of the information.
Signature of intake staff or case manager Date
******ALL ADULT HOUSEHOLD MEMBERS MUST SIGN THIS DOCUMENT******
I/We understand that HUD and/or HUD may review the information contained in my/our file in order to
verify my/our eligibility for the program or for auditing purposes.
I/we certify that I/we have received the documents noted above. I/we was provided the opportunity to ask
questions and have those questions answered satisfactorily.
Applicant Signature Date
Other Adult Household Member Signature Date
HUD Form HCD-158
Page 42)0
Page 1
PERSONAL DECLARATION
Please complete all information requested in ink and in your own handwriting.Do not leave blanks,if the question does not apply,
enter N/A,if you do not understand a question,or if you need help to complete this form,please ask.Please print clearly.
Effective Date:
L Household Information
Head of Household Name Date of Birth
Unit Address _Telephone
City _State Zip Code Email
II.Household Member Information:Please list all persons who will live in the assisted unit beginning with the applicant.
PLEASE PROVIDE TWO FORMS OF INDENTIFICATION FOR EACH HOUSEHOLD MEMBER(SUCH AS:DRIVER'S
LICENSE,STATE ISSUED ID,SOCIAL SECURITY CARDS,BIRTH CERTIFICATES,ETC.).IF APPLICABLE,PLEASE
PROVIDE CUSTODY COURT ORDERS.IF YOU DO NOT HAVE THIS INFORMAITON,PLEASE MAKE AGENCY STAFF
AWARE,SO THEY MAY ASSIST YOU IN OBTIANING PROPER DOCUMENTATION.
Relationship Date of Place of Social Security
Name Sex to Applicant Birth Birth Last four *Race
*Race:White,Black,American Indian/Alaska Native,Asian or Pacific Islander,Hispanic,Other
You are not required to report if someone in your household has a disability,however,if a household member has a disability you may
qualify for additional deductions in your rent amount. Does any household member have a disability? El Yes 1-1No If yes,list name(s)
Is there any specific accommodation you would like to request that would allow you to fully utilize our programs? -Yes-No
If yes,please explain:
You can voluntarily provide information on an alternate contact person.If we are unable to contact you,we will try to contact the
alternate person on your behalf. NAME: TELEPHONE NUMBER:
ADDRESS:
III.Household Income
Please provide all income/earnings information below for all household members.This income may include but is not limited to:
Employment Income,Self-Employment Income,Unemployment Compensation,Social Security,K-TAP,Disability Income,Child
Support,Pensions,Baby-Sitting Income,etc.If you have no income,write NONE below.
Name of Employment or Weekly Social Security/ K-TAP Child Other Income
Household Self-Employment Unemployment SSI Monthly Monthly Support List-Type and
Member Gross Weekly Benefits Benefits Income Monthly Monthly Amount
Receiving Income and Income
Income Employer Name
Does anyone in your household have any other earnings/income or receive any money not listed above? Yes No
If yes,list type and amount monthly:
Does anyone help you pay your bills? Yes No If yes,list name and monthly amount:
IV.Housine Assets:
Do you have a checking account?nYes-No Balance Bank Name:
Page 44 of 70
PAGE 2
Do you have a savings account? Yes No Balance Bank Name:
Do you own any real estate/property? Yes No Type Value Address
Do you have any of the following: Money Market Account?-Yes-No Certificate of Deposit?f1Yes f1No IRA Account?1-1Yes
-No Stocks?f1Yes f1No Bonds flYes f1No Other(list)
Have you disposed of any assets for less than Fair Market Value during the preceding two years? -Yes f1No
If yes,please list
V.Conflict of Interest
Are you an employee or board member of this agency? Yes No
Are you related to an employee or board member of this agency? -Yes f1No
If yes to either question above,please give details:
This is a declaration for federally subsidized housing assistance.Upon the return of this completed form,
this agency will begin the process of recertifying your eligibility for assistance.
VI.Signatures/Certification of True and Correct Information
I/We understand that any misrepresentation of information or failure to disclose information requested on this declaration may
disqualify me/us from consideration for participation in the assistance program,and may be grounds for termination of assistance.
I/We hereby certify all information given on this application is true,accurate,and complete to the best of my/our knowledge.I/We
hereby authorize inquiries to be made to verify the information supplied on this form.
(Applicant Signature) (Date)
(Spouse Signature) (Date)
WARNING:Section 1001,of Title 18 of the U.S.code,makes it a criminal offense to make willful false statements or
misrepresentation to any department or agency of the United States as to any matter within its jurisdiction
Page 45 of 70
Verification of Disability
I authorize (agency) to obtain necessary information
regarding my disability status or that of a member of my household:
XXX-XX-
(Print) Disabled Household Member Relationship to Head/Applicant SSN (last 4 digits)
I understand that this information is to help me qualify for appropriate housing and supportive services. By
signing below I authorize the release of this information.
Applicant Signature Date
The above named person has applied for housing under a U.S. Department of Housing and Urban
Development(HUD) program that requires verification of a disability under the applicable HUD
definition. Please indicate which condition(s)you have diagnosed this person to have.
1. A condition that:
• Is expected to be long-continuing or of indefinite duration; AND
• Substantially impeded the person's ability to live independently; AND
• Could be improved by the provision of more suitable housing conditions;AND
• Is a physical, mental, or emotional impairment, including an impairment caused by alcohol or drug abuse, post-
traumatic stress disorder, or brain injury.
2. A developmental disability (as defined in Section 102 of the Developmental Disability
Assistance and Bill of Rights Act of 2000 (42 USC 15002)).Which means a severe,chronic
disability of an individual that:
• Is attributable to a mental or physical impairment or combination of mental and physical impairments;AND
• Is manifested before the individual attains age 22;AND
• Is likely to continue indefinitely;AND
• Results in substantial functional limitations in three or more areas of major life activity; (a)Self-care; (b) Receptive
and expressive language; (c) Learning; (d) Mobility; (e)Self-direction; (f) Capacity for independent living; (g)
Economic self-sufficiency; AND
• Reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, or
individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually
planned and coordinated. OR
• An individual from birth to age 9, inclusive, who has a substantial developmental delay or specific congenital or
acquired condition, may be considered to have a developmental disability without meeting three or more of the
criteria described above if the individual, without services and supports has a high probability of meeting those
criteria later in life.
3. The disease of acquired immunodeficiency syndrome (AIDS) or any conditions arising from
the etiological agent for acquired immunodeficiency syndrome, including infection with the
human immunodeficiency virus(HIV).
Is not considered disabled according to the above definitions.
Please Print: THIS SECTION MUST BE COMPLETE TO BE VALID
Name of Certifying Official
(print clearly)
Title/License#/State Issued
(print clearly)
Office Address
Telephone and Fax
Your signature below certifies that the above named individual meets the disability definition indicated above AND
you are professionally licensed by the state in which you practice to diagnose and treat the indicated disability.
Signature Date
WARNING: It is unlawful to provide false information to the government when applying for federal
public benefit programs per Section 1001 of Title 18 of the United States Code.
HUD Form HCD-123
Page 46 o'
Verification of Employment
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The person referenced above is a participant in a federally assisted housing program. Federal regulations require
that we verify the income of program participants. The information provided will remain confidential to satisfaction of
that stated purpose only. I do hereby authorize the release of this information:
Applicant Name (print clearly) Signature of Applicant Date
SECTION TO BE COMPLETED BY THE EMPLOYER
Employer:
Address City State Zip
Employee Job Title:
Presently Employed: Yes - Employment Date No - Last Day of Employment
Current Wages/Salary: $
(circle one) hourly weekly bi-weekly semi-monthly monthly yearly other
Average# of regular hours per week: Year-to-date earnings: $ through
Overtime Rate: $ per hour Average# of overtime hours per week:
Shift Differential Rate: $ per hour Average# of shift differential hours per week:
Commissions, bonuses, tips, other: $
(circle one) hourly weekly bi-weekly semi-monthly monthly yearly other
List any anticipated change in the employee's rate of pay within the next 12 months:
If the employee's work is seasonal or sporadic, please indicate the layoff period(s):
Additional remarks:
Employer's Signature Employer's Printed Name Date
Phone Number: Fax:
WARNING: It is unlawful to provide false information to the government when applying for federal public benefit
programs per Section 1001 of Title 18 of the United States Code.
HUD Form HCD-138
Page 47 of 70
Zero Income Certification
, have applied for emergency or rental assistance
through the program. Program regulations require
verification of all income from participating households.
Income includes but is not limited to:
• Gross wages, salaries, overtime pay, commissions, fees, tips and bonuses
• Net income from operation of a business or from rental or real personal property
• Interest, dividends and other net income of any kind for real personal property
• Periodic payments received from Social Security, annuities, insurance policies, retirement
funds, pensions, disability or death benefits and other similar types of periodic receipts
• Lump sum payment(s) for the delayed start of a periodic payment (except as provided in
24 CFR 5.609 (b)(5))
• Payments in lieu of earnings, such as unemployment and disability compensation,
worker's compensation, and severance pay
• Public assistance
• Alimony and child support payments (whether through the court system or not)
• Regular pay, special pay and allowances of a head of household or spouse who is a
member of the Armed Forces (whether or not living in the dwelling)
• Regular monetary gifts from family and/or friends
I have stated during this verification process that I have no income at this time. I have not received
income since . I do not expect to receive any
income until . I applied for
(other financial assistance) on (date).
I understand that any misrepresentation of information or failure to disclose information requested
on this form may disqualify me from participation in the program for which I am applying, and may
be grounds for termination of assistance. I certify that the above information is true and correct. I
also understand that it is my responsibility to report all changes to my household composition or
income when they occur.
Signature: Date:
Witness: Date:
WARNING: It is unlawful to provide false information to the government when applying for federal
public benefit programs per Section 1001 of Title 18 of the United States Code.
HUD Form HCD-151
121
Page 48 of 70
Verification of Child Support
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The person referenced above is a participant in a federally assisted housing program. Federal
regulations require that we verify the income of program participants. Please complete all
information below.
I do hereby authorize the release of this information:
Applicant Name (print clearly) Signature of Applicant Date
SECTION BELOW TO BE COMPLETED BY CHILD SUPPORT PROVIDER
Amount of child support payments: $ weekly; $ monthly; $ other
If inconsistent, list total amount in last six months: $
Date child support payments began: Date ended:
Names of children for which payments are made:
Name Name
Name Name
Name Name
I certify this information is true and complete.
Name (Print) Signature Date
Address City State Zip Telephone
Title or relation to participant (agency if applicable)
Page 49 of 70
Verification of Informal Support
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The person referenced above is a participant in a federally assisted housing program. Federal
regulations require that we verify all income for the program participant's household. The
information provided will remain confidential. Please complete all information below.
I do hereby authorize the release of this information:
Applicant Name (print clearly) Signature of Applicant Date
SECTION BELOW TO BE COMPLETED BY INFORMAL SUPPORT PROVIDER
I certify that I provide financial assistance in the amount of$ weekly monthly
The assistance provided is for:
I certify this information is true and complete.
Name (print) Signature Date
Relationship to Participant Agency (if applicable) Telephone
Address City State Zip
Page 50 of 70
Verification of Benefits or Pension
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The person referenced above is a participant in a federally assisted housing program. Federal
regulations require that we verify all household income of program participant. The information
provided will remain confidential. Please complete all information below.
I do hereby authorize the release of this information:
Applicant Name (print clearly) Signature of Applicant Date
SECTION BELOW TO BE COMPLETED BY BENEFITS ADMINISTRATOR
Amount of monthly payment to participant: $
OR
Amount of weekly payments to participant: $
Date Payments Began: Date Payments Ended:
Deductions from gross income for medical insurance premiums: $
Type of Benefit (check one): Pension Annuity Retirement VA Welfare
Social Security Unemployment Kinship K-TAP Other (please list):
I certify this information is true and complete.
Name (print) Signature Date
Title Agency/Company Telephone
Address City State Zip
Page 51 of 70
Verification of Assets
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The above referenced person is an applicant in a federally assisted housing program. Federal regulations require
that we verify all assets of the program participants and their household. This information will remain confidential
to the satisfaction of that stated purpose only.
By signing below I authorize the release of this information.
Participant's Signature Date
SECTION BELOW TO BE COMPLETED BY BANKING INSTITUTION
Interest Rate Date Account
Current Balance on Account Opened
Checking Account#1: $ $
Checking Account#2: $ $
Interest Rate Date Account
Current Balance on Account Opened
Savings Account#1: $ $
Savings Account#2: $ $
Other Accounts:
Interest Rate Date Account
Account Type Current Balance on Account Opened
$ $
I
$ $
certify that this information is accurate.
Name (print clearly) Title Signature Date
Financial Institution Telephone Number
Address City State Zip
WARNING: It is unlawful to provide false information to the government when applying for federal public benefit
programs per Section 1001 of Title 18 of the United States Code.
HUD Form HCD-160
Page 52 of 70
General Telephone Verification
THIS FORM TO BE COMPLETED BY AGENCY STAFF PARTICIPATING IN TELEPHONE CONVERSATION
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
Date of call:
Time of call:
Person/Company Name:
Phone number called:
Spoke with:
Title:
Conversation:
I certify the information above is a true and accurate representation of the telephone conversation that
took place:
Agency Staff Signature Date
WARNING: It is unlawful to provide false information to the government when applying for federal public
benefit programs per Section 1001 of Title 18 of the United States Code.
HUD Form HCD- 170
Page 53 of 70
Income Verification Due Diligence
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The completion of this form is required when source documents and/or third-party verifications
of income are not obtainable and/or HUD's preferred method of verifying income is not followed.
HUD specifies the following order for income verifications: source documents, written third- party,
oral third-party, and self-certification.
Potential reasons for not obtaining source documents: applicant/participant does not receive
paystubs due to direct deposit, the first paycheck has not yet been received, social security
award letter has been misplaced or lost, etc.
Potential reasons for not obtaining third-party verification include: inability to contact third party,
third party refused to provide information, etc.
Efforts reflecting attempts to follow HUD's preferred order include phone calls, e-mails, letters,
faxes, etc.
When documenting the efforts and outcomes for phone call attempts, descriptions must include
the name and title of the individual, contact number, date and time. Copies of efforts to obtain
third-party documentation through e-mail correspondence, certified letters, faxes, etc. should be
attached to this document.
Describe the reason(s) for the inability to acquire HUD's preferred income verification:
Describe efforts to follow HUD's preferred method of verifying income and the outcome:
Document(s) attached: Yes No
If yes, specify:
I certify this information is true and complete.
Signature Date
Print Name Title
Page a0
Verification of Child Care Expense
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The individual referenced above is a participant in a federally assisted housing program. Federal
regulations require that we verify expenses paid for the care of dependent children enabling the
family member to be employed or to attend school. The amounts provided must be paid
out-of-pocket by the participant and may not be reimbursed from another source.
By signing below I authorize the release of this information and certify that I am not reimbursed
from any source for the amount paid:
Applicant's Signature Date
THIS SECTION TO BE COMPLETED BY CHILD CARE PROVIDER
By signing below, I certify that I provide child care services for the above-referenced participant
and receive the amount of compensation stated. Please complete all information requested.
Names of children for which child care is provided:
Name Name
Name Name
I receive $ weekly for services (OR) I receive $ monthly for services.
Date child care began: number of hours child care is provided: daily
(OR) weekly (OR) monthly.
Is any portion of the child care expense paid by another source? Yes No
If Yes: Total child care amount: $ Amount paid by another source: $
If amounts are received for child care during holidays, vacations, etc., please provide dates and
amount received:
I certify that this information is accurate:
Child Care Provider Signature Name (print)
Child Care Facility (if applicable) Telephone#
Address City State Zip
Page 55 GI'
Verification of Attendant Care Expense
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The individual referenced above is a participant in a federally assisted housing program. Federal
regulations require that we verify attendant care expenses paid for unreimbursed, anticipated costs. The
amounts provided must be paid out-of-pocket by the individual or family member and may not be
reimbursed from another source.
By signing below I authorize the release of this information and certify that I am not reimbursed from
any source for the amount paid:
Applicant's Signature Date
SECTION BELOW TO BE COMPLETED BY ATTENDANT CARE PROVIDER
By signing below, I certify that I provide attendant care for the above-referenced participant and
receive the amount of compensation stated.
Is any portion of the attendant care expense paid by another source? Yes No
If Yes: Total amount: $ Amount paid by another source: $
I receive $ weekly for services (OR) I receive $ monthly for services.
Date attendant care began:
Number of hours attendant care is provided: daily (OR) weekly (OR) monthly.
If amounts are received for attendant care during holidays, vacations, etc., please provide dates and
amount received:
I certify this information is true and complete.
Attendant Care Provider Signature Name (print)
Attendant Care Facility (if applicable) Phone Number
Address City State Zip
WARNING: It is unlawful to provide false information to the government when applying for federal public
benefit programs per Section 1001 of Title 18 of the United States Code.
HUD Form HCD-153
Page 56 of 70w
Verification of Auxiliary Apparatus Expenses
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The individual referenced above is a participant in a federally assisted housing program. Federal
regulations require that we verify the out-of-pocket medical expenses of program participants. This
information includes the estimated out-of-pocket medical expenses (e.g. wheelchair, walker, ramp, vision
impaired expenses, etc.) of the participant for the anticipated next 12-month period. If not available, then
provide medical expenses for the past 12-month period. Expenses do not include amounts covered by
insurance or reimbursed to the participant.
By signing below I authorize the release of this information and certify that I am not reimbursed from any
source for the amount paid:
Applicant's Signature Date
SECTION BELOWTO BE COMPLETED BY DOCTOR OR OFFICE STAFF
Total Out-of-Pocket Amount Paid by Participant
Description of Expenses Anticipated 12 Mo.
p (OR) Last Actual 12 Mo.
The information is provided by:
Name (print) Signature Date
Title Name of Business Phone Number
Address City State Zip
WARNING: It is unlawful to provide false information to the government when applying for federal public
benefit programs per Section 1001 of Title 18 of the United States Code.
HUD Form HCD-154
Page 57 of 70
Verification of Medical Expenses
RE: SSN XXX-XX-
Applicant's Name (print) (last four digits)
The individual referenced above is a participant in a federally assisted housing program. Federal regulations
require that we verify the out-of-pocket medical expenses of program participants. This information must be
provided by a third party, such as a doctor or pharmacist, familiar with the actual or estimated out-of-pocket
medical expenses of the participant for the next 12-month period. If not available, please provide medical
expenses for the past 12-month period. Expenses do not include amounts covered by insurance or
reimbursed to the participant.
By signing below I authorize the release of this information and certify that I am not reimbursed from
any source for the amount paid:
Applicant's Signature Date
SECTION BELOWTO BE COMPLETED BY DOCTOR, PHARMACIST OR OFFICE STAFF
Total Out-of-Pocket Amount Paid by Participant
Description of Medical Expenses Anticipated 12 Mo. (OR) Last Actual 12 Mo.
The information is provided by:
Name (print) Signature Date
Title Name of Business Phone Number
Address City State Zip
WARNING: It is unlawful to provide false information to the government when applying for federal public
benefit programs per Section 1001 of Title 18 of the United States Code.
Page 58 of 70
Rent Reasonableness Checklist and Certification
**See utility allowance instruction when calculating utility allowances.
Proposed Unit Unit#1 Unit#2 Unit#3
(if possible,same owner as
proposed unit)
Address
Number of Bedrooms
Square Feet
Type of
Unit/Construction
Housing Condition
Location/Accessibility
Amenities
Unit:
Site:
Neighborhood:
Year of Construction
Which Utilities are
Provided by the
Owner(type-Gas,
Electric, etc.)
Unit Rent
Utility Allowance**
Gross Rent
Handicap Accessible?
Most Recent Rent
Charged For Reason For Change:
Proposed Unit
This household qualifies for a payment standard of:
This unit is less than the payment standard
This unit is more than the payment standard
CERTIFICATION: Based upon a comparison with rents for comparable units, I have determined that the proposed rent
for the unit IS IS NOT reasonable.
Name: Signature: Date:
Page 59 of 70
Rent Reasonableness Checklist and Certification
**See utility allowance instruction when calculating utility allowances.
Proposed Unit Unit#1 Unit#2 Unit#3
(if possible,same owner as
proposed unit)
Address 123 Main Street, #2 123 Main Street, #5 456 First Street, # 1 789 Maple Street, #2
Frankfort, KY 40601 Frankfort, KY 40601 Frankfort, KY 40601 Frankfort, KY 40601
Number of Bedrooms 2 2 2 2
Square Feet 900 900 1000 950
Type of Apt/Garden Apt./Garden Apt./Garden Apt./Garden
Unit/Construction
Housing Condition Good(recently Good(recently Fair(repairs needed) Good(well
renovated) renovated) maintained)
Location/Accessibility Downtown Downtown Downtown downtown
Amenities Washer/Dryer hookup Washer/Dryer hookup Washer Dryer Dishwasher
Unit: Off street parking Off street parking Property Mgt Laundry Facilities
Company/onsite Elevator
Site: Maintenance
Public Public
Neighborhood: Transportation/grocery transportation/grocery Park Nearby Shopping
Year of Construction 1942 1942 1979 1983
Which Utilities are All All All Water, Sewer,
Provided by the Garbage
Owner(type-Gas,
Electric, etc.)
Unit Rent $650 $650 $675 $650
Utility Allowance** 0 0 0 111
Gross Rent 650 650 675 761
Handicap Accessible? No No Yes yes
Most Recent Rent
Charged For 575 Reason For Change: recently renovated and addition of off street
Proposed Unit parking
This household qualifies for a payment standard of: $768
X This unit is less than the payment standard
This unit is more than the payment standard
CERTIFICATION: Based upon a comparison with rents for comparable units, I have determined that the proposed rent
for the unit X IS IS NOT reasonable. 7 e�
Name: Jane Doe Signature: Poe vete Date: 3/21/2017
Page 60 of 70
Instructions for Completing the Rent Reasonableness Checklist and Certification
Ensure the applicable rent reasonableness checklist is completed for the type of assistance
provided for the unit. The selection of comparables may require the review of similar units owned
by the same person/entity who owns the proposed unit. It is recommended that the unit selection
be a reasonable reflection of the market to determine rent reasonableness. For example, the
selection of three units within the same complex will not demonstrate an accurate comparative
market analysis. When completing the form, focus considerations on the factors that affect rent
rather than trying to measure against the arbitrary standard of average rents. The person
conducting the rent reasonableness should provide sufficient information about the evaluation
process so that a supervisor or monitor can understand how the comparables were used to
determine the appropriate rent for the program units.
Address: Identify the address of the proposed unit as well as the addresses of the comparable
units.
Number of Bedrooms:,Identify the number of bedrooms of each unit. Comparable units should
have the same number of bedrooms as the proposed unit. In some cases, it may be difficult to
identify units that match the location, building type and number of bedrooms. In such cases, the
reviewer may need to review units that(a) have the same number of bedrooms and building type
but in a broader geographic range, or(b)have the same number of bedrooms and are in the same
geographic location but are in other types of buildings. These cases should be rare and
documentation should support these exceptions.
Square Feet: Identify the square footage of the living area in the units.
Type of Unit/Construction: Identify the unit type by selecting one of the following: apartment
(garden 1-4 stories, mid-rise 5-8 stories, or high-rise 9+ stories), townhouse, duplex, single family
house, or other(e.g. mobile home, etc.).
Housing Condition: Describe the condition or quality of the units. Considerations when making
this determination may include: newly constructed, completely renovated, partially renovated, no
renovation since construction, well maintained, repairs needed soon, minor maintenance
required, etc.
Location: Identify the location of the units. Are the comparable units close in proximity or in
different geographic areas? Descriptions may include: downtown, rural, the specific name of a
neighborhood, etc.
Amenities: Identify amenities provided by the owner. Descriptions may include: central NC vs.
window NC units, washer/dryer connections, washer/dryer, dishwasher, garbage disposal,
balcony, patio, etc. If applicable, identify site amenities. Descriptions may include: playground,
covered parking, reserved parking spaces, on-site property management staff, on-site
maintenance, security guards, security cameras, laundry facilities, elevator, etc. Identify
neighborhood/area amenities. Descriptions may include: nearby shopping, public transportation,
park, grocery, walking trail, hospital, etc.
Year of Construction: Identify the year the unit was built: 1978, 2000, 1934, etc.
Page 61 of 70
Which Utilities are provided by the Owner: Identify the utilities provided by the owner of the
unit that are included in the rent amount. This information is used to assist in determining the
utility allowance, if applicable: electric, gas, etc.
Unit Rent: Include the rent amount the owner is charging for each unit.
Utility Allowance: If utilities are not included in the rent, refer to the utility allowance chart to
calculate the utility allowance.
Gross Rent: This figure is the unit rent plus the utility allowance.
Handicap Accessibility: For an individual/family that requires an accessible unit, the accessible
features may justify a higher rent.
Most Recent Rent Charged for Proposed Unit: Enter the most recent amount of rent the owner
charged for the proposed unit.
Reason for Change: If the previous rent charged is higher than what the owner is requesting the
reason for the change must be documented. Examples of reasons for a rent increase include:
installed new appliances, recently renovated, etc.
Comparison to Other Unassisted Units: Compare the rent of the proposed unit to the rent of
other units rented by the same owner. The rent of an assisted unit should be comparable to the
rent of an unassisted unit. This ensures the owner is not trying to charge more for the proposed
unit because it is receiving assistance or subsidy.
Comparison to Payment Standard: Compare gross rent to the payment standard to determine
is this unit is reasonable.
Certification: Once all fields of the form are completed, the reviewer should be able to determine
whether the unit rent is reasonable. Selecting "yes" or"no" indicates the results of the review.
Name, Signature and Date: This document must identify who conducted the rent
reasonableness determination and when.
Page 62 of 70
HUD Instructions for Calculating Utility Allowance
1. Obtain a current Utility Allowance Chart from the appropriate Public Housing Authority (PHA)
for the area in which the unit is located. For counties in which HUD is the Section 8
administrator, HUD Utility Allowance Charts will be used. These can be found on the HUD
website under Program Compliance. For counties where HUD is not the Section 8
administrator, contact your local PHA to obtain the current year's utility allowance. Utility
allowances are updated on an annual basis; please check the date at the top of the utility
allowance chart to ensure you are using the current year's numbers.
2. Determine the utilities the client is responsible for and the fuel source for heating, cooking,
and water heating (e.g. gas, electric, propane, etc.). Also determine whether the
refrigerator and stove are supplied by the landlord (see# 10 below).
3. Determine the category of housing for the unit in question. If the client is responsible for
paying heating costs, locate the correct heat/air utility category for the category of house,
and select the correct fuel source under the correct bedroom size column and circle the
number.
4. If the unit has access to air conditioning, you will always include the air conditioning
allowance whether it is a window air conditioner or central air; circle the air conditioning
number under the correct bedroom size column.
5. If the client is responsible for paying cooking costs, locate the correct fuel source for cooking
and circle the number that corresponds to the correct bedroom size of the unit.
6. If the client is responsible for paying water heating costs, locate the correct fuel source and
bedroom size for water heating and circle that number.
7. If the client is responsible for the electric bill, always include the category of other electric.
This amount covers the lights and other items that get plugged into electric sockets
(including the electricity that runs the refrigerator and stove).
8. If the client is responsible for paying the water and sewer bill, circle those numbers for the
correct bedroom size of the unit.
9. If the client is responsible for paying for garbage pickup, circle the number for the correct
bedroom size of the unit.
10. Range and refrigerator categories will only be circled if the tenant is responsible for
providing their own refrigerator or stove appliance, these categories are not for the utilities to
run these appliances. That is covered under other electric.
11. Do not include other appliances which are not specified on the applicable PHA's utility
allowance chart(e.g. washer and dryer, etc.).
12. Now you are ready to calculate. Looking over your form you should have circles all in one
column which corresponds to the number of bedrooms of the unit. Add all the numbers you
have circled to calculate the utility allowance amount.
Page 63 of 70
Lead Screening Worksheet
About this Tool
The Lead Screening Worksheet is intended to guide agencies through the lead-based paint inspection process to ensure compliance
with the rule. The recipient agency can use this worksheet to document any exemptions that may apply. The accompanying Lead
Visual Assessment Worksheet can be used to document whether any potential hazards have been identified, and if safe work
practices and clearance are required and used. A copy of the Lead Screening Worksheet and the Lead Visual Assessment
Worksheet(if applicable)along with any related documentation must be kept in the client file.
Instructions
To prevent lead-poisoning in young children, the recipient agency must comply with the Lead-Based Paint Poisoning Prevention
Act of 1973 and its applicable regulations found at 24 CFR 35, parts A, B, H, J, K, M, and R. Under certain circumstances, a visual
assessment of the unit is not required. This screening worksheet will help program staff determine whether a unit is subject to a
visual assessment, and if so, how to proceed.
Note:All pre-1978 properties are subject to the disclosure requirements outlined in 24 CFR 35, Part A, regardless of whether they
are exempt from the visual assessment requirements.
Agency name:
Client household name:
Property address:
Street address and apt#(if applicable)
City, State, Zip:
Additional Exemotions
If the answer to any of the following questions is "yes," the property is exempt from the visual assessment requirement
and no further action is needed at this point. Place this screening sheet and all sunoortina documentatiori for each
exemption in the client file.
1. Is this unit a zero-bedroom or SRO unit? Yes ❑ No
2. Has X-ray or laboratory testing of all painted surfaces by certified personnel been conducted in accordancewith
HUD regulations and the unit is officially certified to not contain lead-based paint?
❑ Yes ❑ No
3. Has this unit had all lead-based paint identified and removed in accordance with HUD regulations?
❑ Yes ❑ No
4. Is the client receiving Federal assistance from another program, where the unit has already undergone (and passed)
a visual assessment within the past 12 months (e.g., if the client has a Section 8 voucher)?
❑ Yes ❑ No
5. Does this property meet any of the other exemptions described in 24 CFR 35.115(a)?
❑ Yes ❑ No
• If the answer to any of the above questions is "yes," stop. No further action is needed.
ESTOP
• If the answer to all of these questions is "no,"then continue on to the Visual Assessment Worksheet.
Staff signature: Date:
Lead Visual Assessment Worksheet
Page 64 of 70
Lead Screening Worksheet
Instructions
The lead visual assessment is used to determine if there are any identified problems with paint surfaces. The recipient agency
must conduct a visual assessment prior to providing financial assistance to the unit.
Prior to conducting visual assessments,the recipient agency staff responsible for conducting assessments must
complete training on HUD's website at:
http://www.hud.gov/offices/lead/training/visualassessment/h00101.htm
The initial visual assessment should be conducted at the same time the inspection of the unit is conducted, with the
inspector/assessor noting any problems with painted surfaces. Once the assessment has occurred, complete the section below
and place in the client file along with any additional documentation.
If any problems with paint surfaces are identified during the initial visual assessment,then continue to Page 2 to determine
whether safe work practices and clearance are required.
Agency name:
Client household name:
Property address
Street address and apt#(if applicable)
City, State, Zip:
Date of inspection/assessment:
❑ Initial Visual Assessment&Certification ❑ Follow-up Visual Assessment& CertificationI
1. Has a visual assessment of the unit been conducted? ElQ
Yes l No
2. Were any problems with paint surfaces identified in the unit during the visual assessment?
❑ Yes Ej No
I certify the following:
• I have completed HUD's online visual assessment training and am a HUD-certified visual assessor.
• I conducted a visual assessment on the above unit, on the above inspection/assessment date.
• Yes, or No problems with paint surfaces were identified in the unit/common areas.
Lead assessor's name(print):
Lead assessor's signature: Date:
If no problems with paint surfaces were identified, stop. No further action needed. Place this worksheet
STOPcertification in the client file.
If problems with paint surfaces were identified, then determine if the client should choose another unit or if
repairs will be attempted. If repairs will be attempted, continue to the De Minimus Level Worksheet.
De Minimus Level Worksheet
Page 65 of 70
Lead Screening Worksheet
Instructions
All deteriorated paint identified during the visual assessment must be repaired prior to clearing the unit for assistance. However, if
the area of paint to be stabilized exceeds the"de minimus levels", as defined below, the use of lead safe work practices and
clearance is also required.
If deteriorating paint exists but the area of paint to be stabilized does not exceed the"de minimus levels", then the paint must be
repaired prior to clearing the unit for assistance, but safe work practices and clearance are not required.
Complete the information below to determine if the deteriorated paint exceeds the"de minimus levels"and place this worksheet,
along with any supporting documentation, in the client file.
Agency name:
Client household name:
Property address
Street address and apt#(if applicable):
City, State, Zip:
Date of inspection/assessment:
1. For exterior surfaces, is the deteriorated paint at least 20 square feet in area? ❑ Yes ❑ No
2. For interior surfaces, in one room or space, is the deteriorated paint at least 2 square feet in area?
❑ Yes ❑ No
3. For both exterior and interior surfaces, is the deteriorated paint at least 10% of the total surface area on a
component with a small surface area, such as a window sill, baseboard, door, handrail, or trim?
❑ Yes ❑ No
Lead assessor's name(print):
Lead assessor's signature: Date:
If the answer to all of the above are"no,"then, stop, place a copy of this worksheet and any supporting
STOP documentation in the client file, and determine if the client should choose another unit or if repairs will be
attempted. If repairs are attempted, paint must be repaired and/or stabilized; however safe work practices and
clearance are not required. Once repairs are made, conduct a follow-up visual assessment, and complete the
Paint Stabilization Confirmation Worksheet.
If the answer to any of the above questions is "yes,"then place a copy of this worksheet and any supporting
documentation in the client file, and determine if the client should choose another unit or if repairs will be
attempted. If repairs are attempted, safe work practices and a clearance inspection must be conducted by an
independent certified lead professional. Please note, the clearance inspection cannot be conducted by the
same firm that is repairing the deteriorated paint. Once repairs are made and clearance inspection is complete,
conduct a follow-up visual assessment, and continue to the Paint Stabilization Confirmation Worksheet.
Paint Stabilization Confirmation Worksheet
Page 66 of 70
Lead Screening Worksheet
Instructions
Recipient agency staff should work with property owners and/or managers to ensure that all deteriorated paint identified during the
visual assessment has been stabilized. If the area of paint to be stabilized does not exceed the"de minimus level", safe work
practices and a clearance inspection are not required (though safe work practices are always recommended). In these cases,the
recipient agency should confirm that the identified deteriorated paint has been repaired by conducting a follow-up assessment.
If the area of paint to be stabilized exceeds the"de minimus level", program staff should ensure that the clearance inspection is
conducted by an independent certified lead professional. A certified lead professional may go by various titles, including a certified
paint inspector, risk assessor, or sampling/clearance technician. Note, the clearance inspection cannot be conducted by the same
firm that is repairing the deteriorated paint.
Complete a follow-up lead visual assessment and then complete this confirmation worksheet and gather supporting documentation
such as a copy of the clearance inspection report, a copy of the certified inspector's credentials, and documentation safe work
practices were used in the stabilization efforts and place them in the client file.
Agency name:
Client household name:
Property address
Street address and apt#(if applicable)
City, State, Zip:
Date of initial inspection/assessment:
Date of follow-up inspection/assessment:
1. Has a follow-up visual assessment of the unit been conducted? Yes ❑ No
2. Have all identified problems with the paint surfaces been repaired? Ul Yes ❑ No
3. Were paint surfaces repaired using safe work practices? ❑ Yes a No ❑ N/A
4. Was a clearance inspection conducted by an independent, certified lead professional?
Yes No ❑ N/A
5. Did the unit pass the clearance inspection? 14 Yes Eli No ❑ N/A
Lead assessor's name(print):
Lead assessor's signature: Date:
Note: This worksheet, as well as all other lead worksheets, and all supporting documentation should be
maintained in the client file.
Page 67 of 70
Authorization to Release and Consent
Agency Name:
INFORMATION COVERED
I/We understand that previous or current information regarding me/us may be needed. Verifications and inquiries
that may be requested include, but are not limited to: personal identity, employment, income and assets, medical or
child care allowances, expenses and cost of services. I/We understand that this authorization cannot be used to
obtain any information about me/us that is not pertinent to my eligibility for and continued participation in a Housing
and Community Development(HUD) and or United States Department of Housing and Urban Development(HUD)
funded program.
GROUPS OR INDIVIDUALS THAT MAY BE ASKED
The groups or individuals that may be asked to release the above information include, but are not limited to:
Past and present employers Welfare agencies Veterans Administration
Past, present, future landlords Past, present, future utility providers Retirement/Pension systems
Public Housing Agencies Social Security Administration Banks/other financial institutions
Child support providers Medical providers Mental health providers
Child care providers Alimony providers Service vendors
State unemployment agencies Legal service providers Credit repair providers
Other benefit providers public/private
CONDITIONS
I/We agree that a photocopy of this authorization may be used for the purposes stated above. The original of this
authorization is on file and will stay in effect for a year and one month from the date signed. I/We understand I/we
have a right to review this file and correct any information that is incorrect.
The undersigned hereby authorize all persons or companies in the categories listed below to release without
liability, information regarding employment, income, assets, expenses and/or cost of services provided to:
SIGNATURES
Applicant/Resident Print Name Date
Co-Applicant/Resident Print Name Date
Co-Applicant/Resident Print Name Date
Other Adult Household Member Print Name Date
NOTE: THIS GENERAL CONSENT MAY NOT BE USED TO REQUEST A COPY OF A TAX RETURN.
IF A COPY OF A TAX RETURN IS NEEDED, IRS FORM 4506, "REQUEST FOR COPY OF TAX
FORM" MUST BE PREPARED AND SIGNED SEPARATELY.
WARNING: It is unlawful to provide false information to the government when applying for federal public
benefit programs per Section 1001 of Title 18 of the United States Code.
HUD Form HCD-139
Page 68 of 70
Attachment B -HOME MONITORING CHECKLIST, CASE FILE TBRA PROJECT
-• . •orntoring
Checklist 7-A Case File: TBRA Project
Tenant Name: Tenant ID:
Reviewer: Date:
The monitor should select a sample of individual applicant files to ensure that all required documentation
is contained in each file,and that decisions were made properly(e.g.,preference status, rent subsidy,bed-
room size).
ANSWER
QUESTIONS Y N NOTES
A. APPLICANT DOCUMENTATION
1. Does the file contain a completed application
form?
2. Are income limits of participants at,or below:
*80 percent.of median?
*SO percent of median?
3. Were additional income criteria unposed by the
PJ(if any)met?
4. Did the applicant meet the PM's residency
requirement?
5. Was eligibility for preferences verified and
appropriate preference weight assigned(if
applicable)?
B. LEASING PROCESS DOCUMENTATION
Are these items in the files?
8. Coupon/Offer Date
7. Date of Briefing
8. PJiOwner Contract
9. Acceptable Tenant Lease
10. Proper Tenant.Lease Addendum
11. Tenant Payment Calculation
C. TENANT INCOME RECERTIFICATION
Verify the following actions.
12. On-time and accurate income recertification
13. Copies of notices sent to owners and tenants
noting the change in PJ and tenant.payments
14. Termination information,with date and reason
4 (if applicable)
A HOME Program Model
ATTACHMENT C - HOME MONITORING SUMMARY TBRA PROGRAM
7onitnrin 1 Monitoring Summary: TBRA Program)
ChFx:klist 7-B
PJ Name:
Subreeipient Name(if applicable):
Reviewer: Date:
ANSWER
QUESTIONS Y N NOTES
A. PROGRAM POLICIES AND PROCEDURES
1. Is the program administered in a manner
consistent with the Consolidated Plan?
a. If not,did the PJ receive approval to modify
the program's design?
2. It there an adequate written program description
for the program?
3. Are there adequate procedures for making the
program description available to the public?
B. OUTREACH
4. Is there an acceptable outreach and marketing
plan?
!"i. Is the outreach plan being implemented?
C. PARTICI PANT SELECTION
6. Are there procedures to ensure that all
applicants get fair consideration for assistance?
7. Are adequate application forms need?
8. Based on a review of case files,has there been
proper determination and documentation of the
eligibility of program participants?
9. 1)o 90 percent of all program participants have
incomes at or below 80 percent of area median
income?
10. Are there adequate procedures for determining
and documenting participant eligibility?
a. Is the correct definition of annual income
used?
b. Do files contain the appropriate
documentation to verify each household's
income eligibility?
11. Are there established selection criteria?
12. Arc the local preferences structured in a non-
discriminatory way?
13. Do tenant selection criteria assign weights
consistently to any preferences (if applicable)?
14.Is there a clearly established method of
determining which households should receive
offers and in what order?
r,.Is the offer date consistently documented in
1 n
applicant files?
A HOME Program Model
cinttnnncl
Chncklint 7 B Monitoring Summary: TBRA Program'
ANSWER
QUESTIONS Y N NOTES
18. 1)o case files contain the following required
documents:
a. Program contract?
b. IAla Re?
ce. Total Lcnant payment?
d. Annual income recertification?
e. Documentation of termination(if applicable)?
17. Do case files document unit compliance with
local codes and standards and Section 8 HQS:
a. AL initial occupancy?
b. At annual reinspection?
c. After any code related complaint?
18. Do case files document.that units meet the
following qualifications:
a. Unit is located within the proper jurisdiction
or approved program area?
b. tlnit is not au owner-occupied cxt-operative
unit?
19. Based on a review of case files,arc rents for
participating units reasonable compared to
similar unassisted units?
20. Is there a system for ensuring that rents are
reasonable by comparing them to similar units?
21. Does a spot-check of comparable units indicate
that the units are actually of comparable quality?
22. Are there clear policies for determining
appropriate unit,size, and do case files show that
these policies have been applied consistently?
E. SUBSIDY ADMINISTRATION
AND FILE DOCUMENTS
23.Does the programs payment standard fall
between the minimum and maximum allowed
under the IlOME Program,and is there
adequate documentation of the payment
standard?
24.Do case files show that annual rent adjustments
are consistent with a proper rent reasonableness
determination?
25.Do case files include notices informing the tenant
and the owner of changes in the program and
tenant's share of the rent?
•l6.Are exception payment standards used properly?
Monitoring HOME Program Performance
"'t"ri
"g
CFiecklist 7-B Monitoring Summary: TBRA Program!
ANSWER
QUESTIONS Y N NOTES
27. Do case files show that proper utility allowances
(either PHA allowances or proper local estimates)
were used when determining contract rents?
28. Is there a current utility allowance schedule?
29. Is there a eonsistcnt policy for applying updated
utility allowances?
30. Do case files indicate proper calculation of the
Total Tenant Payment(TTP)and any utility
reimbursement?
A HOME Program Model
Exhibit A
CITY OF CORPUS
CHRISTI,TEXAS
PROJECT BUDGET
Project No
Project Title: Accessible Housing Resources, Inc Tenant-Based
Rental Assistance
Subrecipient: Accessible Housing Resources, Inc
Contract Period: __ _, 2019 to , 2019
Program Budgeted Items Funding Other Funding Total Budget
Sources: (N/A)
HOME
HOME Rents, including $99,341.10 $99,341.10
security deposits
HOME Project Delivery $11,037.90 $11,037.90
Cost
TOTAL $ 110,379.00 $ 110,379.00
In addition to the information provided by here,the City may require a more detailed budget
breakdown than the one contained herein, and the Subrecipient shall provide such
supplementary budget information in a timely fashion in the form and content prescribed by
the City.
Exhibit B
City of Corpus Christi
Time Line for Goals and Expenditures
Agency: Accessible Housing Resources, Inc. (AHRI)
Grant Period: , 2019— , 2020
Name of Program: Tenant Based Rental Assistance
(TBRA)
Rent Deposits Project
Delivery Cost
January 2019
February 2019
March 2019
April 2019
May 2019
June 2019
July 2019
August 2019
September 2019
October 2019
November 2019
December 2019
Remaining Grant
Exhibit C
FY2018 Rents for All Bedroom Sizes for Corpus Christi, TX
HUD FMR Area
PROGRAM EFFICIENCY 1 BR 2 BR 3 BR 4 BR 5 BR 6 BR
LOW HOME RENT LIMIT 563 604 725 837 935 1,031 1,127
HIGH HOME RENT LIMIT 713 765 921 1,054 1,156 1,257 1,359
For Information Only:
FAIR MARKET RENT 752 789 997 1,328 1,518 1,746 1,973
50% RENT LIMIT 563 604 725 837 935 1,031 1,127
65% RENT LIMIT 713 765 921 1,054 1,156 1,257 1,359
The FMRs for unit sizes larger than four bedrooms are calculated by adding 15 percent to the
four-bedroom FMR, for each extra bedroom. For example, the FMR for a five bedroom unit is
1.15 times the four bedroom FMR, and the FMR for a six bedroom unit is 1.30 times the four
bedroom FMR. FMRs for single- room occupancy units are 0.75 times the zero bedroom
(efficiency) FMR.
https://www.hudexchange.info/programs/home/home-rent-limits/
Page 1 of 1
Exhibit D
2018 Adjusted Home Income Limits
Corpus Christi, TX HUD PMR Area
1 2 3 4 5 6 7 8
Person Person Person Person Person Person Person Person
30% LIMITS 13,550 15,450 17,400 19,300 20,850 22,400 23,950 25,500
VERY LOW INCOME(50%) 22,550 25,800 29,000 32,200 34,800 37,400 39,950 42,550
60% LIMITS 27,060 30,960 34,800 38,640 41,760 44,880 47,940 51,060
LOW INCOME (80%) 36,050 41,200 46,350 51,500 55,650 59,750 63,900 68,000
*Income limits are published at least annually by HUD.
https://www.hudexchange.info/programs/home/home-income-limits/
Page 1 of 1
w
Exhibit E
Certification Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion
The following statement is made in accordance with the Privacy Act of 1974(5 U.S.C. §552(a), as amended). This certification is required by the
regulations implementing Executive Order 12549, Debarment and Suspension, and 2 C.F.R. §§ 180.300, 180.355, Participants'responsibilities. The
regulations were amended and published on August 31, 2005, in 70 Fed. Reg. 51865-51880. Copies of the regulations may be obtained by contacting
the Department of Agriculture agency offering the proposed covered transaction.
According to the Paperwork Reduction Act of 1995 an agency may not conduct or sponsor,and a person is not required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0505-0027. The time required
to complete this information collection is estimated to average 0.25 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. The provisions of appropriate
criminal and civil fraud privacy,and other statutes maybe applicable to the information provided.
(Read Instructions On Page Two Before Completing Certification)
A. The prospective lower tier(BIDDER/PROPOSER/SUBRECIPENT)participant certifies, by submission of this
proposal,that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded from participation in this transaction by any Federal department or agency;
B. Where the prospective lower tier(BIDDER/PROPOSER/SUBRECIPENT) participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation to this proposal.
ORGANIZATION NAME
CC 5S; 1131-e oU Sln� heSoufeQs
NAME(S)AND TITLE(S)OF AUTHORIZED REPRESENTATIVE(S)
_ d • \gitom- _ .11010ccl a C O (1+-
Bow
SIG ATURE( DA E
%,4 3(3
r - I 2A/9
Page 1 of 2
Instructions for Certification
(1) By signing and submitting this form,the prospective lower tier participant(BIDDER/PROPOSER/SUBRECIPENT) is
providing the certification set out on page 1 in accordance with these instructions.
(2) The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered
into. If it is later determined that the prospective lower tier participant(BIDDER/PROPOSER/SUBRECIPENT)knowingly
rendered an erroneous certification, in addition to other remedies available to the Federal Government,the department or agency
with which this transaction originated may pursue available remedies, including suspension or debarment.
(3) The prospective lower tier participant(BIDDER/PROPOSER/SUBRECIPENT) shall provide immediate written notice to the
person(s)to which this proposal is submitted if at any time the prospective lower tier participant
(BIDDER/PROPOSER/SUBRECIPENT) learns that its certification was erroneous when submitted or has become erroneous by
reason of changed circumstances.
(4) The terms"covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person,"
"primary covered transaction," "principal," "proposal,"and"voluntarily excluded," as used in this clause,have the meanings set out
in the Definitions and Coverage sections of the rules implementing Executive Order 12549,at 2 C.F.R. Parts 180 and 417. You may
contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations.
(5) The prospective lower tier participant(BIDDER/PROPOSER/SUBRECIPENT) agrees by submitting this form that, should the
proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who
is debarred, suspended,declared ineligible,or voluntarily excluded from participation in this covered transaction,unless authorized
by the department or agency with which this transaction originated.
(6) The prospective lower tier participant further agrees by submitting this form that it will include this clause titled"Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion- Lower Tier Covered Transactions," without modification,
in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
(7) A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction
that is not debarred,suspended, ineligible,or voluntarily excluded from the covered transaction,unless it knows that the
certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its
principals. Each participant may,but is not required to,check the System for Award Management(SAM)database.
(8) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith
the certification required by this clause.The knowledge and information of a participant is not required to exceed that which is
normally possessed by a prudent person in the ordinary course of business dealings.
(9) Except for transactions authorized under paragraph(5)of these instructions, if a participant in a covered transaction knowingly
enters into a lower tier covered transaction with a person who is suspended,debarred, ineligible,or voluntarily excluded from
participation in this transaction, in addition to other remedies available to the Federal Government,the department or agency with
which this transaction originated may pursue available remedies, including suspension and/or debarment.
Page 2 of 2 Page 2 of 2
Instructions for Certification
(1) By signing and submitting this form,the prospective lower tier participant(BIDDER/PROPOSER/SUBRECIPENT)is
providing the certification set out on page 1 in accordance with these instructions.
(2) The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered
into. If it is later determined that the prospective lower tier participant(BIDDER/PROPOSER/SUBRECIPENT)knowingly
rendered an erroneous certification,in addition to other remedies available to the Federal Government,the department or agency
with which this transaction originated may pursue available remedies,including suspension or debarment.
(3) The prospective lower tier participant(BIDDER/PROPOSER/SUBRECIPENT)shall provide immediate written notice to the
person(s)to which this proposal is submitted if at any time the prospective lower tier participant
(BIDDER/PROPOSER/SUBRECIPENT)learns that its certification was erroneous when submitted or has become erroneous by
reason of changed circumstances.
(4) The terms"covered transaction," "debarred," "suspended,""ineligible," "lower tier covered transaction," "participant," "person,"
"primary covered transaction," "principal," "proposal,"and"voluntarily excluded,"as used in this clause,have the meanings set out
in the Definitions and Coverage sections of the rules implementing Executive Order 12549,at 2 C.F.R.Parts 180 and 417. You may
contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations.
(5) The prospective lower tier participant(BIDDER/PROPOSER/SUBRECIPENT)agrees by submitting this form that,should the
proposed covered transaction be entered into,it shall not knowingly enter into any lower tier covered transaction with a person who
is debarred,suspended,declared ineligible,or voluntarily excluded from participation in this covered transaction,unless authorized
by the department or agency with which this transaction originated.
(6) The prospective lower tier participant further agrees by submitting this form that it will include this clause titled"Certification
Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions,"without modification,
in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
(7) A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction
that is not debarred,suspended,ineligible,or voluntarily excluded from the covered transaction,unless it knows that the
certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its
principals. Each participant may,but is not required to,check the System for Award Management(SAM)database.
(8) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith
the certification required by this clause.The knowledge and information of a participant is not required to exceed that which is
normally possessed by a prudent person in the ordinary course of business dealings.
(9) Except for transactions authorized under paragraph(5)of these instructions,if a participant in a covered transaction knowingly
enters into a lower tier covered transaction with a person who is suspended,debarred,ineligible,or voluntarily excluded from
participation in this transaction,in addition to other remedies available to the Federal Government,the department or agency with
which this transaction originated may pursue available remedies,including suspension and/or debarment.
Page 2 of 2 Page 2 of
Exhibit F
Drug Free Workplace Certification
Applicant certifies and agrees that it will provide a drug free workplace by:
(a) Publishing a statement:
a. Notifying employees that the unlawful manufacture, distribution, dispensing,
possession or use of a controlled substance, including cannabis, is prohibited in
the Applicant's workplace.
b. Specifying the actions that will be taken against employees for violations of such
prohibition.
c. Notifying the employee that, as a condition of employment on such contract or
grant, the employee will:
abide by the terms of the statement; and
ii. notify the employer of any criminal drug statute conviction for a
violation occurring in the workplace no later than five (5) days after
such conviction.
(b) Establishing a drug free awareness program to inform employees about:
a. the dangers of drug abuse in the workplace;
b. the Applicant's policy of maintaining a drug free workplace;
c. any available drug counseling, rehabilitation, and employee assistance programs;
and
d. the penalties that may be imposed upon an employee for drug violations.
(c) Providing a copy of the statement required by subparagraph (a) to each employee
engaged in the performance of the grant and to post the statement in a prominent place in the
workplace.
(d) Notifying the Department within ten (10) days after receiving notice under part (B) of
paragraph (3) of subsection (a) above from an employee or otherwise receiving actual notice of
such conviction.
(e) Imposing a sanction on, or requiring the satisfactory participation in a drug abuse
assistance or rehabilitation program by, any employee who is so convicted, as required by Section
5 of the Drug Free Workplace Act.
(f) Assisting employees in selecting a course of action in the event drug counseling,
treatment, and rehabilitation is required and indicating that a trained referral team is in place.
(g) Making a good faith effort to continue to maintain a drug free workplace through
implementation of the Drug Free Workplace Act.
Page 1 of 2
THE UNDERSIGNED AFFIRMS, UNDER PENALTIES OF PERJURY, THAT HE OR SHE IS
AUTHORIZED TO EXECUTE THIS CERTIFICATION ON BEHALF OF THE DESIGNATED
ORGANIZATION.
Applicant
Signature of Authorized Representative Date
14
r 0 1111 It 1/2%)/9
Ti�of Authori ed Representative
'-eit-A-in AR-2..-1 ---
Page 2 of 2
Exhibit G
Accessible Housing Resources Inc. (AHRI)
Tenant Based Rental Assistance Program
Policies & Procedures
January, 2019 * pending Board approval
Table of Contents
Section Page
Introduction 1
Financial Oversight& Accounting 2
Policy
Program Marketing & Fair Housing 2
Policy
Leasing Policy & Procedures 2 - 6
Recertification Procedures 7
Interim Changes Procedures 7 - 8
Self-Sufficiency Procedures 8
Termination of Assistance 9
Procedures
Complaints and Grievances 9
Procedures
Waitlist Management& Informal 9 - 10
Review Procedures
Conflict of Interest Policy 10
Prohibited Activity 10 - 11
Page 1 of 12
Tenant Selection Policy and 11
Criteria
Addendum 12
Introduction
Accessible Housing Resources Inc. (AHRI) provides accessible and decent
housing that is affordable to persons with low, very low, and extremely low
income. The AHRI TBRA Program seeks to meet the needs of the lowest
income populations who are individuals with disabilities, seniors, Veterans,
homeless, and others at risk of homelessness or institutionalization.
AHRI seeks to assist the City of Corpus Christi, Coastal Bend region, and
TDHCA Region 10 communities to address the unmet needs of individuals
with the lowest incomes who lack accessible and affordable housing
options, have extreme rent burden for decent housing, and have the highest
risk of eviction due to housing instability, and may face homelessness or
institutionalization.
AHRI administers HUD HOME Tenant Based Rental Assistance (TBRA)
vouchers funded through Texas Department of Housing and Community
Affairs, and the City of Corpus Christi to address housing needs of qualified
individuals unable to afford the housing costs of market-rate units. HOME
TBRA assistance helps the individual households, rather than subsidizing a
particular rental unit. The assistance moves with the client/tenant. The level
of HOME TBRA subsidy is based on the income of the household, the unit
the household selects, and the payment standards.
AHRI TBRA Program Policies and Procedures meet the rules and
requirements of the Texas Department of Housing and Community Affairs
(TDHCA) and the City of Corpus Christi HUD HOME TBRA programs.
Page 2 of 12
AHRI will provide on-going temporary rental assistance, and may also
provide security deposits, and utility deposits for eligible participants within
the City of Corpus Christi.
Accessible Housing Resources, Inc. (AHRI)
Tenant Based Rental Assistance Program
Policies & Procedures
Financial Oversight & Accounting Policy
AHRI financial oversight and accounting for Tenant Based Rental Assistance
Program (TBRA) follows the procedures as outlined in the financial
management statement. AHRI ensures compliance with The Office of
Management and Budget's (OMB) Uniform Administrative Requirements,
Cost Principles, and Audit Requirements for Federal Awards (commonly
called "Uniform Guidance"). See attached Financial Management Statement.
Program Marketing & Fair Housing Policy
AHRI does not discriminate based on Race, Color, National Origin, Sex,
Religion, Disability, Familial Status, Age, Sexual Orientation, Gender Identity,
or Marital Status.
AHRI complies with and promotes the Fair Housing Act and its application to
providing assistance to individuals with the greatest need for affordable,
accessible and decent housing.
AHRI's outreach is targeted to the lowest income individuals who are least
likely to apply for housing assistance in TDHCA Region 10 (which includes
Corpus Christi), who, according to TDHCA, are individuals with disabilities,
Asians and families with young children. AHRI conducts marketing and
outreach as described in the HUD Fair Housing affirmative marketing plan
(FH-AMP). AHRI works with community partners such as the Area Agency on
Aging/Aging Disability Resource Center, area community action agencies,
housing authorities, Texas Health and Human Services Commission, local MH
and IDD authorities and other non-profits and faith-based organizations to
share information, resources and referrals.
Page 3 of 12
Leasing Procedures
Individuals interested in applying for housing assistance and referred to AHRI
will complete an initial intake screening with the AHRI Coordinator either in
person or over the telephone. If the information about the applicant household
indicates eligibility, the AHRI coordinator will schedule an appointment to
complete the application with supporting documentation.
Step 1- Application for Assistance —AHRI's application is modeled after
the Texas (TDHCA) Home Program intake application. The application
should be completed by a member of the household, and can be assisted at
the applicant's request by the AHRI TBRA Coordinator. All household
members over the age of 18 must sign the application. The AHRI
Coordinator reviews the Application and supporting documents. The
application is considered complete when all supporting documents are
received; at that time the applicants name will be placed on the waitlist by
the date and time the application was completed.
Step 2- Initial Participant Eligibility and Income Determination
1. Applicants are selected from the waiting list in the order established by
AHRI's waitlist preference policy.
2. To determine eligibility the TBRA Coordinator must verify the following:
A. The household's eligibility for preference status (when
applicable, must be done prior to assistance given). This
may be documentation of disability or certification of current
homelessness, and documentation of income.
B. The household's size and composition to determine the unit
size for which the household qualifies will be determined
with driver's licenses or state-issued identification, social
security cards, birth certificates, citizenship documents
and/or custody agreements for verification. The approved
unit size is set by Fair Housing Guidelines, and allows up 2
people per living/sleeping area. While these guidelines
determine the maximum subsidized unit size the applicant
is eligible for, ultimately, a family may choose a smaller
size if it accommodates the families needs. AHRI may
Page 4 of 12
allow exceptions at the request of the household. The
circumstances surrounding the request for the exception
will be reviewed and AHRI will consider current fair
housing guidance and HUD policy and will notify the
applicant of the determination. AHRI may grant an
exception as an accommodation for persons with a
disability. This may include approving an additional
bedroom to accommodate a medically necessary live in aid
or adaptive equipment that does not fit into a 1 bedroom
unit, which will be verified by a medical professional.
C. Gross household income, assets and adjustments to
income will be calculated using the definition of annual
income at 24 CFR Part 5 (Section 8)
• AHRI will determine annual income by reviewing source
documents for at least two months, evidencing annual
income (for example, wage statement, interest statement,
unemployment compensation) for the TBRA-assisted
household.
• Initial Income Eligibility: Income of participating
households must be verified before assistance is provided.
Income limits are established by household size and
revised annually by HUD. For initial income eligibility, a
household qualifies for TBRA assistance if its annual gross
income does not exceed 50 percent of Area Median
Income (AMI) indicated on the HOME Income Limits
• Income and asset source documentation for new TBRA
recipients is good for a six- month period. If TBRA
assistance is not provided before the six months has
expired, the household's income eligibility must be
reviewed again before assistance may be provided. AHRI
recognizes that persons with disabilities may need the
accommodation of additional time to locate accessible
housing because of local shortages. When this occurs, and
no other changes in the household have occurred, AHRI
will use the existing income verification.
Page 5 of 12
• Income eligibility criteria must be met regardless of the type
of TBRA program operated by the subrecipient (e.g., rental
assistance, utility deposits, security deposits, etc.).
D. AHRI does not conduct criminal background checks on
applicants. It will be the discretion of landlords and property
owners to determine criminal background screening criteria
that comply with the HUD fair housing regulations.
3. Applicants determined eligible for assistance based on the criteria
above are given an approximate rent guideline and are asked to
identify their choice of units.
4. Applicants determined ineligible after the application process shall be
notified of the reasons for this decision, and AHRI will provide
information about appealing the decision. Applicants may be
determined ineligible if they do not meet the income qualifications, fail
to provide requested support documentation, decline to apply for
permanent subsidized housing, or provide false or misleading
information on the application.
Step 3 Unit / Lease Approval
Once the household has located a unit within the Corpus Christi service area
and notifies the AHRI coordinator of their choice, the AHRI coordinator will
contact the owner/landlord or property manager to determine guidelines for
eligibility and an agreement to accept TBRA program vouchers.
If the landlord has agreed to participate, and the rent is determined to meet
tenant affordability per the Home TBRA Tenant Payment Worksheet, the AHRI
coordinator requests a W-9 from the landlord and proceeds with the HQS
inspection, rent reasonableness review and landlord's lease review.
1 . Rent Reasonableness Review— Units must rent for a reasonable
amount when compared to other unassisted units in the same area.
2. Affordability- The AHRI coordinator will determine affordability of
the unit to the applicant, by utilizing the HOME TBRA total Payment
Page 6 of 12
Worksheet to ensure that the applicant's portion of rent and utilities
are at least 30% but do not exceed 40% of the applicants income.
3. HQS Inspection — AHRI uses HUD form 52580 to conduct a unit
inspection. The unit must meet Section 8 HQS standards before
TBRA assistance is provided. Owner/landlord must correct any
deficiencies identified in the inspection prior to move in date.
Inspections will be made at initial occupancy and annually during
the length of TBRA assistance.
4. Landlord's Lease Review — The TBRA administrator will review
the owner's lease and prepare the Home TBRA Lease addendum
for signature by the applicant and landlord.
Step 4 Contract / Lease Execution
The TBRA Rental Coupon Contract, the Lease Addendum and the Lease
are signed by the tenant and the landlord. The TBRA Contracts will begin
on the first day of the lease, unless program exceptions are allowed
through the funding source.
Step 5. Initiation of Payments
AHRI will advance funds to the landlord on the rent due date and then
request repayment from the funder as required by its process.
The AHRI Coordinator will submit a check request to AHRI Accountant
for payment of approved expenses to be received by required due date.
Tenant is responsible for the tenant portion of the rent and will submit
their portion to the landlord by the due date as stipulated in their lease.
Recertification
Each household will be recertified annually based on the anniversary date of
move-in. Recertification may begin 90 days prior to ensure the tenant continues
to be eligible for assistance and that all verifications are received prior to the
anniversary date. TBRA participants must provide current income and asset
documents, complete new intake paperwork, and pass HUD 52580 inspection
to qualify for a second year of TBRA assistance and execution of a new lease.
Page 7 of 12
Step 1 — Re-Application
The household is asked to update all household information on the
application.
Step 2 — Determination
Using the information from the application, the AHRI Coordinator will
repeat the income verification, lease approval, subsidy calculation and
contract/lease execution steps identified in the Initial Lease- up. The
HQS inspection and all documentation will be done and dated prior to
the anniversary date. Recertification documents become part of the
client/tenant file. For income eligibility at recertification, tenants may
exceed 60% AMFI but must be below 80%AMFI at time of recertification
as verified per section 8 income verification method.
Step 3 — Notification
The landlord and tenant will be notified of updated rent amounts,
whether or not the rent portions change. A new rent should take effect
on the anniversary date and a full 30-day notice of any rent increase will
be provided to the tenant by AHRI. If rent certification is late and
decreases the 30-day timeframe, the rent increase may not take effect
until the following month. Copies of all notice correspondence will be
maintained in the client file.
Interim Changes
Revisions to the lease can occur when there is reasonable cause occurring in
a non-annual recertification month. A revision may be necessary with a
change in address or household income, losing or adding a household
member or property suddenly becomes uninhabitable.
Households are not required to report income changes until the Annual
Recertification process, however, households may request Interim Recerts if
household income has decreased. AHRI will follow all three steps listed under
Recertification. Decreases in the client/tenant portion of rent do not require
a 30-day notice. The decrease will take effect immediately, for example, a
change of income is reported and verified on May 20th, starting June 1, the
tenant's portion would be the lesser amount.
Self-Sufficiency Requirements
Page 8 of 12
1.The AHRI Coordinator will assist each TBRA voucher recipient to complete
a Self Sufficiency Plan as a requirement of TBRA assistance. The Plan will
include the participant's description of their desired permanent housing and the
steps they plan to take in securing the housing.
2.The AHRI Coordinator will provide resource listings to assist participants to
identify affordable or subsidized housing in the service area. It is the
responsibility of each participant to initiate and take steps to access
permanent housing prior to the expiration of the TBRA voucher support.
3. When needs are identified within the SS Plan that exceed the scope of
services provided by AHRI, participants will be referred by AHRI's case
manager to community partners, including Coastal Bend Center for
Independent Living, the Aging and Disability Resource Center and others.
4. Applicants will be informed of the housing properties AHRI owns/manages
if available as a short term or permanent housing option. AHRI will not
provide TBRA vouchers at any of its properties.
5. Participants are required to seek and maintain active status on subsidized
waiting lists for permanent housing (HUD Section 8, Public Housing
Authority, etc.). When TBRA Program participants reach 6 months of
assistance, they will be asked to provide a report of their status in identifying
permanent subsidized housing.
Termination of Assistance
TBRA assistance may be terminated for the following reasons:
1 . a participant fails to accept a subsidized unit offered during the duration of
AHRI assistance;
2. a participant is evicted from the TBRA assisted unit;
3. a participant refuses to comply with lease requirements; and/or
4. if the participant, by his or her actions, threatens the business relationship
between AHRI and a property owner/landlord. Actions may include breaking
the lease, or behavior that threatens other tenants or the landlord. Should any
Page 9 of 12
unacceptable behavior be directly linked to an individual's disability, AHRI will
attempt to counsel the individual and may refer to an appropriate professional.
Handling Complaints and Grievances
Each applicant and participant has the right to appeal any decision made at the
staff level (TBRA Coordinator) or file a grievance with the AHRI Board of
Directors. The decision of the Board of Directors is final.
Wait List Policy and Procedure
During the initial application procedure applicants are placed on a wait list
by date and time of application and remain on the waitlist until their
application and all supporting documentation is completed. AHRI will
announce the program availability to community partners focusing on those
that serve the target population of Individuals with disabilities, seniors
defined as persons over 55, Veterans, those who are homeless as defined
by 24 CFR 91 .5, and others at the very low and extremely low income levels
who may be at risk of homelessness or institutionalization. AHRI will
announce a date to begin receiving applications. When requested,
accommodations will be made for persons with disabilities such as large print
application and assistance with completing the application. Applicants will
be served on a first come, first served basis.
Applicants with verified preferences will be prioritized. The approved
preferences and documentation required are:
• Senior, over 55, documented with state issued ID, Drivers License, or
birth certificate.
• Veteran- documented with DD214
• Disability- documented with a statement from a health care provider
or Social Security Disability Income award letter
• Homeless- documented with eviction notice, letter from homeless
shelter, or self certification claiming homelessness as defined by 24
CFR 91 .5,
• Extremely low income- income below 30% of AMFI- verified by
Section 8 income verification described above, all applicants under
Page 10 of 12
30% AMFI and otherwise qualified will be served to ensure that half of
all eligible applicants assisted is a household under 30% AMFI.
If funds are not available when eligibility is determined, applicants remain on
a waiting list maintained by AHRI, and are served in a first come, first served
order when funds become available.
Conflict of Interest
AHRI will comply with the City of Corpus Christi Housing and Community
Development Conflict of Interest Policy.
Prohibited Activity
AHRI will not use TBRA funds for the following prohibited activities:
• Application fees for housing units
• Applicant background checks
• Telephone and cable deposits
• Landlord vacancy and/or damage claims
• Down payment and/or closing costs in conjunction with a lease-purchase
program
• To make commitments to specific owners for specific projects. Tenants must
be free to use the assistance in any eligible unit
• To assist resident owners of cooperative housing that qualifies as
homeownership housing. Cooperative and mutual housing may qualify as
either rental or owner-occupied housing, depending on the provisions of the
agreement applying to the unit
• To prevent displacement of or provide relocation assistance to tenants as a
result of activities other than the HOME Program
• To provide TBRA to homeless persons for overnight or temporary shelter.
Any HOME TBRA subsidy must be sufficient to enable a homeless person to
rent a transitional or permanent housing unit that meets Housing Quality
Standards (HQS)
• To provide assistance for more than 24 months. The term of rental
assistance contract providing assistance with HOME funds may not exceed
24 month, but may be renewed, subject to the availability of HOME funds
Page 11 of 12
• To duplicate existing rental assistance programs that already reduce the
tenant's rent payment to 30 percent of income. For example, if the household
is already receiving assistance under the Section 8 Housing Choice Voucher
Program (Section 8), the household may not also receive assistance under a
HOME TBRA program
• To provide assistance outside of the agency's service area.
Tenant Selection Policy and Criteria
Administration of HOME-funded TBRA programs must have a written tenant
selection criteria that clearly specifies how families will be selected for
participation in their programs. AHRI shall create and select families based on
written tenant selection policy. There are two major components of tenant
selection, income eligibility and preferences.
1. Income eligibility: households who receive HOME-funded TBRA must
have an annual income that does not exceed 80 percent of the area
median income.
2. Preferences: Use of HOME-funded TBRA programs to support a
a specific or variety of local goals and initiatives.
AHRI shall provide and meet tenant selection process requirements by HUD
and approved by the AHRI Board of Directors and the applicable funding
sources.
Addendum
Changes, additions or replacement language to these Policy and Procedures
is allowable through an amendment process that will be approved by the AHRI
Board of Directors and the applicable funding sources.
Page 12 of 12
EXHIBIT H
INSURANCE REQUIREMENTS
CONTRACTOR'S LIABILITY INSURANCE
A. Contractor must not commence work under this agreement until all insurance required has been obtained
and such insurance has been approved by the City. Contractor must not allow any subcontractor Agency
to commence work until all similar insurance required of any subcontractor Agency has been obtained.
B. Contractor must furnish to the City's Risk Manager and Director Human Resources, 2 copies of
Certificates of Insurance (COI) with applicable policy endorsements showing the following minimum
coverage by an insurance company(s) acceptable to the City's Risk Manager. The City must be listed as
an additional insured on the General liability and Auto Liability policies by endorsement, and a waiver
of subrogation is required on all applicable policies. Endorsements must be provided with COI. Project
name and or number must be listed in Description Box of COI.
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-written day notice of cancellation, Bodily Injury and Property Damage
required on all certificates or by applicable Per occurrence - aggregate
policy endorsements
CRIME/EMPLOYEE DISHONESTY $150,000 Per Occurrence
Contractor shall name the City of Corpus
Christi, Texas as Loss Payee
ERRORS & OMISSIONS $1,000,000 Per Occurrence
$1,000,000 Aggregate
C. In the event of accidents of any kind related to this agreement, Contractor must furnish the Risk Manager
with copies of all reports of any accidents within 10 days of the accident.
II. ADDITIONAL REQUIREMENTS
A. Applicable for paid employees, Contractor must obtain workers' compensation coverage through a
licensed insurance company.The coverage must be written on a policy and endorsements approved by the
Texas Department of Insurance. The workers' compensation coverage provided must be in an amount
sufficient to assure that all workers' compensation obligations incurred by the Contractor will be promptly
met.
B. Contractor shall obtain and maintain in full force and effect for the duration of this Contract, and any
extension hereof, at Contractor's sole expense, insurance coverage written on an occurrence basis, by
companies authorized and admitted to do business in the State of Texas and with an A.M. Best's rating of
no less than A- VII.
Page 1 of 3
C. Contractor shall be required to submit a copy of the replacement certificate of insurance to City at the
address provided below within 10 days of the requested change. Contractor shall pay any costs incurred
resulting from said changes. All notices under this Article shall be given to City at the following address:
City of Corpus Christi
Attn: Risk Manager
P.O. Box 9277
Corpus Christi, TX 78469-9277
D. Contractor agrees that with respect to the above required insurance, all insurance policies are to
contain or be endorsed to contain the following required provisions:
• List the City and its officers, officials, employees, volunteers, and elected representatives as additional
insured by endorsement, as respects operations,completed operation and activities of,or on behalf of,the
named insured performed under contract with the City, with the exception of the workers' compensation
policy;
• Provide for an endorsement that the "other insurance" clause shall not apply to the City of Corpus Christi
where the City is an additional insured shown on the policy;
• Workers' compensation and employers' liability policies will provide a waiver of subrogation in favor of
the City; and
• Provide thirty(30) calendar days advance written notice directly to City of any suspension, cancellation,
non-renewal or material change in coverage, and not less than ten (10) calendar days advance written
notice for nonpayment of premium.
E. Within five (5)calendar days of a suspension,cancellation, or non-renewal of coverage, Contractor shall
provide a replacement Certificate of Insurance and applicable endorsements to City. City shall have the
option to suspend Contractor's performance should there be a lapse in coverage at any time during this
contract. Failure to provide and to maintain the required insurance shall constitute a material breach of
this contract.
F. In addition to any other remedies the City may have upon Contractor's failure to provide and maintain any
insurance or policy endorsements to the extent and within the time herein required,the City shall have the
right to order Contractor to remove the exhibit hereunder, and/or withhold any payment(s) if any, which
become due to Contractor hereunder until Contractor demonstrates compliance with the requirements
hereof.
G. Nothing herein contained shall be construed as limiting in any way the extent to which Contractor may be
held responsible for payments of damages to persons or property resulting from Contractor's or its
subcontractor's performance of the work covered under this agreement.
H. It is agreed that Contractor's insurance shall be deemed primary and non-contributory with respect to any
insurance or self insurance carried by the City of Corpus Christi for liability arising out of operations
under this agreement.
Page 2 of 3
I. It is understood and agreed that the insurance required is in addition to and separate from any other
obligation contained in this agreement.
2018 Insurance Requirements
Housing and Community Development
Project Funding—Accessible Housing Resources, Inc.
11/28/2018 sw Risk Management
Page 3 of 3
Exhibit I—Client Service Spreadsheet
TBRA Agency
Month
Tenant Security Ten Utility
Client Name Bed Code Deposit Ten Cont Subs Amt Tot Rent Payments diff Hisp(Y/N) HH Race HH Size HH Head Enter Date Cont End Date
Subsidy Totals $ - $ - $ -
Page 1 of 2
o. of Bedrooms Code Hispanic Race of Head of Household Code Size of Household
1 — 1 Bedroom n—no 11 —White 1 — 1 Person
2—2 Bedrooms y—yes 12—Black or African American 2—2 Persons
3—3 Bedrooms 13—Asian 3—3 Persons
4—4 Bedrooms % of Area Median Code 14—American Indian or Alaska Native 4—4 Persons
5—5 or more Bedrooms 1 —0—30% 15—Native Hawaiian or Other Pacific Islander 5—5 Persons
2—30—50% 16—American Indian or Alaska Native&White 6—6 Persons
Head of Household Code 3—50—60% 17—Asian& White 7—7 Persons
1 —Single/Non Elderly 4—60—80% 18—Black or African American&White 8—8 or more Persons
2—Elderly 19—American Indian or Alaska Native&
3—Related/Single Parent Black or African American
4—Related/Two Parent 20—Other Multi-racial
5—Other
Ten Cont=Tenant Contribution
Subs Amt=Amount of rental subsidy paid in the
current month Tot Rent=Amount of monthly rent
charged by landlord
Diff=Difference between what is paid in current month and monthly
rental amount Enter Date=Date on which client first started receiving
HOME services
Cont. End Date=Subsidy Contribution End Date
Page 2 of 2
Exhibit 1
rusk
CITY OF CORPUS CHRISTI - DISCLOSURE OF INTEREST
City of Corpus Christi Ordinance 17112, as amended, requires all persons or firms seeking to do business with the City
to provide the following information. Every question must be answered. If the question is not applicable, answer with
"NA." See the definitions for the Disclosure of Interest in Section II -General� IInformation.COMPANY NAME: C (`�7S I 1,Q :S1 r� � MicoC] To C 64-14-e0
ADDRESS: t5 3 c) ! t� ,.`)c i , lC)t J\c (`t CoirS -78110
Select one: Corporation ( ✓ ) Partnership ( ) Sole Owner( )Association Other( )
DISCLOSURE QUESTIONS: If additional space is needed, please use reverse side of this page or attach a separate
sheet.
1. State the names of each "employee" of the City of Corpus Christi having an "ownership interest"constituting 3% or
more of the ownership in the above named "firm."
NameJobJob Title and City Department(if known)
NII '
2. State the names of each "official" of the City of Corpus Christi having an "ownership interest" constituting 3% or
more of the ownership in the above named "firm."
Name Title
3. State the names of each "board member" of the City of Corpus Christi having an "ownership interest" constituting
3% or more of the ownership in the above named "firm."
Name Board, Commission, or Committee
N\
4. State the names of each employee or officer of a "consultant" for the City of Corpus Christi who worked on any
matter related to the subject of this contract and has an "ownership interest" constituting 3% or more of the ownership
in the above named "firm."
Name Consultant
t\\
CERTIFICATE-I certify that all information provided is true and correct as of the date of this statement, that I have not
knowingly withheld disclosure of any information requested, and that supplemental statements will be promptly
submitted to the City of Corpus Christi, Texas as changes occur. ^I
Certifying Person: k a q _• • Title: cgco1- `QS 1(31
Qn-}
PR ► '*�
Signature: 4111.1. iI I/ Date: At(
41