Application

APPLYING FOR HUD HOUSING ASSISTANCE? THINK ABOUT THIS ... IS FRAUD WORTH IT?

Do You Realize ...

If you commit fraud to obtain assisted housing from HUD, you could be:

• Evicted from your apartment or house.
• Required to repay all overpaid rental assistance you received
• Fined up to $10,000.
• Imprisoned for up to five years.
• Prohibited from receiving future assistance.
• Subject to State and local government penalties.

Do You Know ...
You are committing fraud if you sign a form knowing that you provided false or misleading information. The information you provide on housing assistance application and recertification forms will be checked. The local housing agency, HUD, or the Office of Inspector General will check the income and asset information you provide with other Federal, State, or local governments and with private agencies. Certifying false information is fraud.
Documentation to provide at the time of your interview (all documents must be original documents & income statement must be dated within the last 90 days of the time of your interview)

 

YOU MUST HAVE THE FOLLOWING. YOUR APPLIATION CANNOT BE COMPLETED UNTIL WE RECEIVE THE INFORMATION BELOW.

1. Birth Certification or Verification of Birthday or Baptismal Certificate, Military Discharge papers, valid passport, vensus document showing age Naturalization certificate or Social Security Administration Benefits printout for entire household. 
2. Social Security Card or Other good forms of documentation for SSN: Original document issued by a federal or state government agency which contains the name, SSN, and other identifying information of the individual, Driver's license with SSN, Identification card issued by a medical insurance provider, or by an employer or trade union. Earnings statements or payroll stubs, Banks tatement, Form 1099, Benefit award letter, Retirement benefit letter or Life insurance policy or Court records for entire household. 
3. Proof of household income (check stub, employer statement, etc.) for entire household.
4. Photo ID (driver's license or I.D. card) for any person 18 yrs. or older listed on application. 

IT IS VERY IMPORTANT THAT YOU FURNISH ALL OF THE ABOVE INFORMATION SO THAT YOUR APPLICATION MAY BE PROCESSED. IF YOU CAN NOT KEEP THIS APPOINTMENT, PLEASE CALL THE OFFICE AT  (870) 633-2781

So Be Careful!

When you fill out your application and yearly recertification for assisted housing from
HUD make sure your answers to the questions are accurate and honest. You must include:

• All sources of income and changes in income you or any members of your household receive, such as wages, welfare payments, social security and veterans' benefits, pensions, retirement, etc.
• Any money you receive on behalf of your children, such as child support, AFDC payments, social security for children, etc.
• Any increase in income, such as wages from a new job or an expected pay raise or bonus.
• All assets, such as bank accounts, savings bonds, certificates of deposit, stocks, real estate, etc., that are owned by you or any member of your household.
• All income from assets, such as interest from savings and checking accounts, stock dividends, etc.
• Any business or asset (your home) that you sold in the last two years at less than full value.
• The names of everyone, adults or children, relatives and non-relatives, who are living with you and make up your household. (Important Notice for Hurricane Katrina and Hurricane Rita
• Evacuees: HUD's reporting requirements may be temporarily waived or suspended because of your circumstances. Contact the local housing agency before you complete the housing assistance application.)

Ask Questions
If you don't understand something on the application or recertification forms, always ask questions. It's better to be safe than sorry.
Watch Out for. Housing Assistance Scams!

• Don't pay money to have someone fill out housing assistance application and recertification forms for you.
• Don't pay money to move up on a waiting list.
• Don't pay for anything that is not covered by your lease.
• Get a receipt for any money you pay.
• Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges).

Report Fraud
If you know of anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information, report that person to the HUD Office of Inspector General Hotline. You can call the Hotline toll-free Monday through Friday, from 10:00 a.m. to 4:30 p.m., Eastern Time, at 1-800-347-3735. You can fax information to (202) 708-4829 or e-mail it to Hotline@hudoig.gov. You can write the Hotline at:
HUD OIG Hotline, GFI, 451 7th Street, SW
Washington, DC 20410

St. Francis County Housing
116 S Izard St
Forrest City, AR 72335
Phone: (870) 633-2781 
Email: wsfcha01@swbell.net

Household Information: Complete the following information for each household member that will occupy the unit at time of move-in:

Notification: Section 504 prohibits discrimination on the basis of disability in any program, service, or activity that receives federal financial assistance. A person with disabilities may not be denied the opportunity to participate in a program, service, or activity; may not be required to accept a different kind or lesser program service than what is provided to others, and may not be required to p1rticipa1c in separ111c programs and services, even if separate programs and services exist. A housing provider may not deny or refuse to sell or rent to a person with a disability, and nay not impose application or qualification criteria, rental fees or sales prices, and rental or sales terms or conditions that are different than those required of or provided to persons who are not disabled. Housing providers may not require persons with disabilities to live only on certain noon, or to all live in one section of the housing. Housing providers may not refuse to make repairs, and may not limit or deny someone with disability access to recreational and other public and common use facilities, parking privileges, cleaning or janitorial services, or 11ny services which are made available to other residents. People with disabilities may not be denied the opportunity 10 serve on planning or advisory boards because of their disabilities.

Notification: Section S04 prohibits discrimination on the basis of disability in anprogram. service, or activity that receives federal financial assistance. A person with disabilities may not be denied thwonunity to panicipate in a program, setVice, or activity; may not be required to 11ccept a different kind or lesser program oservice than what is provided to others, and may not be required to participate in separate programs and services, even if separate programs and services exist. A housing provider may not deny or refuse to sell or rent to a pcrso with a disability, and nay not impose application or qualification criteria, rental fees or sales prices, and rental or sales terms or conditions that are different than those required of or provided to persons who are notdisabled. Housing providers may not require persons withdisabilitics to live only on certain floors, or to all live in one section of the housing. Housing providers may not refuse to make repairs, and may not limit or deny socmne with a disability access to recreational and other public and common use facilits, parking privileges, cleaning or janitorial services, or any services which are made 11v11ilable to other residents. People with disahies may not be denied the opponunity lo serve on planning or advisory boards because of their disabilities.

Income Information:

Earned income is counted only for household members 18 or older and members who are legally emancipated. Unearned income such as a grant or benefit is counted for all household members, including minors.
Include all GROSS income (before taxes) each household member expects to earn in the next 12 months. (Check either YES or NO to each question.) Do YOU or ANYONE in your household receive OR expect to receive income from:

Asset Information: INCLUDE ALL ASSETS HELD BY ALL HOUSEHOLD MEMBERS INCLUDING MINORS.

Notification: Section 504 prohibits discrimination on the basis of disability in anprogram, service, or activity that receives federal financial assistance. A person with disabilities may not be denied the oportunity to participate in a program, service, or activity; may not be required to accept a different kind or lesser program or service than what is provided to others, and may not be required to participate in separate programs and services, even if separate programs and services exist. A housing provider may not deny or refuse to sell or rent to a person with a disability, and may not impose application or qualification criteria, rental recs or sales prices, and rental or sales terms or conditions that arc different than those required of or provided to persons who are not disabled. Housing providers may not require persons with disabilities to live only on certain floors. or to all live in one section of the housing. Housing providers may not refuse to make repairs, and may not limit or deny someone with a disability access to recreational and other public and common use facilities, parking privileges, cleaning or janitorial services, or any services which arc made available to other residents. People with disabilities may not be denied the opportunity to serve on planning or advisory boards because of their disabilities.

APPLICANTS CERTIFICATION:
I certify that the information provided on household composition, income, family assets and items for allowances and deductions, is accurate and complete to the best of my knowledge. I have received the application form and certify that the information shown is true and correct.
REPORTING CHANGES IN INCOME AND HOUSEHOLD COMPOSITION
I know I am required to report immediately (within 10 business days) in writing any changes in income and any changes in the household size, when a person moves in or out of the unit. I know I am required to cooperate in supplying all information needed to determine my eligibility, level benefits, or verify my true circumstance. Cooperation includes attending pre-scheduled meeting and completing and signing needed forms. I understand failure or refusal to do so may result in delays, termination of assistance, or eviction. I understand the rules regarding guest/visitors and when I must report anyone who is staying with me.
REPORTING ON PRIOR HOUSING ASSISTANCE:
I certify that I have disclosed where I received any previous Federal Housing Assistance and whether or not any money is owed at the Housing Agency. I certify that for this previous assistance I did not commit any fraud, knowingly misrepresent any information, or vacate the unit in violation of the lease agreement.
NO DUPLICATE RESIDENCE OR ASSISTANCE
I certify that the house or apartment will be my principal residence and that I will not obtain duplicate Federal Housing Assistance from another agency while I am in this current program. I will not live anywhere else without notifying the Housing Authority immediately in writing. I will not sublease my assisted residence.
CRIMINAL AND ADMINISTRATIVE ACTIONS FOR FALSE INFORMATION
Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent stata11ents to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring a civil action for damages and seek other relief, as may be appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8)-Violation of these provisions are cited as violations of 42 U.S.C. Section **408 {a) (6), (7) and (8). I understand that knowingly supplying false, incomplete or inaccurate information is punishable under Federal or State criminal law and is grounds for termination of housing assistance or termination of tenancy.
Section 504 of the Rehabilitation Act of 1973 states: No otherwise qualified individual with a disability in the United States shall, solely by reason of her or his disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program, service or activity receiving federal financial assistance or under any program or activity conducted by any Executive agency or by the United States Postal Service. (29 U.S.C. 794). This means that Section 504 prohibits discrimination on the basis of disability in any program or activity that receives financial assistance from any federal agency, including the U.S. Department of Housing and Urban Development (HUD) as well as in programs conducted by federal agencies including HUD.
All household members 18 and over must sign below:

BEFORE SUBMITTING YOUR APPLICATION, YOU MUST READ AND FILL OUT EACH FORM BELOW. YOUR APPLICATION WILL NOT BE ACCEPTED IF EACH FORM IS NOT FILLED OUT.

Notification: Section S04 prohibits discrimination on the basis of disability in anprogram, service, or activity that receives federal financial assistance. A person with disabilities may not be denied thcpponunity 10 panicipate in a program, service, or activity; may not be required 10 accept a different kind or lesser program oservice than what is provided to others, and may not be required to panicipate in separate programs and services, even if separate programs and services exist. A housing provider may not deny or refuse to sell or rent to a pcrso with a disability, and nay not impose application or qualification criteria, rental fees or sales prices, and rental or sales terms or conditions that arc different than those required of or provided to persons who arc notdisabled. Housing providers may not require persons withdisabilities to live only on cenain floors. or to all live in one section of the housing. Housing providers may not refuse to make repairs, and may not limit or deny soaone with a disability access to recreational and other public and common use facilili!, parking privileges, cleaning or janitorial services, or any services which are made available to other residents. People with disal:lia may not be denied the opponunity to serve on planning or advisory boards because of their disabilities.