NAPA PARK HOMES
790 Lincoln Avenue, Napa, CA 94558
707-255-3119
Professionally Managed by Napa Valley Community Housing since 2005
Waitlist Application Checklist
Thank you for your interest in Napa Park Homes rental housing. For your
convenience we’ve summarized below the items you must bring when you submit
your waitlist application. Applications cannot be accepted until all items,
applicable to your household, are present. This means that every form must
be completed in full and required documents provided. Thank you!
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Completed and Signed Waitlist Application.
Completed and signed Race and Ethnicity forms, one per household.
Most recent Pay Check Stub for all applicants’ who are working or receiving
unemployment. Note: If pay amounts vary from one pay period to the next,
it is advisable to provide more than one pay stub.
State or National photo ID for each adult household member.
Current Social Security, SDI or SSI award letter, if anyone in the
household is receiving benefits
Current EDD or other benefit letter, if anyone in the household is receiving
Unemployment, Disability or Workers Compensation.
Current Passport to Services letter, if receiving public assistance (TANF,
food stamps, etc.)
EQUAL OPPORTUNITY HOUSING
Napa Valley Community Housing
5 Financial Plaza, Suite 200
Napa, CA 94558
www.nvch.org
Rev. 01/25/2010
NAPA PARK HOMES
790 Lincoln Avenue, Napa, CA 94558
707-255-3119
Manejados Profesionalmente por Napa Valley Community Housing desde el 2005
Lista de documentos para la solicitud de lista
de espera
Gracias por su interés en aplicar a los departamentos Napa Park Homes. Para
su comodidad enseguida hemos resumido los artículos que necesita traer cuando
presente su solicitud. No se aceptaran solicitudes incompletas. Esto significa
que cada uno de los formularios tienen que ser llenados completamente y todos
los documentos requeridos sean proveídos a la hora de entrega. ¡Gracias!
EN
AR
EN
IN
G
LE
S
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LL
TE
EN
LA
M
SO
O
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Solicitud para la lista de espera completada y firmada.
Formulario completado de raza y grupo étnico, llenar un formulario por hogar.
Ultimo talón de cheque mas reciente para todos los solicitantes con empleo o
que reciben desempleo. Nota: Si el total de paga varea de fecha de pago a
fecha de pago se les recomienda traer más de un talón de cheque.
Identificación Estatal o Nacional con foto para cada uno de los adultos
miembros de familia.
Carta actual de pagos del seguro social, SDI o SSI si alguien en la familia
recibe estos beneficios
Carta del EDD actual u otra carta de beneficios si alguien in la casa recibe
Desempleo, Discapacidad o Compensación de Trabajadores.
Pasaporte o carta de servicios actual si usted recibe ayuda pública (TANF,
estampillas de comida, etc.)
PL
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EJ
EM
EQUAL OPPORTUNITY HOUSING
Napa Valley Community Housing
5 Financial Plaza, Suite 200
Napa, CA 94558
www.nvch.org
Rev. 01/25/2010
OFFICE USE ONLY
ONE / TWO / THREE
NAPA PARK HOMES, INC.
790 Lincoln Avenue, Napa, CA 94558
APPLICATION FOR WAITING LIST
Please complete all sections by printing in ink. DO NOT LEAVE ANY SECTION BLANK. If it does not apply, write “N/A.” Extra space
is provided on the back. Thank you
Middle Initial
Driver’s License/I.D.#
First Name
APPLICANT/Last Name (Head of Household)
SPOUSE (CO-TENANT)/Last Name
First Name
Middle Initial
Driver’s License/I.D.#
Present Address/Street No.
City, State, Zip
Length of Residence
Phone Number
(
)
TENANT HISTORY (Five [5] years minimum)
Address
City
State
Length of Stay
Landlord Name/Phone
HOUSEHOLD COMPOSITION:
List all persons, including yourself, who will reside in the unit. Note: The number to the left indicates the “Household
Member Number” and is the number requested to indicate a particular household member in the remaining sections of this application.
Relationship Sex
Social Security or
Age
Birthdate Birthplace/
Occupation
to Head
Alien Registration #
(Circle
(U.S. City or
Full Name
#
one)
Head of
Household
1 2 3 4 5 6 7 M
F
M
F
M
F
M
F
M
F
M
F
M
F
Foreign)
INCOME * EMPLOYMENT ONLY:
List all full-time, part-time and/or seasonal employment for EACH household member, including self-employment
earnings. Include Overtime Pay, Tips and Bonuses. (If you have income from “other” sources, see next page.)
HH
Employer
Name of
Annual Income
Employment Address
Member #
(Including Zip code)
Place of Employment
(Yearly Total)
Phone
Supervisor
USO DE OFICINA SOLAMENTE
NAPA PARK HOMES, INC.
UNA / DOS / TRES
790 Lincoln Avenue, Napa, CA 94558
APLICACION PARA LA LISTA DE ESPERA
Por favor complete todas las secciones con tinta. NO DEJE NINGUN ESPACIO EN BLANCO. Si alguna información no le aplica
escriba “N/A”. Espacio adicional proporcionado al reverso. Gracias
Inicial de Segundo
# de Licencia de
SOLICITANTE/Apellido (Cabeza del Hogar)
Primer Nombre
Nombre
Conducir/I.D.
ESPOSA(O)/(CO-ARRENDANTE) – Apellido
Primer Nombre
Inicial de Segundo
Nombre
# de Licencia de
Conducir/I.D.
Dirección actual/ No. de calle
Ciudad, Estado, Código
Duración de
Arriendo
Número de Teléfono
(
)
Estado
Tiempo de Estancia
EN
AR
Nombre del Dueño/Teléfono
LE
S
Ciudad
IN
G
Dirección
EN
HISTORIAL DE ARRENDAMIENTO (Mínimo 5 años)
COMPOSICION DEL HOGAR: Escriba todas las personas, incluyéndose usted mismo, que vivirán en la unidad. Nota: El número de la izquierda indica el
3 4 O
EJ
EM
2 5 6 7 Edad
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Fecha de
Nacimiento
# Seguro Social o
Registración
Extranjera
Ocupación
Lugar de
Nacimiento
TE
(Circule
uno)
SO
Cabeza del
Hogar
1 Sexo
EN
Nombre Completo
PL
#
Relación con
el Cabeza de
Hogar
(EE.UU., o
Extranjero)
LA
M
LL
“Número de Miembro del Hogar” y es el número requerido para indicar miembros del Hogar en particular en las siguientes secciones de esta aplicación.
INGRESOS * EMPLEO SOLAMENTE: Escriba todos los empleos de tiempo completo, tiempo parcial y/o temporal para TODOS los miembros del hogar
incluyendo ingresos de negocio propio. Incluya horas extras, propinas, y bonos. (Si tiene ingresos de “otras” fuentes, vea la página siguiente.)
# Miembro Teléfono de Nombre de
Ingreso Anual
Dirección de Empleo
del Hogar
(Incluyendo Código Postal)
Lugar de Empleo
(Total al Año)
Empleador
Supervisor
PREFERENCES:
To indicate that your household qualifies for one of the Preferences established for this property, check the applicable box below.
My household has been displaced from housing by government action.
My household has been displaced from housing due to a presidentally declared disaster.
INCOME FROM OTHER SOURCES: Please list ALL income from sources other than “employment” for ALL family members. This Includes but is not
limited to, Welfare, TANF, Social Security, SSI, SDI or other Disability, Death Benefits, Unemployment, Alimony, Child Support, etc.
HH Member
Income
Number
Source of Income
Address of Source
Annual
(Yearly Total)
$
$
$
CHECKING ACCOUNTS:
HH Member
Number
Account Number
Bank Name
Current
Balance
Complete Bank Address
Interest
Rate
$
%
$
%
$
%
SAVINGS ACCOUNTS:
HH Member
Number
Account Number
Bank Name
Current
Balance
Complete Bank Address
Interest
Rate
%
$
%
$
%
$
STOCKS, BONDS, CREDIT UNION SHARES, ETC.:
HH Member
Number
Current
Value
Description of Asset
REAL ESTATE:
Annual
From this Asset
$
$
$
DO YOU OWN REAL ESTATE?
Yes
No
$
If Yes, are you receiving any income from this property?
Yes
No
If Yes, ADDRESS OF PROPERTY:
Annual INCOME from this Property: $
EXPENSES (type/amount):
MEDICAL AND/OR CHILD CARE EXPENSES:
CHECK
IF HEAD OF HOUSEHOLD OR SPOUSE IS:
1) Handicapped ( )
2) Disabled ( )
3) Age 62 or Older ( )
If you checked box 1, 2, or 3 above, please list below out-of-pocket medical expenses not covered by Insurance here:
DO YOU INCUR CHILDCARE OR DISABLED ADULT CARE COST/S?
Yes (
)
No (
)
ARE ALL ADULT FAMILY MEMBERS EITHER WORKING, STUDYING OR SEEKING EMPLOYMENT? Yes (
)
No (
)
If you answered “Yes” to the above two (2) questions, please list payments made to childcare provider below.
HH Member
Number
Description of Expense/s
Paid To
Cost per
Month
Address
$
$
PREFERENCIAS: Para indicar que su hogar califica para una de las Preferencias establecidas para esta propiedad, marque la caja correspondiente abajo.
Mi Hogar ha sido desplazado de vivienda debido a acción gubernamental.
Mi Hogar ha sido desplazado de vivienda debido a desastres declarados presidencialmente.
INGRESOS DE OTRAS FUENTES: Por favor anote TODOS los ingresos de otras fuentes aparte de “empleo” de TODOS los miembros del hogar. Esto incluye pero no está
limitado a “Welfare”, TANF(asistencia pública), Seguro Social, SSI, SDI o Discapacidad, Beneficios por Muerte, Desempleo, Manutención de Cónyuge, Manutención de niños, etc.
# Miembro
Fuente de Ingreso
Del Hogar
Ingreso Anual
(Total al Año)
Dirección
$
$
$
CUENTAS DE CHEQUES:
# Miembro
Número de Cuenta
Nombre del Banco
$
IN
G
$
EN
%
$
%
$
%
$
TE
Tasa de
Interés
EN
AR
%
Balance
Actual
Dirección completa del Banco
%
LL
Nombre del Banco
%
# Miembro
$
CUENTAS DE AHORROS:
Número de Cuenta
Tasa de
Interés
Del Hogar
Balance
Actual
Dirección completa del Banco
LE
S
Del Hogar
# Miembro
Descripción de los Bienes
EJ
EM
Si, Sí, DIRECCION DE LA PROPIEDAD:
PL
BIENES RAICES: ES DUEÑO DE BIENES RAICES? Si
No
INGRESO Anual de esta Propiedad: $
Ingreso Anual
de esta Acción
$
$
$
SO
O
Valor
Actual
LA
M
Del Hogar
EN
ACCIONES, BONOS FINANCIEROS, ACCIONES DE UNION DE CREDITO, ETC.: $
si contesto Sí, ¿Está recibiendo algún ingreso por esta propiedad? Si
No
GASTOS (tipo/cantidad):
GASTOS MEDICOS Y/O DE CUIDADO DE NIÑOS:
MARQUE
SI EL CABEZA DEL HOGAR O ESPOSA(O) ES: 1) Discapacitado( ) 2) Incapacitado( ) 3) Mayor de 62 años( )
Si marcó opciones 1,2 ó 3 arriba, por favor escriba abajo gastos médicos no cubiertos por aseguranza y que usted paga
de su bolsillo:
¿TIENE GASTOS DE CUIDADO DE NIÑOS O DE ADULTO DISCAPACITADO?
Si (
)
No (
)
¿ESTAN TODOS LOS ADULTOS MIEMBROS DEL HOGAR TRABAJANDO, ESTUDIANDO, O BUSCANDO EMPLEO? Si (
) No (
)
Si contestó “Si” a las dos preguntas de arriba, por favor escriba abajo los pagos que hace al proveedor de cuidado.
# Miembro Descripción de Gasto/s
Del Hogar
Pagado a
Costo Por
Mes
Dirección
$
$
AUTOMOBILE / VEHICLE: List ALL motor vehicles owned by/registered to a family member. (Include Motorcycles)
HH Member
Number
Name of Registered Owner
Model/Make
Year
License Plate Number
State
Color
Please indicate your answers to the following questions:
1. Have you sold or given away any assets in the last two years for less than its fair market value?
2. Have you ever been evicted from tenancy?
3. Have you ever been terminated from a housing program because of fraud, non-payment of rent
comply with a recertification process?
or failure to
4. Has any adult in your household filed for bankruptcy in the last three years?
5. Does your household have debts of more than $6,000 which are currently in collection?
6. Has any member of your household been convicted of a crime in the last five (5) years? (Including the use
manufacture or sale of illegal drugs or domestic violence)
7. Have you ever-applied to live at this property before?
8. Is at least one member of your household a U.S. citizen or qualify as a U.S. legal Non-citizen?
9. Does anyone in your household need a unit with special features intended for persons with disabilities?
[
[
[
] Yes*
] Yes*
] Yes*
[
[
[
] No
] No
] No
[1]
[2]
[3]
[
[
] Yes*
] Yes*
[
[
] No
] No
[4]
[
] Yes*
[
] No
[6]
[
[
[
] Yes*
] Yes*
] Yes*
[
[
[
] No
] No
] No
[8]
[
] No [10]
[5]
[7]
[9]
(No applicant, who is otherwise qualified, will be denied housing solely by reason of his/her disability)
Describe special features required
10. Do you anticipate any changes in your household size in the next twelve months?
11. Are any members of this household full-time students? List HH Members #’s
12. How/Where did you hear about this housing facility?
[
] Yes*
*Explain any “Yes” answers here:
PLEASE NOTE: THIS IS A PRELIMIARY APPLICATION AND GIVES NO LEASE OR RENTAL RIGHTS. ADDITIONAL INFORMATION WILL BE
REQUIRED AT A LATER DATE TO COMPLETE PROCESSING WHEN THE WAITLIST APPLICANT IS INVITED TO APPLY FOR A VACANT UNIT.
WAITLIST APPLICANTS MUST UPDATE THEIR APPLICATION BY COMPLETING AND RETURNING A WAITLIST UPDATE FORM EVERY SIX
MONTHS IN ORDER TO REMAIN ON THE LIST.
GROUNDS FOR DENIAL: An explanation of our Grounds for Denial for Housing Applications can be found within the attached Tenant Selection Plan,
pgs. 10-11. Please acknowledge here that you have received a copy of the T.S.P. and located these reason for possible rejection. _
Initials, Head of Household
APPLICANT CERTIFICATION:
I/We certify that if I/We were selected to move into this project, the unit would be my/our only place of residence. I/We understand that the above
information is being collected to make a preliminary determination of my/our eligibility for subsidized housing. I/We certify that the statements made in this
application are true and correct to the best of my/our knowledge and belief. I/We understand that false statements of information are punishable under
Federal Law.
Head of Household
Date
Spouse/Co-Tenant
Date
Other Adult Household Member
Date
Other Adult Household Member
Date
Other Adult Household Member
Date
Other Adult Household Member
Date
Received By:
Date:
Time:
Residency at Napa Park Homes is open to all eligible, qualified persons without
regard to race, color, religion, national origin, age, disability, sex,
familial status, ancestry, or sexual orientation.
AUTOMOVIL/VEHICULO: Anote TODOS los vehículos propios/registrados de los miembros del Hogar. (Incluya Motocicletas)
# Miembro
Del Hogar Nombre del Dueño Registrado
Modelo/Marca
Año
No. de Placa
Estado
Color
Por favor indique sus respuestas a las siguientes preguntas:
LE
S
1. ¿Ha vendido o regalado alguna acción en los últimos dos años por menos del valor justo del mercado?
[
[
2. ¿Ha sido desalojado de alguna vivienda?
3. ¿Ha sido alguna vez terminado de algún programa de vivienda debido a fraude, incumplimiento con el pago de renta o
incumplimiento con el proceso de re-certificación?
[
4. ¿Algún adulto en el hogar se ha declarado en banca rota en los últimos 3 años?
[
[
5. ¿Alguien en su hogar tiene deudas de mas de $6,000 las cuales actualmente están en colección?
6. ¿Alguien en su hogar ha sido convicto de algún crimen en los últimos cinco (5) años? (Incluyendo el uso,o venta
de drogas ilegales o violencia doméstica).
[
7¿Ha aplicado para vivir en esta propiedad anteriormente?
[
8. ¿Es al menos uno de los miembros del hogar ciudadano de los EE.UU. ó califica como no-ciudadano legal de
EE.UU?
[
[
9. ¿Alguien en su hogar requiere adaptaciones especiales previstas para una persona con discapacidades?
] Si*
] Si*
[
[
] No
] No
[[1]
] Si*
] Si*
] Si *
[
[
[
] No
] No
] No
[3]
] Si *
] Si *
[
[
] No
] No
] Si *
] Si *
[
[
] No
] No
[8]
] Si *
[
] No
[10]
[2]
[4]
[5]
[6]
[7]
[9]
Describa las adaptaciones especiales requeridas
10. ¿Anticipa cambios en el tamaño de su hogar en los próximos 12 meses?
11. ¿Hay algunos miembros de este hogar estudiantes de tiempo completo?
12. ¿Cómo/Dónde escuchó de esta facilidad de vivienda?
IN
G
Ningún solicitante, que de cualquier otra manera califique, se le negará vivienda por el solo hecho de su discapacidad)
EN
*Explíque cualquier respuesta contestada “Si" en este espacio:
EN
AR
[
Escriba el # de Miembro/(s)
TE
LL
POR FAVOR NOTE: ESTA ES UNA APLICACION PRELIMINARIA QUE NO DA DERECHOS A CONTRATO O ARRENDAMIENTO. INFORMACIÓN
ADICIONAL SERÁ REQUERIDA DESPUES PARA COMPLETAR EL PROCESO CUANDO EL APLICANTE SEA INVITADO A APLICAR PARA UNA
UNIDAD VACANTE. SOLICITANTES DE LA LISTA DE ESPERA DEBEN ACTUALIZAR SU APLICACIÓN AL COMPLETAR Y REGRESAR LA FORMA
DE VERIFICACION DE ESTATUS DE APLICACIÓN CADA SEIS MESES EN ORDEN DE MANTENERSE EN LA LISTA DE ESPERA.
LA
M
EN
FUNDAMENTOS PARA LA DENEGACIÓN: Una explicación de nuestros fundamentos para la denegación de la solicitud de arrendamiento puede ser
encontrada adjunto del “Tenant Selection Plan”, páginas 10-11. Por favor indique aquí que usted ha recibido una copia del TSP y ha localizado las
razones posibles de rechazo.
_
Iniciales, Cabeza de Familia
O
SO
CERTIFICACIÓN DE SOLICITANTE:
Yo/Nosotros certificamos que si somos seleccionados para movernos a esta propiedad, la unidad será mí/nuestro único lugar de residencia.
Yo/Nosotros entendemos que la información arriba es colectada para hacer determinaciones preliminares de mi/nuestra elegibilidad para subvención de
vivienda. Yo/nosotros certificamos que las declaraciones hechas en esta aplicación son verdaderas y correctas a lo mejor de mi/nuestro conocimiento y
entendimiento. Yo/nosotros comprendemos que declaraciones falsas de información son castigadas bajo la ley Federal.
Cabeza del Hogar
Otro Adulto Miembro del Hogar
Otro Adulto Miembro del Hogar
EJ
EM
PL
Fecha
Esposa (o)/ Co-arrendador
Fecha
Fecha
Otro Adulto Miembro del Hogar
Fecha
Fecha
Otro Adulto Miembro del Hogar
Fecha
Recibida Por:
Fecha:
Hora:
Residencia en Napa Park Homes está abierta a todas las personas
elegibles, calificadas, sin importar la raza, color, religión, origen nacional,
edad, discapacidad, sexo, estatus familiar, ascendencia, u orientación
sexual.
OMB Control # 2502-0581
Exp. (11/30/2015)
Optional and Supplemental Contact Information for HUD-Assisted Housing Applicants
SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING
This form is to be provided to each applicant for federally assisted housing
Instructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing,
the name, address, telephone number, and other relevant information of a family member, friend, or social, health, advocacy, or other
organization. This contact information is for the purpose of identifying a person or organization that may be able to help in resolving any
issues that may arise during your tenancy or to assist in providing any special care or services you may require. You may update,
remove, or change the information you provide on this form at any time. You are not required to provide this contact information,
but if you choose to do so, please include the relevant information on this form.
Check this box if you choose not to provide the contact information.
Applicant Name:
Mailing Address:
Telephone No:
Cell Phone No:
Name of Additional Contact Person or Organization:
Address:
Telephone No:
Cell Phone No:
E-Mail Address (if applicable):
Relationship to Applicant:
Reason for Contact: (Check all that apply)
Emergency
Unable to
contact you
Termination of rental assistance
Eviction from unit
Late payment of rent
Assist with Recertification Process
Change in lease terms
Change in house rules
Other:
Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues
arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the
issues or in providing any services or special care to you.
Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the
applicant or applicable law.
Legal Notification: Section 644 of the Housing and Community Development Act of 1992 (Public Law 102-550, approved October 28, 1992)
requires each applicant for federally assisted housing to be offered the option of providing information regarding an additional contact person or
organization. By accepting the applicant’s application, the housing provider agrees to comply with the non-discrimination and equal opportunity
requirements of 24 CFR section 5.105, including the prohibitions on discrimination in admission to or participation in federally assisted housing
programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on
age discrimination under the Age Discrimination Act of 1975.
Signature of Applicant
Date
The information collection requirements contained in this form were submitted to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The
public reporting burden is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers participating
in HUD’s assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option to include in the application for occupancy the name, address,
telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such information is to
facilitate contact by the housing provider with the person or organization identified by the tenant to assist in providing any delivery of services or special care to the tenant and assist with resolving any
tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information. Providing the
information is basic to the operations of the HUD Assisted-Housing Program and is voluntary. It supports statutory requirements and program and management controls that prevent fraud, waste and
mismanagement. In accordance with the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless the collection
displays a currently valid OMB control number.
Privacy Statement: Public Law 102-550, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be
used by HUD to protect disbursement data from fraudulent actions.
Form HUD- 92006 (05/09)
El presente documento es la traducción de un documento legal emitido por el Departamento de Vivienda y Desarrollo Urbano (Housing and Urban Development, HUD). El
HUD le brinda esta traducción únicamente para su comodidad, con el objeto de ayudarle a comprender sus derechos y obligaciones. La versión en inglés de este documento
es el documento oficial, legal y prevaleciente. El presente documento traducido no constituye un documento oficial.
N.º de control de OMB 2502-0581
Exp. (07/31/2012)
Información de contacto opcional y complementaria para solicitantes de asistencia de vivienda del HUD
COMPLEMENTO PARA SOLICITUD DE VIVIENDA CON ASISTENCIA FEDERAL
Este formulario será proporcionado a cada solicitante de vivienda con asistencia federal
Instrucciones: Persona u organización de contacto opcional: Tiene derecho por ley de incluir, como parte de su solicitud de vivienda, el nombre, la
dirección, el número de teléfono y otra información relevante de un familiar, amigo u organización social, médica, de defensa o de otra índole. Esta
información de contacto se recopila con el objeto de identificar a una persona u organización que puede ayudar a resolver cualquier problema que podría
surgir durante su alquiler o que puede ayudar a proporcionar cualquier servicio o atención especial que usted pudiera requerir. Podrá actualizar, quitar o
cambiar la información que proporcionó en este formulario en cualquier momento. No se le exigirá que brinde la información de este contacto, pero si
escoge hacerlo, incluya la información relevante en este formulario.
Nombre del solicitante:
Dirección postal:
N.º de teléfono celular:
LE
S
N.º de teléfono:
IN
G
Nombre de la persona u organización de contacto adicional:
N.º de teléfono celular:
EN
AR
N.º de teléfono:
Dirección de correo electrónico (si corresponde):
Relación con el solicitante:
Motivo del contacto: (Marcar todo lo que corresponda)
TE
Emergencia
Ayuda con el proceso de recertificación
Cambio en los términos del arrendamiento
Cambio en las reglas de la casa
Otro:
LA
M
EN
No
SO
es posible comunicarse con usted
Rescisión de la asistencia de alquiler
Desalojo de la unidad
Pago atrasado de la renta
LL
EN
Dirección:
PL
O
Compromiso del propietario o de la autoridad de la vivienda: Si es aprobado para la vivienda, esta información será conservada como parte de su archivo
de locatario. Si surgen problemas durante su alquiler o si requiere de algún servicio o atención especial, es posible que nos comuniquemos con la persona u
organización que incluyó para que lo ayude a resolver los problemas o le proporcione algún servicio o atención especial.
EJ
EM
Declaración de confidencialidad: La información proporcionada en este formulario es confidencial y no será divulgada a nadie salvo según lo permitido por
el solicitante o la ley vigente.
Notificación legal: La sección 644 de la Ley de Desarrollo Comunitario y de Vivienda de 1992 (Ley Pública 102-550, aprobada el 28 de octubre de 1992)
exige que a cada solicitante de vivienda con asistencia federal se le ofrezca la opción de proporcionar información relacionada con una persona u organización
de contacto adicional. Al aceptar la solicitud del solicitante, el proveedor de vivienda acuerda cumplir con los requisitos de igualdad de oportunidades y no
discriminación de 24 CFR sección 5.105, que incluye las prohibiciones sobre discriminación en la admisión o participación en programas de viviendas con
asistencia federal debido a la raza, el color de la piel, la religión, el origen nacional, el sexo, la discapacidad y el estado familiar según la Ley de Vivienda
Justa, y la prohibición sobre discriminación debido a la edad según la Ley contra la Discriminación por la Edad de 1975.
Marque esta casilla si escoge no proporcionar la información de contacto.
Se eliminó el cuadro de la firma
Los requisitos de recopilación de información contenidos en este formulario fueron enviados a la Oficina de Administración y Presupuesto (Office of Management and Budget, OMB) según la Ley de
Reducción del Papeleo de 1995 (Título 44, secciones 3501-3520 del Código de los EE. UU.). Se calcula que la carga de declaración pública es de 15 minutos por respuesta e incluye el tiempo para revisar
las instrucciones, buscar fuentes de datos existentes, recopilar y conservar los datos necesarios, y completar y revisar la recopilación de la información. La sección 644 de la Ley de Desarrollo Comunitario
y de Vivienda de 1992 (Título 42, sección 13604 del Código de los EE. UU.) impuso al HUD la obligación de solicitar a los proveedores de viviendas que participan en programas de viviendas con
asistencia del HUD que proporcionen a todas las personas o familias que soliciten la ocupación de una vivienda con asistencia del HUD la opción de incluir en la solicitud el nombre, la dirección, el
número de teléfono y demás información relevante de un familiar, amigo o una persona relacionada con una organización social, médica, de defensa o similar. El objeto de proporcionar tal información es
facilitar el contacto por parte del proveedor de viviendas con la persona u organización identificada por el locatario para que ayude a brindar todo servicio o atención especial al locatario y ayudarlo a
resolver cualquier problema de alquiler que surgiere durante el alquiler por parte de dicho locatario. Esta información de solicitud complementaria será conservada por el proveedor de vivienda y en carácter
de confidencial. Proporcionar la información es básico para las operaciones del Programa de Vivienda con Asistencia del HUD y es un acto voluntario. Respalda los requisitos reglamentarios y los controles
de administración y del programa para prevenir el fraude, el derroche y la mala administración. De conformidad con la Ley de Reducción del Papeleo, una agencia no podrá conducir ni
patrocinar, y no se le solicitará a una persona que responda a una recopilación de información, salvo que en la recopilación de información aparezca un número de control de OMB válido en la actualidad.
Declaración de privacidad: La Ley Pública 102-550 autoriza al Departamento de Vivienda y Desarrollo Urbano de los EE. UU. (HUD) a que recopile toda la información (salvo el número de seguro
social [SSN]), la cual será usada por el HUD para proteger los datos de desembolso de acciones fraudulentas.
Form. HUD- 92006 (05/09)_Spanish
RESIDENT SELECTION PLAN
NAPA PARK HOMES
Napa, CA
Section 8 Programs
August 24, 2015 Revision
10-15-12 Version
RESIDENT SELECTION CRITERIA
Please read the Resident Selection Criteria carefully. These are the standards by which your
application for housing will be reviewed. Management will consider the following screening criteria
when determining an applicant's eligibility for residency at NAPA PARK HOMES.
A. PROPERTY ELIGIBILITY SPECIFIC REQUIREMENTS
Napa Park Homes Inc. is a California based corporation which owns and operates Napa Park
Homes, an apartment housing facility consisting of 140 apartments in Napa, CA.
Napa Valley Community Housing acts as the managing agent for this property.
The purpose of this equal opportunity housing facility is to provide affordable housing for
low, very low, and extremely low-income households through the Department of Housing
and Urban Development's Sections 8 and 236 programs.
NAPA PARK HOMES has 140 apartments as follows:
116 Property Based Section 8 Apartments:
29 - 1 Bedrooms
44 - 2 Bedrooms
43 - 3 Bedrooms
24 Section 236 Apartments:
3 - 1 Bedrooms
8 - 2 Bedrooms
13- 3 Bedrooms
Residents moving into NAPA PARK HOMES must meet age and income qualifications in order to
be approved for occupancy.
The United States Department of Housing and Urban Development (HUD) requires that residents
be recertified annually. HUD also requires interim certification if the family income cumulatively
increases by $200.00 or more per month or there is a change in household composition.
B. APPLICATION ACCEPTANCE
Applications will be accepted from all persons aged 18 and above and/or emancipated minors.
Applications will be screened. When it is determined that the applicant meets the property
Eligibility and Basic Program Eligibility Requirements listed in this document, the applicant will
be invited to attend a personal interview.
In addition to providing income and asset documents, each household/applicant will be required
to provide authorization for a credit report(s) and criminal background check(s) for all household
members who are 18 years or older.
C. GENERAL INFORMATION
Residency is open to:
All qualified eligible persons in accordance with The Fair Housing Act Amendments of
1988 which prohibits discrimination in housing and housing related transactions based
on race, color, religion, sex, national origin, disability and familial status.
In accordance with Title VI of the Civil Rights Act of 1964 which prohibits
discrimination on the basis of race, color, or national origin in any program or activity
receiving federal financial assistance from HUD.
All qualified eligible persons in accordance with any State recognized protected classes.
2 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
Section 504 of the Rehabilitation Act of 1973 prohibits discrimination based on disability in
any program or activity receiving federal financial assistance from HUD.
Napa Park Homes does not discriminate based upon age for any reason, excluding HUD
program/property requirements. All interested persons, applicants, residents and the public will
be given information on LEP (Limited English Proficiency) and asked if they need any assistance
in applying or completing any essential documents. See LAP (Language Assistance Plan) for
details.
Napa Park Homes will make "reasonable accommodations” to individuals whose disabilities in
accordance with the Napa Park Homes Reasonable Accommodation Policies and Procedures, fair
housing guidelines as dictated by DFHEO and HUD regulations. This includes the application
process and residency period. For more information and the designated 504 Coordinator for the
site, please refer to management’s Section 504 Policy.
A person, in order to be a resident at Napa Park Homes, must be capable of fulfilling the lease
requirements. This means that the applicant must be able to meet all of his/her personal needs
and be able to fulfill the lease obligations with or without assistance.
Napa Park Homes does not provide, nor has the authority to provide, any care or supervision
services, does not accept or retain residents who demonstrate any level of need for care and
supervision services that cannot be provided by the resident or aides supervised by the resident,
and does not promise or make available in the future any assistance with personal activities of
daily living.
All potentially eligible, qualified applicants will be considered in accordance with the marketing
procedures of HUD and NAPA PARK HOMES. All applicants must comply with any applicable
admissions requirements in the HUD 4350.3 Handbook.
Napa Park Homes reserves the right to alter their Resident Selection Plan at any time. In such
an event, management will provide applicants and residents with 30 days notice.
D. CITIZENSHIP REQUIREMENTS
By law, only U.S. citizens and eligible non-citizens may benefit from federal rental assistance.
Compliance with these rules ensures that only eligible families receive subsidy. These
requirements apply to families making application to the property, families on the waiting list and
residents. Assistance in NAPA PARK HOMES is restricted to the following:
U.S. Citizens or nationals; and
Non-citizens who have eligible immigration status as determined by HUD.
All applicants who wish to be considered for the Section 8 units must submit evidence of
citizenship or eligible immigration status at the time of application. All families, regardless of age
must declare their citizenship or immigration status. Non-citizens (except those ages must sign a
Verification Consent Form and submit documentation of their status or sign a declaration that
they do not claim to have eligible status. Non-citizens age 62 and older must sign a declaration of
eligible immigration status and provide a proof of age document. Management will verify eligible
immigration status though the Department of Home Land Security web site. U.S. citizens must
sign a declaration of citizenship.
Mixed families, a family with one or more ineligible family member and one or more eligible family
members may receive prorated assistance continued assistance, or a temporary deferral of
termination of assistance.
3 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
E. INCOME REQUIREMENTS
The local “Section 8” Income Limits apply to this property and applicants must meet specific
income restrictions to be eligible for housing. This facility will house extremely low, very low, and
low-income elderly individuals and families, per program requirements. You may request a copy
of the current income limits from the Napa Park Homes Management Office. A copy of the
current income limits is referenced below.
Zero Income-An applicant or resident who claims zero income will be required to complete an
Income Questionnaire and sign a Certification of Zero Income on a quarterly basis (January,
March, June and September annually). Management will check the EIV system, Department of
Child Support Services and Department of Human Services for possible unreported income.
If a household reports zero income for a period of six months or more, management will require
copies of the most recent tax return and household members will be required to complete a
4506-T Form to obtain this information from the Internal Revenue Service.
Maximum Income-Applicant's household income limit cannot exceed the Maximum Income
Limits for the household size as set forth by the Department of Housing and Urban
Development (HUD) (See below):
Effective March 6, 2015
HUD Published Income Limits for 2015
Section 8
50%
30% Very Low
Low
1 Person
$30,600 $18,350
$30,600
$48,900
2 Person
$34,950 $21,000
$34,950
$55,850
3 Person
$39,300 $23,600
$39,300
$62,850
4 Person
$43,650 $26,200
$43,650
$69,800
5 Person
$47,150 $28,410
$47,150
$75,400
6 Person
$50,650 $32,570
$50,650
$81,000
7 Person
$54,150 $36,730
$54,150
$86,600
APPLICANTS FOR SECTION 8 SUBSIDY MUST HAVE GROSS ANNUAL INCOME AT OR BELOW THE
VERY LOW INCOME LIMIT (50%) FOR NAPA COUNTY AS DEFINED BY HUD
APPLICANTS FOR SECTION 236 APARTMENTS MUST HAVE ADJUSTED ANNUAL INCOMES AT OR
BELOW 80% OF AMI AS PUBLISHED BY HUD.
PLEASE NOTE: THESE GUIDELINES ARE UPDATED ON AN ANNUAL BASIS, NOT NECESSARILY
CONCURRENT WITH THE CALENDAR YEAR.
4 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
F. SOCIAL SECURITY REQUIREMENT
*All applicant and tenant household members must disclose and provide verification of
the complete and accurate SSN assigned to them except for those individuals who do
not contend eligible immigration status or tenants who were age 62 or older as of
January 31, 2010, and whose initial determination of eligibility was begun before January
31, 2010. This paragraph explains the requirements and responsibilities of applicants or
tenants to supply owners with this information, the responsibility of owners to obtain this
information, and the consequences for failure to provide the information.*
Key Requirements
*Applicants and tenants must disclose and provide verification of the
complete and accurate SSN assigned to each household member.
Failure to disclose and provide documentation and verification of SSNs
will result in an applicant not being admitted or a tenant household’s
tenancy being terminated.
Required Documentation
*Applicants and tenants must provide adequate documentation to verify the
complete and accurate SSNs assigned to all household members. Adequate
documentation means a social security card issued by the Social Security
Administration (SSA), an original document issued by a federal or state
government agency, which contains the name and SSN of the individual along
with identifying information of the individual, or other acceptable evidence of the
SSN listed below:
.
Provisions for Accepting Applicants without Documentation of Social
Security Numbers
*An applicant may not be admitted until SSNs for all household members have
been disclosed and verification provided.
G. VALIDATION OF SOCIAL SECURITY NUMBER
NAPA PARK HOMES will confirm HUD’s validation of the tenant’s SSN by viewing the
Household’s Summary Report and the Identity Verification Report in the EIV system.
H. TIMEFRAME FOR PROVIDING SOCIAL SECURITY NUMBERS
APPLICANTS CURRENTLY ON OR APPLYING TO WAITING LIST
Applicants do not need to disclose or provide verification of a SSN for all non-exempt
household members at the time of application and for placement on the waiting list.
However, applicants must disclose and provide verification of a SSN for all non-exempt
household members before they can be housed.
I.
HOUSING APPLICANTS FROM THE WAITING LIST
If all household members have not disclosed and/or provided verification of their SSNs at the
time a unit becomes available, the next eligible applicant must be offered the available unit.
The applicant who has not disclosed and provided verification of SSNs for all household
members must disclose and provide verification of SSNs for all household members to the
owner within 90 days from the date they are first offered an available unit.*
If the owner has determined that the applicant is otherwise eligible for admission into the
property, and the only outstanding verification is that of *disclosing and providing verification
of* the SSN, the applicant may retain his or her place on the waiting list for the *90*-day
period during which the applicant is trying to obtain documentation.
After *90* days, if the applicant has been unable to supply the required SSN *and verification*
documentation, the applicant should be determined ineligible and removed from the waiting list.
5 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
J.
VERIFICATION OF SOCIAL SECURITY NUMBER
Napa Park Homes will verify and document each disclosed SSN by:
Obtaining the documentation listed below from each member of the applicant’s or
tenant’s household:
Acceptable Verification Documents
Social Security Card
If you do not have a Social Security Card, Napa Park Homes may ask you to
provide one or more of the following documents:
1. Original document issued by a federal or state government agency which
contains the name, SSN, and other identifying information of the
individual*
2. Bank Statement
3. Benefit Award Letter
4. Court Records
5. Driver’s license with SSN
6. Earnings statements on payroll stubs
7. Identification Card Issued by a Medical Insurance Provider, or by an
Employer or Trade Union.
8. Form 1099
9. Life Insurance Policy
10. Retirement Benefit Letter
Making a copy of the original documentation submitted, returning the original to the individual
and retaining the copy in the file folder;
Recording the SSN on line 45 of the form HUD-50059 and transmitting the data to
TRACS in a timely manner.
To ensure that the SSN transmitted to TRACS is valid; Napa Park Homes will use the
Failed EIV Pre-Screening Report and the Failed Verification Report in EIV in accordance
with the instructions in the current HUD Housing Notice, Enterprise Income
Verification System.
The Failed EIV Pre-Screening Report identifies residents who failed the EIV pre-screening
test due to invalid or missing personal identifiers.
The Failed Verification Report identifies residents that have had their personal identifiers sent
to SSA, via HUD’s computer matching program with the SSA, but the data could not be
verified by SSA due to missing or invalid information or other SSA issues.
SOCIAL SECURITY NUMBER DOCUMENT REJECTION
We will reject a document that:
Is not an original document; or
Is the original document but it has been altered, mutilated, or is not legible; or
Appears to be a forged document (e.g., does not appear to be authentic).
Applicant or tenant will be notified in writing regarding the reason(s) why the document(s) is not
acceptable and request the individual obtain acceptable documentation.
6 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
ONCE SOCIAL SECURITY NUMBER VERIFIED
Once the individual’s SSN has been verified, Napa Park Homes will remove and destroy
the copy of the documentation referenced above by no later than the next recertification
of family income or composition.
Paper documentation may be destroyed by shredding, pulverizing or burning. Currently,
Napa Park Homes uses the shredding method.
Electronic documentation will be destroyed by erasing or permanently deleting the file.
The retention in the tenant file of the Household Summary Report from the EIV system
which will report the status of the identity verification process provides verification of the
SSN. Retaining this report in the tenant file and destroying the copy of the SSN
documentation will minimize the risk of exposing the individual’s SSN.
K. ELIGIBILITY REQUIREMENT FOR STUDENTS WHO ARE HEAD OR CO-HEAD OF A
HOUSEHOLD
The applicant who is the head and/or co-head in the household must be of legal contract age
under state law. The individual must have established a household separate from parents or
legal guardians for at least one year prior to application for occupancy or he/she meets the U.
S. Department of Education’s definition of an independent student. The individual must not
be claimed as a dependent by parents or legal guardians pursuant to IRS regulations. The
individual must obtain a certification of the amount of financial assistance that will be
provided by parents, guardians or others signed by the individual providing the support. This
certification is required even if no assistance will be provided. The financial assistance
provided by persons not living in the unit is part of annual income that must be verified to
determine eligibility and at annual recertification to determine rent.
L.
POLICY FOR ELIGIBILITY OF STUDENTS TO RECEIVE SECTION 8 ASSISTANCE
Restrictions on Eligibility of Students for Section 8 Assistance
NAPA PARK HOMES is required to determine whether applicants are eligible to occupy the
subsidized property and receive housing assistance. Eligibility is determined by federal
statute and HUD regulation. For HUD programs, eligibility is only determined at move-in or
at initial certification except as discussed in paragraphs **3-13, Determining Eligibility of
College Students for Assistance** and paragraphs **3-16 of the HUD 4350.3 Handbook,
Determining the Eligibility of a Remaining Member of a Resident Family. **HUD's general
eligibility requirements are found in HUD's regulations at 24 CFR, part 5.
No assistance shall be provided under Section 8 of the 1937 Act to any individual whom:
a) Is enrolled as either a part-time or full-time student at an institution of higher
education for the purpose of obtaining a degree, certificate, or other program
leading to a recognized educational credential;
b) Is under the age of 24;
c) Is not married;
d) Is not a veteran of the United States Military;
e) Does not have a dependent child;
f) Is not a person with disabilities, as such term is defined in (b) (3) (E)) and was not
receiving section 8 assistance as of November 30, 2005
g) Is not living with his or her parents who are receiving Section 8 assistance; and
h) Is not individually eligible to receive Section 8 assistance and has parents (the
parents individually or jointly) who are not income eligible to receive Section 8
assistance
For a student to be eligible independent of his or her parents (where the income of the
parents is not relevant), the student must demonstrate the absence of, or his or her
independence from, parents. NAPA PARK HOMES may use additional criteria for determining
the student’s independence from parents and the student must meet, at a minimum all of the
following criteria to be eligible for Section 8 assistance. The student must:
7 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
a)
b)
c)
d)
Be of legal contract age under state law;
Have established a household separate from parents or legal guardians for at
least one year prior to application for occupancy, or Meet the U.S. Department of
Education’s definition of an independent student.
Not be claimed as a dependent by parents or legal guardians pursuant to IRS
regulations; and
Obtain a certification of the amount of financial assistance that will
be provided by parents, signed by the individual providing the
support. This certification is required even if no assistance will be
provided.
Any financial assistance a student receives (1) under the Higher Education Act of 1965, (2) from
private sources, or (3) from an institution of higher education that is in excess of amounts
received for tuition is included in annual income, except if the student is over the age of 23 with
dependent children or if the student is living with his or her parents who are receiving Section 8
assistance.
If an ineligible student is a member of an applicant household or an existing household receiving
Section 8 assistance, the assistance for the household will not be prorated but will be terminated
in accordance with the HUD guidance
During the application process, management will appropriately screen applicants and households
for eligibility under this final rule. An applicant who is a student and who does not meet the
income eligibility requirements or jointly, do not meet the income eligibility requirements for
Section 8 assistance are not eligible for Section 8 assistance and will be prohibited from
participating in the program. A student under the age of 24 who is not a veteran, unmarried,
does not have a dependent child and who is currently receiving Section 8 assistance, if at
recertification is determined to be ineligible, will have his/her assistance terminated.
NAPA PARK HOMES will determine a student’s eligibility for Section 8 assistance at move-in,
annual recertification, initial certification (when an in-place resident begins receiving Section 8),
and at the time of an interim recertification if one of the family composition changes reported is
that a household member is enrolled as a student
**Students with disabilities receiving Section 8 as of November 30, 2005 are exempt from
the Independent Student restrictions on receiving Section 8 Rental Assistance.
NOTE: NAPA PARK HOMES cannot evict or require an ineligible student to move from a
unit as long as the student is in compliance with the terms of the lease.
M. RESIDENCE CRITERIA
A. KEY REQUIREMENT
Assisted tenants must have only one residence and receive assistance only in
that unit. This rule is meant to ensure that the government pays assistance on
Only one unit for a family and provides assistance to as many eligible families as
possible with available funding.
B. SOLE RESIDENCE REQUIREMENT
1. A family is eligible for assistance only if the unit will be the family’s only Residence.
2. The owner must not provide assistance to applicants who will maintain a Residence in addition
to the HUD-assisted unit.
C. PROHIBITION AGAINST DOUBLE SUBSIDIES
Under no circumstances may any tenant benefit from more than one of the following subsidies: RENT
SUPPLEMENT, RAP, SECTION 202 PAC, SECTION 202 PRAC OR SECTION 811 PRAC, OR PROJECTBASED SECTION 8 HOUSING ASSISTANCE, INCLUDING SECTION 202/8.
8 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
1.
Tenants must not receive assistance for two units at the same time.
2.
Tenants must not benefit from housing choice voucher assistance in a Unit already assisted
through PROJECT-BASED SECTION 8, RENT SUPPLEMENT, RAP, SECTION 202 PAC OR
SECTION 202 **PRAC** AND **SECTION** 811 PRAC.
This prohibition does not prevent a person who is currently receiving Assistance from applying for an
assisted unit in another property. The Assisted tenancy in the unit being vacated must end the day before
the Subsidy begins in the new unit.
N. PROCEDURES FOR ACCEPTING APPLICATIONS AND SELECTING FROM THE WAITING LIST
All persons/families interested in applying for housing at Napa Park Homes must comply with
the following requirements to be "considered for housing":
Applications may be picked up at the Management Office located at 790 Lincoln Avenue,
Napa, California, 94558 between the hours of 9:00 a.m. - 12:00 p.m. and 1:00 p.m. - 5:00
p.m., Wednesday and Thursday.
Requests for an application to be sent through the mail may be made by writing to the above
address or by telephoning (707) 255-3119 during the above business hours. Applications should
be returned during business hours in person or via first class mail. Allowances will be made for
persons with mobility impairments, who request a reasonable accommodation or who live out-ofstate. Applications will be date and time stamped and applications will enter the Waiting List in
the chronological order of receipt.
Application must list all family members who will reside in the unit.
Applicant must present an acceptable credit/criminal history per credit and criminal
screening criteria established by management, as reported by a credit bureau and/or by
any credit references listed on the application. A credit/criminal report will be run on the
applicant(s) by the Napa Park Homes in accordance with HUD Notice H2012-11, all
applicants age 18 or older will be subject to a criminal background check. Applicant
must not have an eviction for drug related criminal activity or display a pattern of abuse
of alcohol that would interfere with the health, safety or right to a peaceful enjoyment of
the premises by other residents. No family member can have a conviction other than
acquittal for any sexual offense.
Provide good/acceptable references from all landlords, both current and previous, listed
on the application and in credit bureau files.
Provide proof of citizenship for household members as well as social security numbers for
members of the family in accordance with Sections E, F, G and H of this document.
Show that the applicant has the ability to fulfill all the lease requirements (with or
without care assistance) where applicable.
Demonstrate satisfactory housekeeping habits that will not jeopardize the health,
security or welfare of other residents.
All of this information will be verified in accordance with HUD Regulations and
Requirements, as stated in HUD Handbook 4350.3 and all revisions. Applicants will be
required to sign appropriate forms authorizing management to verify any and all factors that
affect the applicant’s eligibility or the rent that the applicant will pay. All of this information
may be released by HUD to other Federal, State and Local Agencies.
In the event the applicant is personally unable to complete the form, the applicant must
provide the information to someone assisting in completing the form. The person assisting
the applicant must sign and date the application, indicating that it was completed at the
direction of the named applicant.
9 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
If an applicant fails to supply all necessary verification forms, information, or meet the
requests of the application process, or Napa Park Homes cannot obtain verification of
specific required information due to illegible forms/application, the applicant will be rejected
(please refer to Rejection Procedures for further information).
**If the applicant is a person with disabilities, Management must consider extenuating
circumstances where this would be required as a matter of reasonable
accommodation.
O. PROCEDURE FOR ACCEPTING APPLICATIONS AND PRE APPLICATIONS
1)
Initial Application. Applications are taken only when the Wait List is open for unit
type being requested. This property does not use pre applications. All Prospective
residents 18 years and over must fill out the application in full. The form is
reviewed with the applicant(s) if application is returned in person to make sure that
answers are clear and that all information is given. All persons intended to reside in
the apartment must be named, and no one not listed may live in the unit. If an
appropriate unit is available now or in the near future, and no eligible waiting list
applicant has priority, the application is processed immediately for approval or rejection.
The application information allows tentative determination (subject to confirmation) of the
applicant’s eligibility (family size, household characteristics, estimated anticipated annual
income, assets now owned and disposition of assets during the previous two years.)
Disability status is required only if the applicant is requesting a disabled-accessible unit
or special accommodation.
Applications may be picked up and dropped off in the management office between the
hours of 9:00 a.m. - 12:00 p.m. and 1:00 p.m. - 5:00 p.m. on Wednesday and
Thursday. We do not accept faxed copies. You may also mail your completed
application. See above for address.
2)
Pre-Qualifying Eligibility. The three applicants at the top of the waiting list are considered
active prospects even if a unit is not yet available. Steps are taken to qualify the applicants
so that when a unit becomes available the pre-screening, including verifications, is already
completed. Verifications are kept current within 120-day periods. If the top applicant is
found to be ineligible, the next party on the wait list is the lead applicant.
3)
Interview. An interview is held to determine final qualifications of the applicant to be placed
in the next available unit. Application information is updated, the applicant is advised of the
penalty for false information, current income and asset data are checked, and additional
verification forms are signed if needed. Social Security information or certifications are given.
Potential accommodation for disabled applicants is considered. Final occupancy
determination is not made until certification procedures are completed.
Upon receipt of the original application, the application is preliminarily reviewed. The
initial review will be for application completeness, to make sure that the application is
legible and to initially determine if the applicant appears to qualify for the Section 8
Program. This in no way means that an applicant qualifies, or is eligible. Eligibility can
be confirmed only after all items, which may have any bearing on the rent that the
applicant may pay, or subsidy he/she may receive are verified: income, assets, family
composition, etc. The applicant must be determined eligible to be offered housing.
As an applicant's name approaches the top of the Waiting List, or when an applicant is
being offered housing, a formal interview will be scheduled. At that time the applicant is
interviewed, all items on the application will be discussed and confirmed, and verification
forms will be signed by the applicant authorizing management to verify all of these
issues/items. Until all items are verified, eligibility cannot be determined, nor any
housing offered. Management must attempt to verify all factors with "third party" written
verification, per HUD Regulations and Procedures.
10 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
In the absence of third party verification within 14 days after attempting third party
verification, and no response being received, management will use “Review of Documents”
to verify items/issues in accordance with the HUD Handbook 4350.3 and all revisions.
4)
Placement on Wait List. A wait list is maintained for each unit type. If no appropriatetype unit is available for eligible applicants, they are placed on the list for desired unit
type, if requested. Based on current experience with turnover on that unit type, an estimate
is made as to the possible length of waiting time. No promise is made, since conditions,
time schedules and priorities may change.
Any applicant, who appears to qualify after Napa Park Homes reviews the application,
but before any information is formally verified, and for whom a unit is not currently
available, will be placed on the Waiting List. All received applications are noted with date
and times received, and enter the Waiting List in the chronological order of receipt. One
Waiting List is maintained for all apartments at Napa Park Homes. The applicant is
informed of the approximate wait for a unit and/or placement position on the waiting list.
It is the applicant’s responsibility to report changes on the application to Napa Park
Homes in a timely fashion.
Any applicant on the Waiting List is required to contact Napa Park Homes every six (6)
months to update their information, by completing a revised application form when
necessary. Any applicant on the Waiting List is required to contact the Napa Park Homes
when a change of address, phone, income or family composition occurs. This contact
must be done in the form of writing. Contact may be initiated by Napa Park Homes in
the form of a routine letter/postcard, sent to all applicants on the Waiting List,
requesting update information, asking if they wish to remain on the Waiting List and
stating that if the letter is not responded to within fourteen (14) days, their name will be
dropped from the Waiting List without further notice.
When the number of names/families on the Waiting List for any particular size exceeds
the annual apartment turn over for that size unit, the Waiting List may be closed.
Management will advise potential applicants of the closure of the waiting list and refusal
to take additional applications. A notice will be prominently posted in the
Management/rental office or reception area and in a local newspaper, stating the reason
Waiting List is closed and the effective date of the closure. When the Waiting list is to be
reopened, notice of this will be placed in the same local publication, as well as
notifications sent to appropriate social service agencies stating when the Waiting List will
be re-opened, as well as times and days that applications will be taken. This is done in
accordance with the Affirmative Fair Housing and Marketing Plan (HUD Form
935.2A).
If an applicant on the Waiting List is offered an apartment and refuses the offered
apartment, he or she may remain on the Waiting List if the refusal is for a verifiable
medical reason. The applicant will move to the bottom of the Waiting List. Any other
refusal reasons are considered valid reasons for refusal at management's discretion. In
any event, a second refusal, for any reason other than one due to a medical reason, will
cause the application to be rejected and the applicant's name removed from the Waiting
List. This applicant may reapply in the future, at a time that applications are being taken.
When a unit becomes available, in-place residents requiring a different unit will be
housed appropriately before we move in an applicant on the Waiting List. This allows
management to treat current residents having the greatest housing need prior to
applicants on the Waiting List. In this manner, we are able to avoid displacing, through
any action, current residents whose housing needs have changed since admission.
Applicants who are experiencing hardships due to health reasons will not be moved from
their original date on the waiting list if proper documentation is received by management.
5)
Notification and Updating. The applicant is notified when an appropriate unit is available.
Applicant interest is verified at least annually. The applicant can be asked to re-contact the office
in six months; however, management is responsible for reviewing the list and confirming
11 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
continued applicant interest and eligibility. An annual inquiry letter sent by management does
this. If there is no response from applicant within two weeks after sending letter, or a negative
response (returned undeliverable), the applicant is removed from the waiting list.
6)
Applicant Refusal. Applicants who are offered occupancy and refuse an apartment two different
times will be removed from the waiting list, unless the applicant has a verified “hardship”. A
“hardship” will be defined as, but not limited to, poor health.
7)
Holding Period. An apartment will be held for a maximum of 14 days for an applicant (from the
time the applicant is notified that an apartment is available) to effective date of the lease.
8)
Changes to Application. All changes to the application and waiting list updates must be in
writing from the applicant. Changes to the application will become effective when received from
the applicant at the rental office. It is the responsibility of applicant to notify management of any
changes to the contact information. Applicants may be rejected if they do not keep management
informed of current contact information.
9)
Process Start. When the applicant’s name nears the top of the Waiting List, the detailed
verifications process begins. Resident files contain documentation of all verifiable data. All
information pertinent to the eligibility, admission and continued occupancy of a resident
household must be verified in accordance with Federal program regulations. Interviewing and
documentation will be completed by the management staff to ensure that all applicants/residents
are made aware of the Federal program regulations. Verifications will be used to determine if all
of the information contained on the Application/Recertification Checklist is true and correct.
Information to be verified includes, but is not limited to:
Allowances
Assets
Credit History
Criminal Record
Enterprise Income Verification (EIV) will be used to determine if applicants are receiving
Section 8 subsidy from their current landlord
Enterprise Income Verification (EIV) will then be used on all residents at their interim and
annual recertifications to check the records kept by certain public agencies
Family Composition
Income from all sources
Rental History
SAVE System for noncitizen status
Interview. The eligible applicant/resident is interviewed by the Management Representative to
determine their eligibility status. At this time the applicant/resident is requested to sign releases
for verification.
Documents. All “permanent” documents (photo identification i.e. driver licenses, birth
certificates, social security cards, etc.) are photocopied and placed in the applicant/resident file,
at the time of application.
Independent Verification. Third parties are used as a primary source for information.
Release Consent. All applicants and residents (age of 18 and up) are required to sign Consent to
the Release of information (HUD 9887 AND 9887a) at admission, annual recertification, interim
recertification or initial certification. Failure to do so is grounds for rejection or termination of
your lease.
Zero Income. An applicant or resident who claims zero income will be required to complete and
sign a Certification of No Income on a monthly basis by the sixth (6th) of each month. If an
applicant/resident does not apply for benefits for which they may be qualified (e.g., AFDC,
unemployment, child support, etc.), verification by the Management Representative of not
receiving benefits is not required. However, there must be a signed statement from the
applicant/resident verifying that they have chosen not to participate in the benefit program for
which they may be eligible in the applicant file.
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P.
ENTERPRISE VERIFICATION SYSTEM (EIV)
The use of the EIV system as upfront income verification (UIV) technique, serves as a valuable
tool in validating tenant reported income during interim and annual recertifications of family
income; as well as in streamlining the income verification process, resulting in less administrative
burden in complying with third party verification requirements. EIV helps identify and cure
inaccuracies in housing subsidy determinations, which benefits Napa Park Homes, residents and
taxpayers by ensuring that the level of benefits provided on behalf of families is proper. Finally,
the use of EIV assists in preventing fraud, waste and abuse within Multifamily Housing’s Rental
Assistance Programs.
EXISTING TENANT SEARCH REPORT
This report identifies applicants applying for assisted housing that may be receiving rental
assistance at the time of application processing at another location.
We will use this report during the interview process as follows:
(1) When we are processing an applicant for admission to determine if the applicant or any
applicant household members are currently being assisted at another Multifamily Housing or
Public and Indian Housing (PIH) location.
(2) Discuss with the applicant if the report identifies that the applicant or a member of the
applicant’s household is residing at another location, giving the applicant the opportunity to
explain any circumstances relative to his/her being assisted at another location.
(3) Follow up with the respective PHA or O/A to confirm the individual’s program
participation status before admission, if necessary, depending on the outcome of the
discussion with the applicant. The report gives Napa Park Homes the ability to coordinate
move-out and move-in dates with the PHA or Owner/Agent of the property at the other
location.
(4) Retain the search results with the application along with any documentation obtained as a
result of contacts
ANNUAL RECERTIFICATION
A current form HUD-9887 must be on file before accessing the employment or income data
contained in EIV for a tenant. The form must be signed and dated by:
(1) Each adult member of a household regardless of whether he or she has income.
(2) The head of household, spouse or co-head, regardless of age, and each family member
who is 18 years of age or older must sign and date the form at move-in, at initial (when
tenant begins receiving a subsidized rent, e.g., Section 236, tenant begins receiving
Section 8 and annual recertification)
(3) A family member when he/she turns 18.
The form is valid for 15 months from the date of signature.
Q.
PROCEDURES FOR APPLYING PREFERENCES INCLUDING INCOME-TARGETING IN
SECTION 8 PROPERTIES
1) Preferences.
Napa Park Homes has permanently suspended Federal Preferences, in accordance with HUD
directives. However, preference will be given to individuals and families displaced by
government action or a presidentially declared disaster. In the event of such a displacement
by government action, selection of displaced applicants will follow in compliance with the
Extremely Low Income requirements.
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Preferences affect only the order of applicants on the Wait List. They do not make anyone
eligible who was not otherwise eligible, and they do not change management’s right to adopt
and enforce resident screening criteria (please refer to ELI Procedures within this Plan for
further information).
2)
Special Priority. NAPA PARK HOMES has no apartments especially equipped for
persons with physical disabilities. Reasonable accommodations will be made for those
people who are disabled in accordance with Section 504.
3)
Income-Targeting (HUD 4350.3: 4-5). NAPA PARK HOMES is required to lease not less
than 40% of the dwelling units (assisted under the contract) that become available for
occupancy in any property fiscal year to extremely low-income families. To accomplish this
income-targeting requirement, management will alternate between the first extremely lowincome applicant on the waiting list and the applicant at the top of the waiting list (HUD
4350.1, 4-5 B 2 b (2). To implement this method, NAPA PARK HOMES will select the first
extremely low-income applicant on the waiting list (which may mean “skipping over” some
applicants with higher incomes) for the available unit, and then select the next eligible
applicant currently at the top of the waiting list (regardless of income level) for the next
available unit. As subsequent units become available, resident selection continues to
alternate between the next extremely low-income applicant and the eligible applicant and the
eligible applicant at the top of the waiting list until the 40% target is reached. A status letter
will be sent to any qualified applicant who may have been skipped over in order to meet HUD
required income targeting.
R. APPLICANT SCREENING CRITERIA
The following are areas management will consider when approving applicants for residency:
Assets
In accordance with the Department of Housing and Urban Development’s guidelines, we will
apply an asset test to all applicants.
Assets include all liquid asset accounts, including but not limited to Checking Accounts,
Certificates of Deposit, Gifts, Savings Accounts and stocks.
Causes for Rejection
An applicant will only be rejected after consideration of the Mitigating Circumstances Policy,
including but not limited to successful rent payment history over the past 36 months. The causes
for rejection are further outlined in each of the sections noted below.
Certification Process
Upon initial occupancy, household income cannot exceed the income restriction for the respective
unit size as determined by the area median income which is adjusted for household size.
Third-party income verification will be required from all sources, including, but not limited to:
Child/Spousal/Family support;
Disability;
Employment;
Government Assistance, SSI, TANIF, AFDC, GA, etc.;
Pensions/Retirement/Annuities;
Property, Home, Stocks, Bonds, Annuities, IRA, etc.;
Savings and Checking;
Social Security;
Unemployment Benefits
Income calculations are based on the household’s annual anticipated gross income for the 12
(twelve) months. Annual gross income includes income from any and all assets.
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Credit
A credit check will be run on all applicants 18 years and over at initial certification as condition of
occupancy.
Credit standards are set forth below:
Applicant passes review by credit agency and/or by direct contact with banks and other
financial sources. Lack of credit history in itself does not justify rejection. Past credit
problems may be explained by the applicant so that credit judgment is made on current
information.
Credit reports are pulled for all adult household members. Each member must meet the same
requirements. Although there are some exceptions listed below in the Reasons to Overturn a
Rejection upon Appeal Section, reasons for rejection of an application due to information
contained on applicant’s credit report include the following factors that have affected
applicant’s ability to pay rent in prior tenancies:
Bankruptcy/Repossessions
Any personal bankruptcy within the past thirty six months that has
not been remedied
Charge-Offs/Collections
Accounts over 120 Days Past Due within the past thirty six months
“Charge-Off” of delinquent debt within the past thirty six months
Unpaid collections, judgments or liens exceeding $5,000.00, excluding
medical bills and student loans within the past thirty six months;
Unpaid balance due a current or prior landlord;
A significant number (3) of Non Sufficient Funds (NSF) checks within
the past thirty six month period;
Evictions/Prior Landlords/ Unlawful Detainers
A negative Unlawful Detainer Report indicating repeated failure to meet
financial obligations in past tenant history within the last thirty six
months
An eviction for cause within the past thirty six months for any reason
other than documented medical hardship
Foreclosures, Mortgage Defaults, Reverse Mortgage and Short Sales
Applicants who have a foreclosure, mortgage defaults, reverse mortgage or short sale will be
denied, however, management will allow applicant 14 days in accordance with the Napa Park
Homes Grievance and Appeal Procedure for the applicant to provide additional information
regarding the default or foreclosure. The information will be evaluated on a case-by-case
basis.
Lawsuits
Any suit pending or not remedied which is deemed to affect financial
ability
Examples of the type of lawsuits which would fall into this category
include:
Bankruptcy That Has Not Been Discharged
Check Fraud
Embezzlement
Eviction
Welfare Fraud
Repossessions
Repossessions, excluding voluntary repossessions within the past
thirty-six months except when part of a bankruptcy, divorce or legal
separation
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Tax Liens
Current tax liens
Reasons to overturn a rejection upon appeal include:
Applicant lacks credit history, since lack of a credit history does not
constitute negative credit.
Applicant can prove that a prior eviction or poor credit is the result of a
divorce or the result of the applicant having been a victim of domestic
violence and that it was determined in a court settlement that the
applicant’s spouse was solely responsible for such poor credit or
eviction and such spouse will not be living with applicant at NAPA
PARK HOMES; or,
Applicant can prove that a prior eviction or poor credit is the result of a
documented medical hardship
Proof of adherence to a payment plan for past due collections; or,
The unlawful detainer was caused by non-payment of rent and that
any future rent payment is guaranteed by third party payment.
Criminal Activity
A criminal background check will be run on all applicants 18 years and over at initial
certification and each annual recertification as condition of continued occupancy.
A criminal background check will be required for all household members aged eighteen [18] years
and older and emancipated minors. Criminal standards are set forth below.
Facts regarding behavior of one or more members of the household and prior conduct requiring
police and/or court action will be considered.
A criminal background reference check is conducted to determine if applicants and/or members
of an applicant’s household have any criminal background. During the admissions screening
process, NAPA PARK HOMES must perform the necessary criminal history background checks in
the state where the housing is located and in other states where the household members are
known to have resided;
Applicant households will be reviewed to determine that they have not had any of the following:
NAPA PARK HOMES is required to deny admission to Federally-assisted housing if:
Any household member has been evicted from Federally-assisted housing for drug-related
criminal activity, for three years from the date of eviction. If the evicted household member
who engaged in drug-related criminal activity has successfully completed a supervised drug
rehabilitation program or circumstances leading to the eviction no longer exist, NAPA PARK
HOMES may, but is not required to, admit the household.
Any household member is currently engaging in illegal drug use.
NAPA PARK HOMES determines that there is reasonable cause to believe that a household
member’s illegal use or a pattern of illegal use of a drug may interfere with the health,
safety, or right to peaceful enjoyment of the premises by other residents. (Examples of
evidence of illegal activities may include a conviction record, former landlord references,
etc.)
Any member of the household is subject to a lifetime registration requirement under a
National Sex Offender registration program. In accordance with Federal law, NAPA PARK
HOMES shall establish standards that prohibit admission to any federally assisted property
to sex offenders subject to a lifetime registration requirement under a state sex offender
registration program. During the admissions screening process, NAPA PARK HOMES must
perform the necessary criminal history background checks in the state where the housing
is located and in other states where the household members are known to have resided.
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NAPA PARK HOMES determines that there is reasonable cause to believe that a household
member’s abuse or pattern of abuse of alcohol interferes with the health, safety, or right to
peaceful enjoyment of the premises by other residents.
Employment
If applicant is scheduled to begin employment, but has not yet received his or her first paycheck,
applicant must provide an Offer Letter from employer submitted on employer’s letterhead. This
letter must include the following information:
Hire Date
Rate of Pay
Number of Hours Worked Per Week
Number of Overtime Hours Per Week
Number of Shift Differential Hours Per week
Bonuses Scheduled
Commissions Anticipated
Raises Within Next 12 Months
Tips
Falsification of Application
All information provided on the application will be verified. False, inaccurate or incomplete
information may result in disqualification of an application. Intentionally providing false
information on any part of the application is considered fraud and may result in failure of the
applicant to obtain a unit, or if discovered after an applicant becomes a resident, may result in
loss of the assigned housing unit. All income will be verified by management via third party
verification from employers and/or other sources of income.
HUD Occupancy Criteria
Meets all HUD occupancy criteria. Income is not more than 50% of median income in the
area (“Very Low Income”), for the 126 Section 8 apartments. Income and rent computations,
documentation requirements and verification procedures are explained in HUD 4350.3 Chapter 3.
Identification
In order for household background check to be performed, all household members age 18 and
above must provide one form of identification from the list below:
Birth Certificates- for household members under age 6
Driver’s License
Government Issued Photo Identification Card
Passport
State Identification Card
Visa
Income Documentation
We will consider Gift/Family Support from a family member as “other” income if the family
member can show proof of 12 times the amount of monthly subsidy in a bank account and
complete our “Gift/Family Support Affidavit Form” (which must be notarized) for those
households with incomes that fall below our minimum income requirements.
The following criteria will be considered in conjunction with the Mitigating Circumstances Policy.
References from applicant’s current and previous landlords for a period of three
years will be reviewed.
All applicants must have positive prior landlord references indicating ability to care
for the property and pay rent on time, as well as the ability to peacefully cohabitate
with other residents. A history of violent or criminal behavior may be cause for
denial of application.
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Keeps Agreements
Demonstrated ability and willingness to keep lease agreements, including: pay rent on time,
maintain the unit in good condition, respond to recertification requirements, cooperative
occupancy habits (noise, trash, etc), no family member uses illegal drugs. This information is
obtained from prior landlords, personal credit and criminal references.
Landlord Reference Check
A landlord reference check of an applicant’s rental history for the past thirty six (36)
months is conducted to determine the following:
Demonstrated ability to pay rent on time and in full;
Demonstrated ability to live peacefully with others;
Followed the rules and regulations of rental companies;
Kept rental unit in a manner which did not create an unsafe or unhealthy
environment or pose a health danger to other residents;
Kept rental unit undamaged;
No history of receiving notices for lease violations;
Gave sufficient notice of intent to vacate;
No noise complaints;
No disturbances or illegal activities;
No unpaid Non-Sufficient Funds (NSF) checks;
No unauthorized household members
No blatant disrespectful, disruptive or antisocial behavior toward the
management or staff, the property, or other applicants/residents
No sales of narcotics
No eviction for cause with exception off documented medical hardship
No destruction or theft of property
No acts that threaten the health, safety or welfare of other residents
Applicants who have past evictions or negative landlord references strictly for nonpayment of rent, but who now have a verified payee to guarantee timely rent payment,
will not be automatically declined under the eviction or rental history criterion described
above. However, subject to reasonable accommodations, applicants will be declined for
evictions for other causes.
In cases where applicants do not have any previous landlord, or if no previous landlord is
available, staff will request personal references from someone not related to the applicant,
such as a counselor or caseworker. However, lack of such references is not an automatic
basis for denial.
Other Allowable Screening Criteria
EIV as noted in Section N above.
References
Have favorable (or no unfavorable) comments from prior landlords, personal and credit
references. Mitigating circumstances will be considered.
Retired or Unemployed Individuals
Retired or Unemployed Individuals must supply the previous year’s signed tax returns.
Security Deposit
Household must be able to pay a deposit as calculated on 50059 Form. Installment agreements
are available.
Seasonal Employment
Individuals who receive income from seasonal employment will need to provide the previous years
signed tax returns.
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Self-Employed Individuals
Self- employed individuals must be able to provide last two years of signed tax returns; past,
present and projected Profit and Loss Statements. Self-employed individuals must also sign a
Self-Employment Affidavit which must be notarized.
S.
PROCEDURES FOR REJECTING INELIGIBLE APPLICANTS
The following are reasons why applicants will be rejected.
1)
HUD Criteria. The applicant does not meet HUD’s occupancy requirements, including
unit size, unit type, income limits, etc.
2)
Lack of Adequate Information. The applicant refuses to or cannot provide all required
application information including Social Security numbers or certifications. Refusing to
sign required documents (i.e. Verification Authorization forms, Consent to Release of
information, etc.) will be grounds for rejection.
3)
Negative References. The prior landlord(s) up to three years back or other references
provide negative reports regarding keeping of lease terms, payment of rent and other
occupancy obligations, housekeeping habits, engaging in illegal activity, or
incompatibility with other residents and neighbors. These reports are verified as much
as possible and the applicant is given a fair opportunity to overcome negative reports by
explaining mitigating circumstances. These explanations must be verified. Mitigating
circumstances can include disabled-related problems when there is the potential to
overcome those problems through reasonable accommodation.
4)
Credit. All available credit references are checked without charge to the applicant.
Rejection is possible if credit reports contain substantive negative information. (If other
criteria are satisfactory, the applicant is given an opportunity to respond to negative
credit reports.) Examples of poor credit are:
a)
b)
c)
d)
e)
left prior housing owing money to landlord;
prior eviction unless for documented medical emergency;
An account in collection status exceeding $5,000.00;
bankruptcy within the last three years (36 months) for reasons other than
medical emergency, divorce, death of spouse;
civil judgments against the applicant not yet resolved.
Circumstances will be reviewed and applicant responses considered. Applicants who
have been previously evicted or are currently under eviction will be rejected.
5)
Criminal Record. Facts regarding behavior of one or more members of the household
and prior conduct requiring police and/or court action will be considered. The basis for
rejection includes but is not limited to the following:
a) Any conviction or adjudication other than acquittal for generally violent crimes
and felonies in all states, including but not limited to: criminal homicide,
manslaughter, robbery, assault, arson, etc.
b) Any conviction or adjudication other than acquittal that involved injury or
potential injury to a person or property.
c) Any conviction or adjudication other than acquittal for generally non-violent
crimes, the severity or existence of crime vary from state to state including, but
not limited to other simple assaults, forgery, fraud, embezzlement, weapons, etc.
d) Any conviction or adjudication other than acquittal for the sale, distribution or
manufacture of any controlled or illegal substance.
e) Any conviction or adjudication other than acquittal involving illegal use or
possession of any controlled or illegal substance.
f) Any current illegal user or addict of a controlled or illegal substance.
19 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
g) Any act which results in the person’s tenancy constituting a threat to the health
or safety of other individuals, result in substantial physical damage to the
property of others, or interfere with the peaceful and quiet enjoyment of the
premises.
h) Any conviction or adjudication other than acquittal, for any sexual offense.
i) Registration on any state sex offender registry.
j) Any conviction or adjudication other than acquittal, which involved bodily harm
to a child.
k) Any conviction or adjudication other than acquittal, for domestic violence, dating
violence, sexual assault or stalking.
l) Eviction for Drug Related Criminal Activity from federally assisted housing for
drug related criminal activity within the last 3 years.
m) Alcohol abuse or pattern of abuse, of alcohol interferes with the health, safety or
right to peaceful enjoyment of the premises by other residents.
Applicants have an opportunity to explain all adverse references. Individuals with such
records will not be admitted even if other eligible family members are admitted. Any
applicant or household member who has been arrested for any of the above-described
offenses will have their application suspended until the case has been legally resolved.
(6) Notification. If management rejects an applicant for any reason a rejection letter will be
sent to the applicant. This letter will state in writing the reasons and provide an
opportunity for the applicant to respond or ask for a meeting. If applicant wishes to
appeal the rejection they must do so within 14 days. If requested by applicant the
meeting will be with a staff member or agent who is not the same person who made the
original rejection determination. A follow-up written response will be sent within five
days of the rejection hearing. Rejection records will be kept at least three years.
NOTE: Applicants with no verifiable rental or credit history will be given due consideration
using personal references from three reliable sources other than relatives or close friends
(e.g. clergyman, teachers, employers, etc.)
T. OCCUPANCY STANDARDS
The occupancy limits are as follows:
Apartment
Size
Minimum
Occupancy
Maximum
Occupancy
1 Bedroom
1
3
2 Bedroom
2
5
3 Bedroom
3
7
U. UNIT TRANSFER POLICIES, INCLUDING SELECTION OF IN-PLACE RESIDENTS VERSUS
APPLICANTS FROM THE WAITING LIST WHEN VACANCIES OCCUR
1)
Available apartments will be filled alternately, for appropriate size, by outside applicants on
the wait list and applicants from within the complex who qualify for a move. Exception:
residents eligible for an accessible unit will be offered that unit when available even if the list
includes outside applicants. If no outside applicant is ready for timely move-in, the unit may
be offered to the next current eligible resident. Internal moves require a new lease and
related documentation.
2)
Residents must live at NAPA PARK HOMES for at least one year prior to placement on the
wait list for an internal move unless the move is a result of a reasonable accommodation or a
medical necessity. This is to avoid temporary move-ins to wait for a different-size unit.
20 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
3)
Internal moves may be caused by doctor-verified medical condition, reasonable
accommodations and safety. The cost of all internal moves is a resident responsibility with
the exception of internal moves as a result of reasonable accommodations. Residents
must be given a thirty-day notice of internal moves. Failure to move requires payment of the
market rent on the present unit and failure to pay such rent is a material non-compliance
with the lease.
NOTE: Residents are required to advise management immediately when family size or
other unit-needs change.
4)
Residents qualifying for the Wait List for an internal move must register the move-request in
writing with the management office, or may be notified of such qualification by management
in writing. The wait-list date is the date the family became eligible for the unit change, such
as a change in family size or other condition.
5)
Apartment transfers due to personal preferences or roommate disputes are not considered
transfer-eligible. The resident wishing a transfer must complete an application when the list
is open. The application will be placed on the outside waiting list in chronological order
based on the date and time the application is accepted.
6)
Criminal/Sex Offender Check will be required of all residents who wish to transfer to
another apartment within NAPA PARK HOMES in accordance with guidelines set forth
in HUD Notice 2012-11
Management will allow in-house transfers, in the following situations:
A unit transfer for a medical reason, including a reasonable accommodation (this
will be verified with a medical practitioner using the Napa Park Homes form);
A transfer from a unit due to renovation of the previous unit.
Napa Park Homes will first assign units to in-place residents who have a demonstrated need for
a change in housing before offering units to an applicant on the Waiting List. Requests for
transfers that are based on a need for a reasonable accommodation will be provided priority over
other requests. Transfers will be provided to persons who have a medical or other verified need
because of a disability in the chronological order received. All other transfers will be provided
after requests for reasonable accommodations and will occur in chronological order by the date
the request was received.
V. ANNUAL RECERTIFICATION/REEXAMINATION-SEX OFFENDER REQUIREMENTS
HUD RECOMMENDS THAT AT ANNUAL RECERTIFICATION OR REEXAMINATION,
OWNER /AGENTS (O/A S) ASK WHETHER THE TENANT OR ANY MEMEBR OF THE TENANT’S
HOUSEHOLD IS SUBJECT TO A STATE LIFETIME SEX OFFENDER REGISTRATION IN ANY
STATE PROGRAM IN ANY STATE. O/AS AND PHAS SHOULD VERIFY THIS INFORMATION
USING THE DRU SJODIN NATIONAL SEX OFFENDER DATABASE AND/OR OTHER OFFICIAL,
FEDERAL, STATE, AND OTHER OFFICIAL FEDERAL, STATE, AND LOCAL RESOURCES AND
DOCUMENT THIS INFORMATION IN THE SAME MANNER AS AT ADMISSION.
ALL RESIDENTS WILL BE REQUIRED TO COMPLETE AN ANNUAL RECERTIFICATION
QUESTIONNAIRE AT ANNUAL RECERTIFICATION AND ANSWER QUESTION AS TO WHETHER
THE TENANT OR ANY MEMEBR OF THE TENANT’S HOUSEHOLD IS SUBJECT TO A STATE
LIFETIME SEX OFFENDER REGISTRATION IN ANY STATE PROGRAM IN ANY STATE.
ADDITIONALLY, MANAGEMENT WILL USE THE DRU SJODIN NATIONAL SEX OFFENDER
DATABASE TO DETERMINE WHETHER THE TENANT OR ANY MEMBER OF THE TENANT’S
HOUSEHOLD IS SUBJECT TO A STATE LIFETIME SEX OFFENDER REGISTRATION IN ANY
STATE PROGRAM IN ANY STATE AND DOCUMENT THIS INFORMATION IN THE SAME MANNER
AS AT ADMISSION.
21 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
W. POLICY FOR OPENING AND CLOSING THE WAITING LIST FOR THE PROPERTY
The wait list may be closed when it contains a year’s worth of applicants, based on current
turnover experience, and is re-opened when there is a three-month supply of applicants. A 30day notice will be posted giving the date and time that the waiting list will be opened. Re-opening
and closing of the wait list is posted in the office, communicated to referral groups, and publicly
advertised in accordance with the Affirmative Fair Marketing Plan for the property.
Applications are not accepted when the wait list is closed. The Wait List is kept chronologically
on a form, which states the date and time of the application, Head of Household name, unit size,
income level (i.e. ELI, VLI, LI), Need for accessible unit, Comment/Contact, Removed/Rejected
Date, Move-in Date, Preference Type. This list is a permanent record. (Note wait list may be
closed for only specific unit types i.e. one-bedroom units)
X. GRIEVANCE PROCEDURE
Applicants have fourteen [14) days to notify management in writing if they feel that their
application was unfairly denied. Management will only reconsider your application if you have
any new facts or information that the applicant feels would have an effect on their application.
Management will notify the applicant of their final decision within fourteen [14] days of receiving
the applicant’s written notice of appeal.
Y. VIOLENCE AGAINST WOMEN ACT (VAWA PROTECTIONS)
The VAWA protections apply to families applying for or receiving rental assistance payments
under the Property Based Section 8 program. The law protects victims of domestic violence,
dating violence or stalking, as well as their immediate family members generally, from being
evicted or being denied housing assistance if an incident of violence that is reported and
confirmed.
The landlord may request in writing that the victim, or a family member on the victim’s behalf,
certify that the individual is a victim of abuse and that the Certification of Domestic Violence,
Dating Violence or Stalking, Form HUD 91066, or other documentation as noted on the
certification form, be completed and submitted within 14 business days, or agreed upon
extension date, to receive protection under the VAWA. Failure to provide the certification or other
supporting documentation within the specified timeframe may result in eviction or denial of
housing assistance.
Z.
POLICIES TO COMPLY WITH SECTION 504 OF THE REHABILITATION ACT OF 1973 AND
THE FAIR
Housing Act and other relevant civil rights laws and statutes
NAPA PARK HOMES was developed to provide safe, clean and comfortable housing at rental
rates appropriate for low-income residents. One of the processes necessary to achieve these goals
is to define our selection and occupancy policies for our prospective and current residents. This
publication outlines occupancy requirements and procedures.
NAPA PARK HOMES and Napa Valley Community Housing intends to administer these
selection criteria in a fair and consistent manner and in accordance with regulations of the U.S.
Department of Housing and Urban Development (HUD).
22 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
STATEMENT OF NON-DISCRIMINATION
It is the policy of NAPA PARK HOMES to comply fully with 24 CFR, Part 1 Title VI of the Civil
Rights Act of 1964 Title VIII and Section 3 of the Civil Rights Act of 1968 (As amended by the
Community Development Act of 1994), Executive Order 11063, 24 CFR, Part 8 Section 504 of the
Rehabilitation Act of 1973, Americans with Disabilities Act; 24 CFR, part 100 et seq Fair Housing
Amendments Act; Subpart M of 24 CFR, Part 108 Affirmative Fair Housing Marketing Plan for the
property, 24 CFR Part 146 Age Discrimination Act of 1975 and any legislation protecting the
individual rights of residents, applicants or staff members, which may subsequently be enacted.
Non-Discrimination and Accessibility. NAPA PARK HOMES provides equal housing opportunity for
all eligible persons. There is no actual or implied placement based on race, ethnic origin, religious
affiliation, sexual preference or marital status. All units are specially designed for accessibility.
NAPA PARK HOMES will provide reasonable additional accommodation for disabled
persons including permission to use assistive animals when needed.
NAPA PARK HOMES will not discriminate because of race, color, sex, gender identity, gender
expression, sexual orientation, religion, age, disability, marital status, familial status or
national origin in the rental of housing or in its use or occupancy.
NAPA PARK HOMES will not on account of race, color, sex, gender identity, gender expression, sexual
orientation, religion, age, disability, marital or familial status or national origin:
Napa Park Homes will not:
1)
Deny to any household the opportunity to apply for housing, nor deny to any eligible
applicant the opportunity to rent housing suitable to their needs.
2)
Provide housing, which is different than that provided for others; subject a person to
segregation or different treatment.
3)
Restrict a person’s access to any benefit enjoyed by others in connection with the housing
program
4)
Treat a person differently in determining eligibility or other requirements for admission.
5)
Deny a person Access to the same level of services.
6)
Deny a person the opportunity to participate in Planning or Advisory group, which is an
integral part of the housing program.
7)
Publish or cause to be published an advertisement or notice indicating the availability of
housing that prefers or excludes persons.
8)
Discriminate against someone because of that person’s relation to or association with another
individual; or retaliate against, threaten, or act in any manner to intimidate someone because
he or she has exercised rights under the Fair Housing Act.
NAPA PARK HOMES will not automatically deny admission to a particular group or category of
otherwise eligible applicants. Each applicant in a particular group or category will be treated on an
individual basis in the normal processing routine.
NAPA PARK HOMES will seek to identify and eliminate situations or procedures, which create a
barrier to equal housing opportunity for all. In accordance with Section 504 of the Rehabilitation
Act of 1973, NAPA PARK HOMES will provide reasonable accommodation for individuals with
disabilities (applicants or residents). Such accommodations may include changes in the method of
administering policies, procedures or services.
23 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
STATEMENT OF PRIVACY POLICY
It is the policy of NAPA PARK HOMES to guard the privacy of individuals in accordance with the
Federal Privacy Act of 1994 and to ensure the protection of individual records.
NAPA PARK HOMES management staff will not disclose any personal information contained in
Resident records to any person or agency unless the individual about whom the information is requested
has given written consent to such disclosure.
This privacy policy in no way limits the management’s capacity to collect such information as it may need
to determine eligibility, compute rent or determine an applicant’s suitability for tenancy.
Consistent with the intent of Section 504 of the Rehabilitation Act of 1973, any information obtained
on disabled or disability will be treated in the same confidential manner.
24 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
D E F I NI T I O NS
Disabled Household
(i) Has a disability, as defined in 42 U.S.C. 423;
(A) Inability to engage in any substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be expected to result in death or
which has lasted or can be expected to last for a continuous period of not less than 12
months; or
(B) In the case of an individual who has attained the age of 55 and is blind, inability by
reason of such blindness to engage in substantial gainful activity requiring skills or
abilities comparable to those of any gainful activity in which he/she has previously
engaged with some regularity and over a substantial period of time. For the purposes of
this definition, the term blindness, as defined in section 416(i) (1) of this title, means
central vision acuity of 20/200 or less in the better eye with use of a correcting lens. An
eye which is accompanied by a limitation in the fields of vision such that the widest
diameter of the visual field subtends an angle no greater than 20 degrees shall be
considered for the purposes of this paragraph as having a central visual acuity of 20/200
or less.
(ii) Is determined, pursuant to HUD regulations, to have a physical, mental, or emotional
impairment that:
(A) Is expected to be of long-continued and indefinite duration,
(B) Substantially impedes his or her ability to live independently, and
(C) Is of such a nature that the ability to live independently could be improved by more suitable
housing conditions; or
(iii) Has a developmental disability, as defined in Section 102(7) of the Developmental
Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6001(8)), i.e., a person with a severe
chronic disability that:
(A) Is attributable to a mental or physical impairment or combination of mental and physical
impairments;
(B) Is manifested before the person attains age 22;
(C) Is likely to continue indefinitely;
(D) Results in substantial functional limitation in three or more of the following 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, and
g. Economic self-sufficiency; and
(E) Reflects the person’s need for a combination and sequence of special, interdisciplinary,
or generic care, treatment, or other services that are of lifelong or extended duration and
are individually planned and coordinated.
25 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
Extremely Low-Income Family
A family whose annual income does not exceed 30% of the median income for the area, as determined by
HUD, with adjustments for smaller and larger families, except that HUD may establish income ceilings
higher or lower than 30% of the median income for the area if HUD finds that such variations are
necessary because of unusually high or low family incomes. [24 CFR 5.603]
Elderly Family
Elderly family means a family whose head or spouse or sole member is a person who is at least 62 years
of age. It may include two or more persons who are at least 62 years of age living together, or one or more
persons who are at least 62 years of age living with one or more live-in aides.
Independent Student
To be classified as an independent student for Title IV aid, a student must meet one or more of the
following criteria:
1. Be at least 24 years old by December 31 of the award year for which aid is sought;
2. Be an orphan or a ward of the court through the age of 18;
3. Be a veteran of the U.S. Armed Forces;
4. Have legal dependents other than a spouse (for example, dependent children or an elderly
dependent parent);
5. Be a graduate or professional student; or
6. Be married.
No assistance shall be provided under Section 8 of the United States Housing Act of 1937 (42 U.S.C.
1437f) to any individual who:
1.
2.
3.
4.
5.
6.
7.
Is enrolled as a student at an institution of higher education (as defined under section 102 of the
Higher Education Act of 1965 (20 U.S.C. 1002));
Is under 24 years of age;
Is not a veteran;
Is unmarried;
Does not have a dependent child;
Is not otherwise individually eligible, or has parents who, individually or jointly, are not eligible,
to receive assistance under Section 8 of the United States Housing Act of 1937 (42 U.S.C. 1437f);
Is not a person with disabilities, as such term is defined in section 3(b) (3) (E) of the United States
Housing Act of 1937 (42 U.S.C. 1437a (b) (3) (E)) and was not receiving assistance under such
section 8 as of November 20, 2005.
**Students with disabilities receiving Section 8 as of November 30, 2005 are exempt from the
Independent Student restrictions on receiving Section 8 rental assistance.
For purposes of determining the eligibility of a person to receive assistance under Section 8 of the
United States Housing Act of 1937 (42 U.S.C. 1437f), any financial assistance (in excess of amounts
received for tuition) that an individual receives under the Higher Education Act of 1965 (20 U.S.C.
1001 et seq.), from private sources, or an institution of higher education (as defined under the Higher
Education Act of 1965 (20 U.S.C. 1002), shall be considered income to that individual, except for a
person over the age of 23 with dependent children.
Please refer to Appendix A of FR-5036-N-02 for further definitions pertaining to Independent Students
and applicable eligibility.
26 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
Live In Care Attendant
A person who resides with one or more elderly persons, near-elderly persons, or persons with disabilities,
and who:
1. Is determined to be essential to the care and well-being of the persons;
2. Is not obligated for the support of the persons; and
3. Would not be living in the unit except to provide the necessary supportive services.
A relative may be a Live In Attendant but must meet all of the above requirements, and sign a statement
to that effect. Napa Park Homes will verify this with a physician or recognized health care professional.
The sole purpose of a Live In Attendant is to provide the resident with support services and will not
qualify for continued occupancy in the event the resident vacates the unit. Napa Park Homes may reverify the need for a Live In Attendant when necessary.
The screening of Live In Attendants at initial occupancy and the screening of persons or Live In
Attendants to be added to the resident household after initial occupancy involve identical screening
activities as applicants. Live In Attendants must be screened for drug abuse and other criminal activity,
including lifetime registration as a sex offender, by applying the same criteria established for screening
other applicants. Owner-established screening criteria must also be applied to Live In Attendants.
Person with Disabilities
Such a person has a disability, as defined in 42 U.S.C. 423;
1. Any adult having a physical impairment that is expected to be of long, continued and indefinite
duration, substantially impedes his or her ability to live independently, and is of a nature that
such ability could be improved by more suitable housing conditions.
Very Low Income Family
A very low-income family is a family whose annual income does not exceed 50 percent of the area median
income, as determined by HUD, with adjustments for smaller and larger families. [24 CFR 5.603]
Low Income Family
A low-income family is a family whose annual income does not exceed 80 percent of the area median
income, as determined by HUD, with adjustments for smaller and larger families. [24 CFR 5.603]
__________________________________
Applicant Signature
___________________________________
Date
___________________________________
Applicant Signature
___________________________________
Date
___________________________________
Management Agent Signature
___________________________________
Date
27 | NAPA PARK HOMES RESIDENT SELECTION CRITERIA-G-08-24-15
EXHIBIT I
Napa Park Homes
790 Lincoln Avenue
Napa, CA 94558
Date:
Dear
We regret to inform you that your application for residency at Napa Park Homes has been rejected for the following
reason(s):
Your income is above the HUD approved income limits for initial occupancy in our very low income
apartments, (Sec 8).
Your credit record did not meet our screening criteria. We have enclosed a copy of that report and advise you
that you have the right to contact one of the consumer credit reporting companies responsible for compiling the
information for this report, if you have questions or wish to dispute the accuracy or completeness of any of the
information contained therein. Those companies include the following:
TRANSUNION
2 Baldwin Place
P.O. Box 1000
Chester, PA 19022
(800) 888-4213
EQUIFAX CDI SERVICE CENTER
P.O. Box 740241
Atlanta, GA 30374-0241
(800) 685-1111
EXPERIAN TRW
P.O Box 2104
Allen, TX 75013-2104
(888) 397-3742
No member of your household is a U.S. citizen or eligible non-citizen and therefore, by HUD regulation, you do
not qualify for this federally assisted housing program.
Your records of current and/or previous tenancy did not meet our screening criteria.
You gave false information on your application;
We have not been able to verify this information
You have no rental history, no credit history and no employment history;
You have been convicted of any type of crime that would be considered a real threat to the property or the
ability of other residents to peaceful enjoyment of the premises, and/or including the use, manufacture
or distribution of illegal drugs.
Other: n/a
You may appeal the decision to reject your application by responding in writing to this letter and requesting a
meeting to discuss our decision. The letter requesting that meeting must be received by the Director of
Property Management, Napa Valley Community Housing, 5 Financial Plaza, Suite 200, Napa, CA 94558, within
14 days of receipt of this notice. Note: Persons with disabilities have the right to request reasonable
accommodations in order to participate in any hearing that might be scheduled as a result.
If, at some future date, you feel that your situation has changed sufficiently for you to be admitted onto the Waiting List,
please contact us again.
Sincerely,
Sonia Lima-Flores
Sonia Lima- Flores, Property Manager
Napa Park Homes, Inc
9
RACE AND ETHNICITY DATA
REPORTING FORM
Napa Valley Community Housing
5 Financial Plaza, Suite 200
Napa, CA 94558
Name of Property & Address (if applicable) or Agency
Date
Data Collection for:
Wait List Applicant
Tenant
Unit Applicant
Please list All Members of your Household with
Head of Household as #1):
5.
1.
6.
2.
7.
3.
8.
4.
9.
Select One Ethnic Category For Each Household Member
Ethnic Categories*
HH
#1
2
3
4
5
6
7
8
9
Hispanic or Latino
Not-Hispanic or Latino
Racial Categories*
Select All Races that Apply For Each Household Member
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other (Check “other” for any racial category that is not identified in
one of the five single race categories listed above.)
Add Information for Each Household Member
Other Categories
Gender (“M” or “F”)
Age
Disability
(“Yes” or “No” for all over 5 yrs. of age)
*Definitions of these categories may be found on the reverse side.
There is no penalty for persons who do not complete the form. Initial here
if you choose
not to disclose any or some of the race and/or ethnicity information for your household. If you
choose not to disclose any of the info, head of household ONLY should sign and date below.
Otherwise every adult must sign:
Head of Household Signature
Adult Co-Tenant Signature
Adult Co-Tenant Signature
Adult Co-Tenant Signature
Adult Co-Tenant Signature
Adult Co-Tenant Signature
Adult Co-Tenant Signature
Adult Co-Tenant Signature
Rev. 02/14/2012
1
-Based on form HUD-27061-H (3/2009)
Datos de Raza y Grupo Etnico
Formulario de informe
Napa Valley Community Housing
Five Financial Plaza, Suite 200
Napa, CA 94558
Nombre de la propiedad y Direccion (si aplica) o Agencia
Información coleccionada es para:
Fecha
Aplicante para la lista de espera
Por favor de nombrar todas las personas en su familia
(la cabeza de familia como #1)
Inquilino
Aplicante
5.
6.
2.
7.
3.
8.
4.
9.
LE
S
1.
2
3
4
5
7
8
9
EN
AR
Hispano o Latino
No Hispano ni Latino
Seleccione todas las categorías raciales adecuadas para cada persona en su familia
Categorías Raciales*
LL
Indio Americano o Nativo de Alaska
TE
Asiático
EN
Negro o Afroamericano
LA
M
Nativo de Hawai u otra Isla del Pacífico
Otro (Marque "otro" si ninguna de las categorías
Agregue Informacion por Cada Persona en la Vivienda
EJ
EM
Género (“M”asculino o “F”emeino)
PL
Otros Categorias
O
raciales se aplican a usted.)
SO
Blanco
Edád
6
EN
#1
IN
G
Seleccione una categoría étnica para cada persona en su familia
Categorías Etnicas*
Incapacidad (“Si” o “No” para todos los
mayores de 5 años de édad)
*Las definiciones de estas categorías pueden encontrarse en el reverso.
No hay penalidad para las personas que no completen el formulario. Favor de Poner sus inicales aquí
si opta por
no divulgar la raza y/o información de la etnia de su hogar. Si usted opta no revelar la informacion, la cabeza de familia
SOLO debe firmar y poner la fecha acontinuacion. De lo contrario todos los adultos deben de firmar.
Cabeza de familia
Firmade adulto
Firmade adulto
Firmade adulto
Firmade adulto
Firmade adulto
Firmade adulto
Firmade adulto
1
Rev. 02/14/2012
Based on HUD form 27061-H (3/2009)
Instructions for the Race and Ethnic Data Reporting (Form HUD-27061-H)
A. General Instructions:
This form is to be completed by individuals wishing to be served (applicants) and those that
are currently served (tenants) in housing assisted by the Department of Housing and Urban
Development.
Owner and agents are required to offer the applicant/tenant the option to complete the form.
The form is to be completed at initial application or at lease signing. In-place tenants must
also be offered the opportunity to complete the form as part of the next interim or annual
recertification. Once the form is completed it need not be completed again unless the head of
household or household composition changes. There is no penalty for persons who do not
complete the form.
There is no penalty for persons who do not complete the form. If you choose not to
disclose race or ethnicity, initial the refusal statement on the form, then sign and date
the form at the bottom. All “completed” or “refused” forms must be kept in the
household’s file.
1. The two ethnic categories you should choose from are defined below. You should check
one of the two categories.
a. Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race. The term “Spanish
origin” can be used in addition to “Hispanic” or “Latino.”
b. Not Hispanic or Latino. A person not of Cuban, Mexican, Puerto Rican, South or
Central American, or other Spanish culture or origin, regardless of race.
2. The five racial categories to choose from are defined below: You should check as many
as apply to you.
a. American Indian or Alaska Native. A person having origins in any of the original
peoples of North and South America (including Central America), and who maintains
tribal affiliation or community attachment.
b. Asian. A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China,
India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
c. Black or African American. A person having origins in any of the black racial
groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to
“Black” or “African American.”
d. Native Hawaiian or Other Pacific Islander. A person having origins in any of the
original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
e. White. A person having origins in any of the original peoples of Europe, the Middle
East or North Africa.
3. “Other” – You should check “other: for any racial category that is not identified in one
of the five single race categories listed in Section 2, above.
Rev. 02/14/2012
2
-Based on form HUD-27061-H (3/2009)
Instrucciones para informar los datos de raza y grupo étnico (Formulario HUD-27061-H)
A. Instrucciones generales:
Este formulario debe ser completado por las personas que desean arrendar (solicitantes) y las personas que
ya arriendan (arrendatarios) viviendas subvencionadas por el Departamento de Viviendas y Desarrollo
Urbano.
Se exige a los propietarios y corredores de bienes raíces que ofrezcan al solicitante/arrendatario la opción de
completar el formulario. Se debe completar el formulario al inicio de la solicitud o al momento de firmar el
arrendamiento.
Los arrendatarios ya ubicados también deben recibir la oportunidad de completar el
formulario como parte de la siguiente recertificación pasajera o anual. Una vez que se haya completado, no
necesita completarse nuevamente a menos que cambie el jefe de familia o la composición de la familia. No
existe sanción para las personas que no completen el formulario. Sin embargo, el propietario o corredor
puede colocar una nota en el expediente del arrendatario manifestando que el solicitante/arrendador se
rehúso a completar el formulario.
No hay castigo para las personas que no completan el formulario. Si usted opta por no revelar la raza
o la etnia, iníciale la declaración de rechazo en el formulario, a continuación, firmar y incluya la fecha
en el formulario en la parte inferior. Todos los "completado" o "rechazado" las formas se deben
mantener en el archivo de la familia.
1.
Se definen debajo las dos categorías étnicas entre las que debe elegir:
categorías.
Debe marcar una de las dos
1. Hispano o latino. Una persona que sea de Cuba, México, Puerto Rico, Sudamérica y Centroamérica, o
de otra cultura u origen español, sin considerar la raza. El término “origen español” puede usarse
además de “hispano” o “latino”.
2. No hispano ni latino. Una persona que no sea de Cuba, México, Puerto Rico, Sudamérica y
Centroamérica, ni de otra cultura u origen hispano, sin considerar la raza.
2. Se definen debajo las cinco categorías raciales entre las que debe elegir: Debe marcar todas las opciones
pertinentes.
1. Indio americano o nativo de Alaska. Una persona con orígenes en cualquiera de los pueblos oriundos
de Norteamérica y Sudamérica (incluyendo Centroamérica), y que mantiene afiliación tribal o adherencia
comunal.
2. Asiático. Una persona con orígenes en cualquiera de los pueblos oriundos del Lejano Oriente, Sudeste de
Asia o el subcontinente indio, incluyendo, por ejemplo a Camboya, China, India, Japón, Corea, Malasia,
Pakistán, las Islas Filipinas, Tailandia y Vietnam.
3. Negro o afroamericano. Una persona con orígenes en cualquiera de los grupos raciales negros de
África. El término “haitiano” puede utilizarse además de “negro” o “africano”.
4. Nativo de Hawai u otra isla del Pacífico. Una persona con orígenes en cualquiera de los pueblos
oriundos de Hawai, Guam, Samoa u otras islas del Pacífico.
5. Blanco. Una persona con orígenes en cualquiera de los pueblos oriundos de Europa, Medio Oriente o
Norte de África.
3. “Otro”- Usted debe marcar "otro: para cualquier categoría racial que no se identifica en un
de las cinco categorías raciales individuales que figuran en la sección 2, sobre.
1
Rev. 02/14/2012
Based on HUD form 27061-H (3/2009)
Napa Valley Community Housing
Adaptable Features for Handicap Accessibility
The following is a list of items that can be adapted for handicap
accessibility at our properties:
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Ramps added to access a lower level unit not level with the walkway.
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Vision or peep holes can be added or lowered on the door or can be
changed to a larger viewer.
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Install lever door handles to replace any round knobs.
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Door thresholds changed when higher than 1/2" may be reduced to
1/4" or be removed.
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Doors can be removed and/or changed or swing clear hinges
installed to increase the width of the door opening. Clear door
opening space needs to be 32" wide.
Environmental controls (thermostats) location changed or installs
wireless and/or remote controls.
Smoke detectors changed to ones that have strobe lights.
Change or add handles or easy grip knobs on cabinets and drawers.
Remove cabinets close to the stove, oven and under the sink.
Lower counter heights to no more than 34" above the finished floor.
Install a stove with controls on the front the appliance.
Grab bars for the shower, tub or toilet areas.
Replace toilet with one that is 17” – 19” from floor to top of seat.
Sliding shower doors and tracks may be removed for easier access
to the tub or shower.
Install single lever handles for the sink and shower knobs.
Handheld shower heads mounted on a vertical bar.
Add shower seating.
Adjust the height of clothes rods/shelves.
Install a door chime with flasher module.
Remove or relocate any protruding or low hanging objects.
Install Braille indicators or labels on fuse boxes, mailboxes,
washer/dryers, etc…
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* This list of adaptable items is not all inclusive; requests for any
reasonable accommodation/modification will be evaluated on an
individual basis.
Napa Valley Community Housing
NOTICE OF RIGHT TO REASONABLE ACCOMMODATION
If you have a disability and, as a result of your disability, you need . . .
 a change in the rules or policies or how we do things that would give you an
equal chance to live here and use the facilities or take part in programs on
site,
 a change or repair in your apartment or a special type of apartment that
would give you an equal chance to live here and use the facilities or take part in
programs on site,
 a change or repair to some other part of the housing site that would give you
an equal chance to live here and use the facilities or take part in programs on
site,
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a change in the way we communicate with you or give you information,
you may ask for this kind of change, which is called a REASONABLE
ACCOMODATION.
If you can show that you have a disability and if your request is reasonable
(*does not pose“ an undue financial or administrative burden”), we will try to
make the changes you request.
We will give you an answer within 15 working days unless there is a
problem getting the information we need or unless you agree to a
longer time. We will let you know if we need more information or
verification from you or if we would like to talk to you about other
ways to meet your needs.
If we turn down your request, we will explain the reasons and you can give us
more information if you think that will help.
If you need help filling out a REASONABLE ACCOMMODATION REQUEST
FORM or, if you want to give us your request in some other way, we will help
you.
You can get a REASONABLE ACCOMMODATION REQUEST FORM
at the Napa Valley Community Housing office located at Five Financial
Plaza, Suite 200, Napa, CA 94558, or from the Property Manager’s
office.
NOTE: All information you provide us will be kept confidential and will be
used only to help you have an equal opportunity to enjoy your housing and
the common areas.
• In simple language this legal phrase means if it is not too expensive and
too difficult to arrange