Rental Housing Application - Fairbanks Neighborhood Housing Services

Application for housing

Property Address

Address Line 1

Address Line 2

City

State

Zip Code

Applicant Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Do you receive any Federal or State Rental Assistance?

Directions to applicant:

Please complete the information below for each member of your household, whether those members are related. Include all members who you anticipate will live with you at least 50% of the time during the next 12 months. The information regarding race, ethnicity, and gender is requested to assure the Federal Government, acting through the United Department of Agriculture & Rural Development that Federal Laws prohibiting discrimination against tenant applicants on the basis of race, color, national origin, religion, sex, familial status, age, and handicap are complied with. You are not required to furnish this information but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way.

Head of household information (Applicant)

Name

First

Middle

Last

Social Security #

Co-Applicant

Name

First

Middle

Last

Social Security Number

Other Occupants

Name

First

Middle

Last

Relationship

Social Security #

Date of birth

ID # and Type

Gender

Add Occupant?

Household Information/Eligibility

1. Are any members in the household a Veteran of the US Armed Forces?

2. Do any members in the household have a disability?

3. Are you currently homeless?

4. Are you currently on any federally subsidized housing waitlists?

5. Are you applying for a fully accessible living unit/apartment?

6. Do you need any specific features or unit designs such as wheelchair, accessibility, visual aids, or apparatus for hearing assistance?

7. Do you have any animal that will be moving in with you?

9. Will the above household members reside in the household 100% of the time?

10. Will anyone else live in the unit on either a full-time or part-time basis, such as children temporarily absent, children in a joint custody arrangement, children away at school, unborn children, children in the process of being adopted, or temporarily absent family members?

11. Do you expect the number of household members to change in the future?

12. Have any of the household members above you names or a Social Security number other than what is listed above?

Background Screening Information

1. Have you or another member of the household ever been evicted?

2. Have you or another member of the household been convicted of a felony?

3. Has any member of your household ever been convicted of illegal manufacturer or distribution of a controlled substance?

4. Are you or anyone in your household a drug dealer?

5. Are you or any member of the household required to register as a sex offender?

6. Are there any outstanding judgments against you?

7. Do all persons listed as an applicant or a co-applicant possess the legal capacity to enter into a lease agreement?

8. Do you understand that only the person's listed in this application may live in the unit unless you obtain prior written approval from management question mark

9. Do you understand that if any false or incomplete information is included in this application, it is grounds for rejection of your application or termination of your residency?

Applicant(s) History

Current Residence

Address Line 1

Address Line 2

City

State

Zip Code

Landlord Name & Phone Number

Reason for leaving?

Monthly Rent

Dates moved in and moved out

Previous Residence

Address Line 1

Address Line 2

City

State

Zip Code

Landlord Name & Phone Number

Reason for leaving?

Monthly Rent

Dates moved in and moved out

Current employer (Head of Household)

Company Name

Direct Supervisor & Phone

Position

Start date

Monthly Earnings

HR Phone & Email

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous employer (Head of Household)

Company Name

Direct Supervisor & Phone

Position

Start date

Monthly Earnings

HR Phone & Email

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Current employer (Co-Applicant)

Company Name

Direct Supervisor & Phone

Position

Start date

Monthly Earnings

HR Phone & Email

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous employer (Co-Applicant)

Company Name

Direct Supervisor & Phone

Position

Start date

Monthly Earnings

HR Phone & Email

Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Vehicle Information

Make

Model

Year

Color

License Number

State

Vehicle Information 2

Make

Model

Year

Color

License Number

State

Household Additional Sources of Income

In order to evaluate your eligibility to receive rental assistance/housing, please answer the following questions and fill in the applicable amounts as requested (including minors). Include all GROSS income each household member expects to earn in the next 12 months. A final decision on eligibility cannot be made until all verifications are complete. Please be advised that program auditors will select cases and compare the information families supply with the information Federal, State, or Local agencies have on file. If you are uncertain which types of income must be included or may be excluded, please ask the Property Manager for assistance.

Anticipated Income for all Household Members in the next 12 Months

Do you or anyone in your family receive or anticipate receiving income from the following

Wages from employer (FT, PT, seasonal, etc.)

Gross Monthly Received

Household Member's Name

SSI

SSI/SSDI?

Regular contributions from anyone outside your household (gifts, rental income, etc.)?

(gifts, rental income, etc.)?

Gross Monthly Received

Household Member's Name

Any type of periodic payment not listed above?

Gross Monthly Received

Household Member's Name

Any other sources of income not listed above?

Gross Monthly Received

Household Member's Name

Net Family Assets

Do you have a checking account?

Balance

Household Member's Name

Do you receive interest on your checking account?

Balance

Household Member's Name

Balance

Household Member's Name

If employed, can you withdraw from a retirement or pension fund without terminating employment?

Withdraw?

Balance

Household Member's Name

Do you have personal property held as an investment (gem collection, antiques, autos, etc.)?

Personal property?

Balance

Household Member's Name

Do you own real estate property (land, home/dwelling, etc.)?

Real Estate?

Balance

Household Member's Name

Do you have a whole life insurance policy?

Balance

Household Member's Name

Household Member's Name

mark to

Do you have an employed full-time student 18 years of age or older in your household?

Student 18 or older?

Household Member's Name

Is anyone in your household currently/anticipate becoming a full-time student?

Household Member's Name

If receiving unemployment, disability, or worker’s comp, do you anticipate returning to your previous employment?

Returning to previous employer?

Household Member's Name

Do you or any other household member plan to maintain a separate subsidized rental unit in another location?

Separate subsidized rental unit?

Household Member's Name

Letter of Explanation to Prospective Tenants:

Fairbanks Neighborhood Housing Services is a property management organization that manages units utilizing both the HOME and LIHTC programs. These programs are designed to assist individuals/families with limited income to be able to rent apartments at more affordable rents. Both of these programs many only be rented to individuals who have limited incomes, such as those who earn no more than 60% (or in some cases lower) of the area median income. To ensure that these units are being rented at the properly reduced rates and are being rented to those individuals who qualify by having limited income, AHFC and FNHS together will monitor this program for compliance with both the HOME and LIHTC programs. These compliance monitoring responsibilities will include verifying the amount of income earned by each tenant in either a HOME or LIHTC program.

To determine if you qualify to rent an affordable unit, you and each person who will live in the apartment (18 and older) will be required to disclose and certify in writing the amount of annual income you earn. You will also be required to provide sufficient documentation to verify the amount you and your family earn each year.

Additionally, you will be required to disclose, certify, and provide sufficient documentation each year your total family income to remain qualified as a tenant of these programs. The property manager will be able to assist you in determining whether or not you meet the income limitations. These requirements are required by law; the manager does not have the authority to waive these requirements. If you are unable to disclose, certify, and provide supporting documentation as to your annual income level, than you cannot be a tenant in a HOME or LIHTC program.

Signatures

I/We hereby certify that the housing I am applying for will be my permanent residence. I/We will not maintain a separate subsidized rental unit in a different location. I/We certify that all household assets and income information is correct. I/We certify that all information provided is true and complete the best of my/our knowledge. I/We further understand that providing false representation herein constitutes an act of fraud. False, misleading, or incomplete information will result in the denial of the application or termination of the lease agreement.

Signature of Applicant

Clear Signature

Date

Signature of Co-Applicant (1)

Clear Signature

Date

Signature of Co-Applicant (2)

Clear Signature

Date

AUTHORIZATION FOR RELEASE OF INFORMATION

CONSENT: I/we authorize and direct any Federal, State, or Local agency organization, business, or individual to release to: FAIRBANKS NEIGHBORHOOD HOUSING SERVICES Any information or materials needed to complete and verify my application for participation, and/or to maintain my continued assistance under the Section 8, Rental Rehabilitation, Low-Income Public Housing, U.S. Rural Development, Indian Housing, Public Housing, Rental Assistance Program, Mutual Help Homeownership Opportunity Program, Rent Supplement, Section 23 and 102 Leased Housing, Section 23 Housing Assistance Payments, Section 42 Low Income Housing Tax Credits, Section 202, Section 221 (d)(3) Below Market Interest Rate, Turnkey III Homeownership Opportunities Program and/or other housing assistance programs or rental opportunities. I/we understand and agree that this authorization for the information obtained with its use may be given to and used by the Department of Housing and Urban Development (HUD) and U.S. Rural Development in administering and enforcing program rules and policies.

INFORMATION COVERED: I/we understand that depending on program policies and requirements, previous/current information regarding me or my household may be needed. Verifications and inquiries that may be requested include but are not limited to:

Housing Agencies	Criminal Activity	State Agencies
Courts and Post Offices	State Employment Agencies	Native Corporations
Schools and Colleges	Social Security Administration	Unemployment Agency
Law Enforcement Agencies	Medical/Child Care Providers	Home Health Providers
Support/Alimony Providers	Bank/Other Financial Institutions
Past/Present Employers	Credit Providers/Credit Bureaus
Veterans Administration	Utility Companies
Retirement Systems	Current or Former Landlords
Criminal Activity	Family Composition

Conditions:

I/we agree that a photocopy of this authorization may be used for the purposes stated above. This authorization will stay in affect as long as I am an application or participant in any assisted housing program. I understand that a photocopy of this authorization is as valid as an original.

Name (Head of Household)

First

Last

Signature

Clear Signature

Name (Other Adult)

First

Last

Signature (Other Adult 1)

Clear Signature

Name (Other Adult)

First

Last

Signature (Other Adult 2)

Clear Signature

Items Required for All Applications:

Application completed in full by all applicants
Copy of Birth Certificates for all applicants
Copy of driver’s license or state issued ID for all adult members listed in the application
Copy of Social Security cards for all applicants listed in the application
Proof of all income for all occupants. This would include:
- 4-6 consecutive paystubs (2 months) for all adult applicants listed in the application
- Social Security Award letter
- Unemployment, worker’s compensation, disability statements
- Public Assistance statements
- Benefits, pensions, retirement statements, etc.
Previous year’s tax return if filed
Signed Release of Information form for all adult applicants listed in the application
Three (3) months consecutive, full bank statements for ALL occupants including minors, both checking and savings if applicable.
Copy of housing voucher, if applicable
If divorced, must have copy of the divorce decree and child custody agreement, if applicable
No felony convictions
No evictions

Your Email Address

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1427 Gillam Way, Fairbanks AK, 99701

Phone (907) 451-7230

Fax (907) 451-7236

Email properties@fnhs.org

Application for housing

Directions to applicant:

Head of household information (Applicant)

Co-Applicant

Other Occupants

Name 2

Name 3

Name 4

Name 5

Household Information/Eligibility

Background Screening Information

Applicant(s) History

Current employer (Head of Household)

Previous employer (Head of Household)

Current employer (Co-Applicant)

Previous employer (Co-Applicant)

Vehicle Information

Vehicle Information 2

Household Additional Sources of Income

Anticipated Income for all Household Members in the next 12 Months

Wages from employer (FT, PT, seasonal, etc.)

SSI

SSI/SSDI?

State General Asst? (APA, Senior’s Benefits, etc.)

Food Stamps? (SNAP)

Welfare/TANF/Public Asst?

Income from tips, commission, direct sales, etc.?

Child Support?

Alimony

Veteran’s Benefits?

Unemployment or Worker’s Compensation?

Disability Insurance? (NOT SSDI)

Annuities, retirements, or pensions?

Severance pay?

Student Financial Aid (grants, scholarships, fellowship, etc.)?

Net Income from business or self-employment?

Military Pay?

Rental Property Income?

Adoption or Foster Subsidy?

Alaska Permanent Fund Dividend?

Native Dividend Shares?

Church welfare?

Income from temporarily absent family members?

Income from Insurance policies?

Disability or Death Benefits?

Regular contributions from anyone outside your household (gifts, rental income, etc.)?

Any type of periodic payment not listed above?

Any other sources of income not listed above?

Net Family Assets

Do you have a checking account?

Do you receive interest on your checking account?

Do you have a savings, money markets, CDs, or trust account?

Do you have an individual retirement account (IRA), Keogh, or any other retirement account?

Do you have cash held in Safety Deposit boxes, home, etc.?

Do you have cash held in Safety Deposit boxes, home, etc.?

Do you have any savings bonds?

If employed, can you withdraw from a retirement or pension fund without terminating employment?

Do you have personal property held as an investment (gem collection, antiques, autos, etc.)?

Do you own real estate property (land, home/dwelling, etc.)?

Do you have a whole life insurance policy?

Do you receive Lump Sum Payments?

Have you or any family member disposed of any assets within the last two (2) years?

Have you or any family member given away or sold any assets for less than their value?

Additional Verifications

Are you or any other adult member of your household claiming zero income?

Do you file a Federal Tax Return?

Do you have an employed full-time student 18 years of age or older in your household?

Is anyone in your household currently/anticipate becoming a full-time student?

If receiving unemployment, disability, or worker’s comp, do you anticipate returning to your previous employment?

Do you or any other household member plan to maintain a separate subsidized rental unit in another location?

Letter of Explanation to Prospective Tenants:

AUTHORIZATION FOR RELEASE OF INFORMATION

Conditions: