We will assist an applicant or family member with a disability/handicap to provide reasonable accommodations. A reasonable accommodation is some modification or change we can make to the rules/procedures or to the structure of the property that will assist an otherwise eligible applicant with a disability to take advantage of the program.
Optional and Supplemental Contact Information for HUD-Assisted Housing Applicants
SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING
OMB Control # 2502-0581 Exp. (11/30/2015)
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.
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.
All questions on this application must be completed, if not, the application will be returned to applicant. All of the information provided in this application is preliminary and in no way insures occupancy and is held in the strictest confidence. Additional information may be requested. This is an Equal Housing Opportunity in which there are no barriers to obtaining housing on the basis of race, color, religion, sex or national origin.
Section 1001 of Title 18 of the US Code makes it a criminal offense to make willful false statements or misrepresentations to any agency or department of the United States as to any matter within its jurisdiction. Any false or erroneous information herein shall constitute grounds to void, invalidate or cancel the lease if applicant(s) should qualify and a lease is subsequently executed. By signing below you/we swear that all the information provided herein is true to the best of my/our knowledge.