Forms - Section 8 - Housing Authority

Section 8 Housing Application - Resident

PRIVACY NOTICE - The information requested in this form is to be used by the Department to determine maximum income for eligibility, recommended unit size and amount of the individual contribution to be made by the applicant. It will not be disclosed outside the Department except as required and permitted by law. You do not have to give us this information, however, failure to do so may result in the delay or rejection of program benefits. Authority for collection of this information is Section 7(d) of 42 U.S.C., 3535(d); Section 5(b) of the US Housing Act of 1937 (42) USC 14371).

Project Identification

Name:

Applicant Identification

Full Name:
Email:
Present Address:	Unit or Apt. #:
City:	State:
Phone:	Social Security #:	- -

Family Composition:
List each family member who will live in the dwelling:

Name Relation to Applicant:

Age Sex:

Name Relation to Applicant:

Age Sex:

Name Relation to Applicant:

Age Sex:

Name Relation to Applicant:

Age Sex:

Name Relation to Applicant:

Age Sex:

Name Relation to Applicant:

Age Sex:

Income:

Source, Rate & Type: Current: Anticipated:

Source, Rate & Type: Current: Anticipated:

Source, Rate & Type: Current: Anticipated:

Assets: (include those shown as income as well as all others)

Description: Amount:

Description: Amount:

Description: Amount:

Allowances: (use additional pages if necessary)

Description: Medical: Unusual:

Description: Medical: Unusual:

Description: Medical: Unusual:

I certify that the above information is accurate.

WARNING: Section 1001 of Title 18 of the US Code makes it a criminal offense to make willful false statement of misrepresentation to any Department or Agency of the US as to any matter within its jurisdiction.