Welcome!

This is the first stage of the evaluation process for subsidized housing under the programs of the Department of Housing and Urban Development (HUD). Completing this form does not guarantee admission, but allows us to evaluate your eligibility.

Before you begin, have the following available:

• Valid identification
• Information of all household members including their Social Security cards
• Income and benefits (employment, Social Security, food assistance, TANF, etc.)
• Current housing information

You must report all household income and benefits, including:

• Employment or self-employment
• Social Security and pensions
• Public assistance
• Veterans benefits
• Unemployment
• Income from properties or bank accounts

Housing availability depends on each project.

Submission of this application does not guarantee admission.

For verification purposes, the name must be entered exactly as it appears on your Social Security card.

For verification purposes, the name must be entered exactly as it appears on your Social Security card.

Each member must be included even if they do not generate income. Do not forget to enter minors, dependents, elderly persons, college students, and any other person who permanently resides in the household.

Income includes:
Salary, wages, tips, commissions, bonuses, self-employment, Social Security benefits, economic assistance (TANF), nutrition assistance (SNAP), child support, spousal support, unemployment compensation, Armed Forces benefits, veterans benefits, retirement pension, state disability, State Insurance Fund compensation, Financial Assistance for University Students, asset income (bank accounts, investments, bonds, etc.), rental property income, and family or other assistance for payment of expenses.

IMPORTANT: Each adult member, 18 years of age or older, must read, certify and give consent to the disclosures and statements contained on this page.

I certify and consent to the following:

Legal Notice:

Title 18, Section 1001 of the United States Code provides that a person who knowingly and willingly makes false and fraudulent statements to any department or employee of the United States Government, HUD, a Housing Authority or an Owner may be subject to penalties including fines and/or imprisonment.

The Federal Government requires obtaining information about the history of drug use or abuse, criminal background, and lifetime registry of sex offenders of all family members 18 years of age or older who apply for housing or reside in subsidized housing projects. To comply with this requirement, each family member 18 years of age or older must answer the questions below and sign, authorizing Partners Business Services, LLC to verify such information.

Partners Business Services, LLC informs that all housing applications will be denied or federal rental assistance will be terminated for those applicants or tenants who do not provide correct information in this questionnaire, who do not authorize its verification, or who refuse to answer it.

Answer the following:

I acknowledge that the information requested is necessary to process my housing application or to renew the federal assistance of the unit I currently occupy. I further acknowledge that providing false or incomplete information in this document constitutes sufficient grounds for denying my housing application or for terminating federal assistance of the unit I occupy.

I authorize Partners Business Services, LLC to investigate and verify the information provided and consent to the disclosure of necessary information to determine my eligibility. I also authorize corresponding agencies to disclose criminal records and/or registered sex offender records, or agencies contracted by Partners Business Services, LLC to conduct such investigations.

Title 18, Section 1001 of the United States Code provides that any person who, knowingly and willingly, makes false or fraudulent statements to any department or employee of the United States Government, HUD, a Housing Authority or an owner, may be subject to penalties including fines and/or imprisonment.

A. Information

All members of the household composition, applicants and tenants, must disclose and provide complete and accurate verification of the Social Security number assigned to them, except for those persons who do not dispute their eligible immigration status or tenants who were sixty-two (62) years of age or older on January 31, 2010, and whose initial eligibility determination was initiated before January 31, 2010. Failure to disclose or provide documentation and verification of the Social Security number will result in an applicant not being admitted or the rescission of a tenant's lease.

When it is your turn on the waiting list, the applicant must have provided and/or documented the Social Security number of all household members, as well as evidence of the numbers submitted through the original Social Security card. This requirement includes Live-In Aides, if applicable.

If any household member does not have an assigned Social Security number, they will not be eligible to receive assistance. For this reason, as part of the eligibility process, you may be required to provide one or more of the following documents as an alternative to verify your Social Security information:

1. Original document issued by the state or federal government containing the name, Social Security number and any additional information that helps identify you.
2. Driver's License including Social Security number.
3. Identification card issued by a health insurance, employer and/or labor union.
4. Employment income stubs.
5. Bank statements.
6. Form 1099.
7. Letter from the Social Security Administration showing the award of benefits.
8. Retirement benefit letter.
9. Life Insurance Policy.
10. Criminal background certificate.

B. Time limit for delivery of documents

1. If all household members have not disclosed and/or provided verification of their Social Security number when a unit is available, the unit must be offered to the next eligible applicant.
2. Every applicant who has not provided and/or documented the Social Security information of all household members will have a period of ninety (90) days, counted from the date the available unit is offered to them, to provide such information.
3. If verification of Social Security information is the only pending requirement on the application, the applicant may choose to retain their place on the waiting list while completing the required verification.
4. After the ninety (90) day period has passed, if the applicant has not provided or cannot provide the Social Security information, they will be determined not eligible and will be removed from the waiting list.