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TBRA Policies and Procedures January 2013 of 10

CITY OF VANCOUVER TENANT-BASED RENTAL ASSISTANCE (TBRA) PROGRAM

HOME Program Policies and Procedures

1. OVERVIEW:

A. Definition: Tenant Based Rental Assistance (TBRA) is a rental subsidy used to help individual households afford housing costs. Clients choose their housing and the subsidy stays with the client (not the unit) if they move. This assistance is provided to families who are under 60% AMI and are connected with services that promote self sufficiency. Families must be participating in a self sufficiency program and be determined to be income eligible at time of admission.

B. Portability: Tenant must be able to choose unit in which to live. Rental costs must not be above fair market rent and meet the Rent Reasonableness Test.

C. Contract funding: The agency contract with the City of Vancouver is limited to 12 months.

D. Payment Standards:

Apartments rented can not exceed the maximum rent fair market rent as established annually by HUD. See Attached Form 1 – 2013 HUD Income and Rent Limits. Information is also available on the web site www.cityofvancouver.us/cdbg

Maximum Rental Assistance: Difference between rent and 30% of Adjusted Gross income (certificate method).

Minimum Tenant Payment: 30% of Income TBRA funds can not be used for the following:

o Commitments to specific owners for specific projects; o Assistance to resident owners of cooperative housing that

qualifies as home ownership housing; o Displacement or relocation assistance to tenants as a result of

activities other than the HOME program; o Overnight or temporary shelter; or o In conjunction with another rental assistance program.

E. Location: Rental property may be located anywhere in Clark County. G. Record Retention: All records must be retained for five years after final

rental assistance is provided.


2. MARKETING: Agencies must establish how potential applicants will be notified and selected for the TBRA program. Description should include:

Local preferences (i.e. homeless, participants in self sufficiency programs) Where applications are available and how they are submitted Agency steps to reach applicants who are least likely to apply Outreach to property owners See Attached Form 2 – Sample Outreach and Tenant Selection.

3. FAIR HOUSING: The following information should be included in marketing and agreements with the landlords/owners. Non-Discrimination: The Agency or landlord shall not, in the provision of services or in any other manner, discriminate against any person on the grounds of age, race, color, creed, religion, sex, handicap, national origin, or familial status. 4. TENANT SELECTION: All applicants must be screened and selected through a fair, written and public process.

A. Applications: Agencies must use a written application to determine eligibility. Application will include income information, household information, program rules & policies, complaint & grievance procedures, rent standards, rent calculation form, income limits and adjustments. See Attached Form 3 – Sample TBRA Application.

B. Residency Eligibility: Tenants must be residents of Clark County,

working in Clark County, or have a bona fide job offer in Clark County. Documentation may include drivers license, utility bills, copies of benefit or banks statements.

C. Eligibility: Agencies shall review income and program eligibility prior

to admission and recertify every 90 days.

D. Self Sufficiency Participation: Selected tenants must participate in a self-sufficiency program and have a reasonable likelihood of successfully achieving housing stability either on their own or through acquisition of some other form of permanent housing subsidy.


E. Waiting list: Agencies are permitted to maintain a written waiting list. If using this option, agency must describe how people are selected from list to participate.

F. Notification: Prospective tenants must be notified in writing regarding

the outcome of their application. Requirement extends to all unsuccessful applicants as well as selected tenants.

G. Rental Assistance Coupon: Upon admission into the TBRA program,

prospective tenants are issued a Rental Assistance Coupon which authorized households to begin the search for appropriate housing. At the time the coupon is issued a meeting explaining the responsibilities of each party and the impact of the housing choice upon the payment. See Attached Form 4 – Sample HOME Rental Assistance Coupon. The coupon should include: Agency name Household name Unit size Date issued Location restrictions Expiration date Estimated rent calculation based on tenant income Tenant requirements Agency processes and responsibilities Security Deposit Policy Owner/landlord requirements Length of assistance Equal housing opportunity statement

5. INCOME ELIGIBILITY AND SUBSIDY AMOUNTS: A three step process is used to arrive at the maximum subsidy amount. The forms are available in the appendixes. These are also available in excel by contacting staff. Additionally, the website below will help you calculate the income and provide additional information. http://www.hud.gov/offices/cpd/affordablehousing/training/web/calculator/calculator.cfm

Income Determination Calculating Adjusted Income Total Tenant Payment Calculation A. Income Determination Process: Agencies will use the Annual Income as

Defined in 24 CFR Part 5, to determine TBRA income eligibility. This is


also referred to as Part 5 Annual Income; and was based on the Section 8 model. The income definition is defined as the gross amount of income of all adult household members that is anticipated to be received during the coming 12-month period. See Attached Form 5a – Subsidy Calculation Worksheets (Annual Income Tab).

Program participants will provide proof of income (such as wages or governmental benefits GAU, ADATSA, SSI, SSDI) at enrollment and each time household income changes. A copy of the proof of income or self-declaration of no income is stored in the program participant file.

B. Calculating Adjusted Income: After gross income is determined,

calculation for the "adjusted income" as defined in 24 CFR 5.611 is used to determine total tenant payment (TTP), which is a measure of a household's ability to pay housing costs. See Attached Form 5b – Subsidy Calculation Worksheets (Adjusted Income Tab).

C. Total Tenant Payment Calculation: The TTP is the final calculation used

to determine the Agency's subsidy and tenant's share of rent under a HOME-funded TBRA program. Resident rents are calculated by using annual incomes and applying standard allowances for dependents, childcare, disabilities and medical expenses and based upon established HUD guidelines, Notice CPD-96-03. If all utilities are included in the rent, the tenant’s entire share of housing costs goes directly to the landlord. If utilities are paid separately, the Agency must make utility reimbursements to the household whenever the household’s share of housing costs is insufficient to cover expected utility costs. Agencies must use the utility allowance established by the Housing Authority of the City of Vancouver. Recent versions are available at http://www.vhausa.com/housing/Utility_Allowances.html. See Attached Form 5c – Subsidy Calculation Worksheets (Total Tenant Payment Tab).

D. Maximum Income: Family income must not be above 60% adjusted

median income (AMI) on admission and recertification. Income limits are established by household size and revised annually by the Department of Housing and Urban Development. See Attached Form 1 – 2012 HUD Income and Rent Limits.

6. UNIT SELECTION/APPROVAL Upon admission into the TBRA program, prospective tenants are issued a Coupon (described above) along with a Request for Unit approval. This


document must be completed and forwarded to the City of Vancouver via the provider to trigger the housing quality inspection. See Attached Form 6 – Sample Request for Unit Approval.

A. Unit Inspections: Prior to completing the lease or making any payments, a unit must be inspected to meet the housing quality standards (HUD-52580). The Agency has the option of performing an HQS; however the City must be notified prior to any inspection. The copy of the Request for Unit Approval can be emailed to Peggy Sheehan. Agencies cannot complete the inspections if they own the units.

Unit must meet housing quality standards (HQS) before tenancy and at least annually. Complete records of certification, inspections, and follow-up actions must be kept in the client’s files. Housing safety standards: See Attached Form 7 – HUD HQS Inspection Checklist. Units that are built before 1978 must pass the lead based paint inspection. See Attached Form 8 – Lead-Based Paint Visual Inspection Report.

B. Occupancy Standards: HUD has established occupancy standards that

comply with the HQS requirements and how the number of bedrooms needed by the household will impact the unit size and subsidy. The following basic standards can be modified to take into consideration specific household composition and circumstances (i.e., pending child custody cases, chronic illnesses, family member who is absent most of the time, etc.). Occupancy standards are used to provide consistent criteria for determining the unit size for which the household is eligible and thus, the amount of assistance to be provided. Fair housing rules permit a household to select smaller units that do not create seriously overcrowded conditions.

No more that two persons are required to occupy a bedroom; Persons of different generations (i.e., grandparents, parents, children),

persons of the opposite sex (other than spouses/couples) and unrelated adults are not required to share a bedroom;

Children of the same sex (regardless of age) and couples co-habiting (whether or not legally married) must share the same bedroom for purpose of assigning the bedroom size on housing coupon;

A live-in care attendant who is not a member of the family is not required to share a bedroom with another household member.

Individual medical problems (i.e., chronic illness) sometimes require either separate bedrooms for household members who would otherwise


be required to share a bedroom or an extra bedroom to store medical equipment;

In most instances, a bedroom is not provided for a family member who will be absent most of the time, such as a member who is away in the military.

C. Ownership: Units maybe privately or publicly owned.

D. Rent Reasonableness: Rent for each unit must be determined to be

reasonable when compared to unassisted units. This can be calculated by using the Rent Reasonableness Form. Tenants must complete this form prior to proposing any lease. See Attached Form 9 – Rent Reasonableness Certification.

E. Rent Increases: Any rent increased must be approved by the City of

Vancouver. Individuals will be asked to provide documentation from the landlord about rent adjustments. Adjustment of the subsidy may be re-calculated providing rent amounts continue to maintain the Fair Market Rent standards for the area.

F. Landlord-Tenant Law: Tenants should receive a user-friendly copy of the

Landlord-Tenant Law and be informed on how to use this law when problems arise. Copies of signed receipt of the landlord-Tenant Law should be included in the individual’s file. See Attached Form 10 – Landlord Tenant Law Brochure. The law can also be found on the Office of the Attorney General’s website at www.atg.wa.gov and the NW Justice Project’s website at www.nwjustice.org.

G. Lead Based Paint: Tenants will be notified of about the potential presence

and hazard of lead. All individuals receiving tenant-based rental subsidies will receive a copy of the Environmental Protection Agency brochure titled “Protect Your Family From Lead In Your Home”. See Attached Form 11 – Lead Based Paint Brochure. A signed receipt of the copy should be maintained in the individual’s file.

EPA Disclosure Requirements For All Leased Housing Built Before 1978

The lessor shall provide the lessee with the EPA-approved lead hazard information pamphlet entitled Protect Your Family From Lead in Your Home (EPA #747-K-94-001). See Attached Form 12 – Lead Based Paint EPA Disclosure Form.

The lessor shall disclose to the lessee the presence of any known lead-

based paint and/or lead-based paint hazards, in any housing built


before 1978 that is being leased. The lessor shall also disclose any additional information available such as the basis for the determination that lead-based paint and/or lead-based paint hazards exist, the location of the lead-based paint and/or lead-based paint hazards, and the condition of the painted surfaces.

The lessor shall disclose to each lessee the existence of any available

records or reports pertaining to lead-based paint and/or lead-based paint hazards. This requirement includes records or reports regarding common areas. This requirement also includes records or reports regarding other residential dwellings in multifamily housing built before 1978, provided that such information is part of an evaluation or reduction of lead-based paint and/or lead-based paint hazards in the housing built before 1978 as a whole.

If any of the disclosure activities identified in this section occurs after

the lessee has provided an offer to lease the housing, the lessor shall complete the required disclosure activities prior to accepting the lessee’s offer and allow lessee an opportunity to review the information and possibly amend the offer.

7. LEASE ADDENDUM

A. Terms: At least one year unless the tenant and agency agree otherwise. B. Un-allowable terms in lease: The lease between the owner and the tenant

may not contain the following: Agreement by the tenant to be sued, to admit guilt, or to a judgment in

favor of the owner in a lawsuit brought in connection with the lease; Agreement by the tenant that the owner may take, hold, or sell personal

property of household members without notice to the tenant and a court decision on the rights of the parties. However, the owner may dispose of personal property left by a tenant in accordance with state law;

Agreement by the tenant not to hold the owner or the owner’s agents legally responsible for any action or failure to act, whether intentional or negligent;

Agreement of the tenant that the owner may institute a lawsuit without notice to the tenant;

Agreement by the tenant that the owner may evict the tenant or household members without instituting a civil court proceeding in which the tenant has the opportunity to present a defense, or before a court decision on the rights of the parties;

Agreement by the tenant to waive any right to a trial by jury;


Agreement by the tenant to waive the tenant’s right to appeal, or to otherwise challenge in court, a court decision in connection with the lease; and

Agreement by the tenant to pay attorney’s fees or other legal costs even if the tenant wins in a court proceeding by the owner against the tenant. The tenant, however, may be obligated to pay costs if the tenant loses. See Attached Form 13 – Lease Addendum.

8. AGREEMENT WITH PROPERTY OWNER/LANDLORD The Agency should have an agreement with the property owner/landlord providing information regarding terms, amounts, security deposit fair housing and termination. See Attached Form 14 – Sample TBRA Rental Assistance Contract. 9. TERMINATION: Agency must notify tenant in writing when terminating tenant assistance. Agency must follow landlord tenant rules of Washington State.

A. End of Assistance Time Period: Provide notice in writing to tenant and landlord.

B. Property Owner Termination: If a property owner terminates the tenancy through no fault of the tenant, and the tenant is still eligible for assistance, the Agency will work to find another unit.

C. Tenant Caused Eviction: If tenant is evicted due to breaking the lease or participating in illegal activities, the agency is under no obligation to continue to provide rental assistance.

D. Tenant Moves: Tenant moves are accommodated only on rare instances such as family size or job change.

10. SELF-SUFFICIENCY PROGRAMS: Agreements for self-sufficiency services must be in a separate agreement signed by the agency and the participant 11. UTILITIES:

A. Utility Deposits: Funding associated with the TBRA program can not be used for utility deposits.

B. Utility Costs: Utilities costs are included in the fair market rental calculation. Agencies must use the utility allowance established by the Housing Authority of the City of Vancouver. Recent versions are available at http://www.vhausa.com/landlords/utility allowances.html. The rents must be reduced for tenant paid utilities.


12. BENCEFICIARY DATA / RECORDS: Each agency will track TBRA tenants, rents and occupancy data and

submit to the City of Vancouver with each invoice. The agency may use the attached Tenant, Rents and Low-Income Occupancy form or create its own version of the form. See Attached Form 15 – Tenant Rents and Low Income Occupancy.

Each agency will maintain a Microsoft Excel reporting checklist format provided by City of Vancouver that includes:

o Individual’s name o Individual’s date of birth o Receiving case management o Financial eligibility o Rent below FMR o HQS Inspection completion date o Lead based paint inspection o Lease in file o Amount of subsidy o Rental start date

13. REQUIRED DOCUMENTATION: Note: all forms must have signatures. Agencies receiving HOME funding are required to maintain adequate documentation of the eligibility of persons served using the HUD, Community Planning and Development, Office of Affordable Housing Programs, Tenant Based Rental Assistance Guidelines –A HOME Program Model, January 1997. Records will be retained for five years after final rental assistance is provided.

Application Coupon (rent calculation) Income verification and subsidy calculations Notice of eligibility or ineligibility to prospective applicants Rent Reasonableness HQS Inspection Checklist Tenant, Rents and Low-Income Occupancy Data Lead Based Paint Inspection Report – (Units built before 1978) Lease and addendums Agreement with owner/landlord Case management records Notice of end of rental assistance to both tenant and landlord/property

owner


ATTACHMENT LIST

Form 1 – 2013 HUD Income and Rent Limits Form 2 – Sample Outreach and Tenant Selection Form 3 – Sample TBRA Application Form 4 – Sample HOME Rental Assistance Coupon Form 5 – Subsidy Calculation Worksheets.xls Form 5a– Subsidy Calculation Worksheets (Annual Income Tab) Form 5b– Subsidy Calculation Worksheets (Adjusted Income Tab) Form 5c– Subsidy Calculation Worksheets (Total Tenant Payment Tab) Form 6 – Sample Request for Unit Approval Form 7 – HUD HQS Inspection Checklist Form 8 – Lead-Based Paint Visual Inspection Report Form 9 – Rent Reasonableness Certification Form 10 – Landlord Tenant Law Brochure Form 11 – Lead Based Paint Brochure Form 12 – Lead Based Paint EPA Disclosure Form Form 13 – Lease Addendum Form 14 – Sample TBRA Rental Assistance Contract Form 15 – Tenant Rents and Low Income Occupancy

Form 1 - 2013 HUD Income and Rent Limits (page 1 of 1)

2013 HUD Income Limits Summary for Vancouver, Washington

Median Family Income

Income Limit Category

Number in Household

1 2 3 4 5 6 7 8

$68,300

Four-person household

80% of Median $38,850 $44,400 $49,950 $55,500 $59,950 $64,400 $68,850 $73,300

60% of Median $29,160 $33,360 $37,500 $41,640 $45,000 $48,360 $51,660 $55,020

50% of Median $24,300 $27,800 $31,250 $34,700 $37,500 $40,300 $43,050 $45,850

30% of Median $14,600 $16,650 $18,750 $20,800 $22,500 $24,150 $25,800 $27,500

Source: U.S. Department of Housing and Urban Development, effective December 11, 2012 for CDBG funds and March 15, 2013 for the HOME Program. Vancouver is part of the Portland-Vancouver-Beaverton, OR-WA MSA.

2013 HUD Rent Limits for Vancouver, Washington

Rent (Monthly) Number of Bedrooms

Studio 1 2 3 4 5 6

Fair Market Rent (FMR) (11/13/12)

$659 $766 $912 $1,344 $1,615 $1,857 $2,099

High HOME Rent (2/9/12) $675 $783 $905 $1,200 $1,319 $1,437 $1,555

Low HOME Rent (2/9/12) $638 $684 $821 $949 $1,058 $1,168 $1,277

Source: U.S. Department of Housing and Urban Development, effective November 13, 2012 for FMR and February 9, 2012 for High and Low HOME rent. Vancouver is part of the Portland-Vancouver-Beaverton, OR-WA MSA.

NOTE: Projects with one to four HOME-assisted units are required to have assisted unit rents not exceed the lesser of the Fair Market Rent or High HOME Rent. Projects with five or more HOME-assisted units are required to have 20% of assisted unit rents not exceed the Low HOME Rent and 80% not exceed the lesser of the Fair Market Rent or High HOME Rent. Rents include utilities and must be reduced for tenant paid utilities.

Form 2 - Sample Outreach and Tenant Selection (page 1 of 3)

APPENDIX 1

SAMPLE OUTLINE FOR TENANT SELECTION PLAN AND OUTREACH STRATEGY

Note: Program administrators must have a written description of how tenants will be selected for the TBRA program. Program administrators must also develop a marketing and outreach strategy that specifies how the program will be marketed, playing particular attention to fair housing issues and requirements. This outline assumes a single document that is used for both of these purposes.

I. KEY TBRA POLICIES AFFECTING MARKETING AND TENANT SELECTION

A. Preferences. Describe any established local preferences and how they will be used.

B. Application Procedures. Describe the waiting list that will be used and, if a separate TBRA waiting list is established, describe:

• how the program will be announced. (Opening and closing of waiting lists must be publicly announced.)

• where applications will be- taken (e.g., in one central location; accommodations for elderly/handicapped, etc).

• when applications will be accepted (e.g., on a continuing basis, for a limited time, only during certain hours, etc.).

• the method of application (e.g., in-person; by mail; using interviews, etc.).

C. Occupancy Standards (sample only).

Persons in Household

Coupon Size Minimum Maximum

OBR 1 1 1BR 1 2 2BR 2 4 3BR 4 6 4BR 6 8 SBR 8 10


Unit Assignment Policies (sample only). Units assignments will be made on the following basis:

• Persons of the opposite sex, other than spouses, will not be required to share the same bedroom.

• Children of the opposite sex above the age of six will not be required to share the same bedroom.

• Children will not be required to share a bedroom with a parent.

• An unborn child may be considered for the purpose of assigning the bedroom size.

• Larger size units than indicated by these policies may be assigned if the applicant provide documentation that a larger unit is needed for health/medical reasons.

D. Coupon Expirations and Extensions.

The program administrator should establish a deadline for use of the Coupon, and describe the circumstances under which extensions will be granted. (Include any other established policies that affect how program participants will be selected.)

E. Termination of Tenancy and Tenant Moves.

State the PJ's policy with respect to owner termination of tenancy.

State the PJ's policy with respect to tenant evictions. Will the family be permitted to receive assistance in another dwelling, or will a tenant-caused eviction also terminate the household's eligibility for assistance?

State the PJ's policy with respect to tenant moves. What kind of notice must the family give? Under what circumstances will the household be eligible for continued assistance?

II. OUTREACH TO POTENTIAL APPLICANTS

A. Demographic Description of Eligible Households.

Provide a brief description of the demographic characteristics of the potentially eligible population.

B. Least Likely to Apply Households.

Identify which households by reason of race/ethnicity, age, gender, handicap, familial status, or income source are least likely to apply for assistance.


C. Outreach Activities.

Describe the outreach steps that will be taken to reach potential applicants, especially those identified as least likely to apply. For example:

• media (newspaper, television, radio, etc.) advertisement, news releases, and public service announcements. (Be sure to include both media serving the population in general, and media sources that support a particular group.)

• public meetings and/or contacts with appropriate community organizations and institutions (e.g., social service providers, churches, community/resident groups, etc.).

III. OUTREACH TO OwnerS

A. Identify barriers to landlord participation.

B. Outreach Activities.

Describe the outreach steps that will be taken to reach owners of rental property throughout the community. For example:

• media (newspaper, televis.ion, radio, etc.) advertisement, news releases and public service announcements. (Be sure to include both media serving the population in general and media sources that support a particular group.)

• public meetings and/or contacts with appropriate community organizations and institutions (e.g., apartment managers associations, chamber of commerce, etc.).

• identify any special outreach planned for owners of units outside of areas of lowincome and minority concentration.

IV. COMPLIANCE WITH SECTION 504 ACCESSIBILITY REQUIREMENTS

Describe how the program administrator will comply with Section 504 requirements including:

• providing information materials in alternative formats (large print, on tape, etc.).

• communicating with hearing impaired applicants; and

• making reasonable accommodations to applicants with handicaps.

Form 3 - Sample TBRA Application (page 1 of 2)

SAMPLE TBRA APPLICATIONS

APPLICATION FOR RENTAL ASSISTANCE

( Full Application Version)

APPLICANT NAME:

Current Address:

City, State, Zip Code:

Home Phone No.: Alternate Phone No.: ______ _

HOUSEHOLD COMPOSITION

(List the Head of Household and all other members who will be living in the unit. Give the relationship of each family member to the head.)

Member's Full Name Relationship Birthdate Age Sex Social Security No.

Race of Head of Household (Check One) - Optional (This information is being collected to assure compliance with fair housing and equal opportunity rules.)

o White o Black o Asian/Pacific Islander o Native American/Alaskan Native o Hispanic

Preference Information.2 You may qualify for a preference for housing assistance if any of the following circumstances can be verified for your family. Please check any that apply to you.

o Are you currently homeless or living in substandard housing? If yes, please explain:

o Have you been (or are you about to be) displaced from your housing? If yes, please explain: _____________________________ _

2 Note: These are examples only. Insert the appropriate local preferences.

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Form 3 - Sample TBRA Application (page 2 of 2)

Application for Rental Assistance (Page Two)

INCOME INFORMATION

What is the total annual income of all household members? (Include wages, salaries and tips; other income such as alimony, child support; and Social Security, AFDC or other benefits) ~ ______ _

Member's Full Name Source of Income Annual Amount Payment Basis (weekly, monthly, etc.)

ASSET INFORMATION

List the type and source of any famify assets. Provide both the current cash value and the estimated annual income from the asset.

Member's Full Name Type and Source of Asset Cash Value Annual Income (e.g.bank accounts, investments) of Asset from Asset

EXPENSE INFORMATION

DYes 0 No Does your household have un-reimbursed medical expenses in excess of 3 percent of annual income?

DYes 0 No Does your household pay child care expenses for children under the age of 13 that enable a family member to work or go to school?

DYes 0 No Does your household pay care expenses for the care of a family member with disabilities that enable a family member to work?

APPLICATION CERTIFICATION: I/we understand that the above information is being collected to determine if I/we are eligible to receive rental assistance. I/we authorize the [Program Administrator] to verify all information provided on this application.

Head of Household Signature Date Spouse Signature Date

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Form 4 - Sample HOME Rental Assistance Coupon (page 1 of 3)

APPENDIX 3

HOME RENTAL ASSISTANCE COUPON

TENANT NAME Unit Size:* Coupon No:

Number of Household Members: Issued On: Expires On:

* This is the number of bedrooms for which the tenant family qualifies.

1. HOME Rental Assistance Program

This Coupon has been issued by [program administrator] to the Tenant identified above who is eligible to participate in the Home Rental Assistance Program. Under this program, the program administrator makes monthly payments to a Landlord on behalf of an eligible Tenant. The tenant selects a decent, safe and sanitary dwelling unit and the [program administrator] makes payments to the Landlord to help the Tenant to afford the rent. 1

When the [program administrator] issues this Coupon, it fully expects to have money available to provide assistance. However, the [program administrator] is under no obligation to the Tenant or the Landlord or any other party until the [program administrator] has approved the unit and entered into an Agreement with the Landlord and the Tenant. .

2. Key Steps in Using this Coupon

A. The Tenant must select a rental unit within the City/County limits of ____ 2 that meets the program's housing quality standards and has a reasonable rent. When the Tenant finds a suitable unit, the Tenant must give the (program administrator) a "Request for Unit Approval" form, signed by the Landlord and also provide a copy of the Landlord's lease.

(Note: The Tenant has _3 days to use the Coupon. If a Request for Unit Approval has not been submitted by the expiration date shown above, the Coupon will expire unless the [program administrator] approves an extension.)

B. After the (program administrator) receives the Request for Unit Approval, the [program administrator] will inspect the unit and review the Landlord's lease. If the unit meets the program's standards and the rent for the unit is reasonable, the (program administrator) will notify the Landlord and the Tenant that the unit has been approved.

Note: This document assumes payments will go to the landlord.

2 Note: This paragraph may need to be adjusted depending upon the extent of portability permitted by the PJ.

3 Note: Enter the number of day permitted before the coupon expires.


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SAMPLE

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Home Rental Assistance Coupon (Page Two)

[Note: If the unit or lease cannot be approved, the (program administrator) will give the Landlord an opportunity to correct the problem, or the Tenant can begin to look for another unit.]

C. The (program administrator) will then work with the Landlord and the Tenant to execute all of the necessary documents as follows:

• The Landlord and the Tenant must sign a (program administrator) approved lease.

• The Landlord and the (program administrator) must sign a HOME Coupon Contract.

• Once all necessary documents have been signed and the Tenant moves into the unit, payments to the Landlord will begin.

3. Security Deposit4

The (program administrator) will pay a security deposit to the Landlord consistent with local market practices. When the Tenant moves out, any reimbursement of the deposit that are due from the Landlord under state and local laws will be paid to [the TenanVthe (program administrator)].

4. Tenant and (program administrator) Share of the Rent

A. The portion of the rent payable by the Tenant to the Landlord ("tenant's share") is calculated based upon the Tenant's ability to pay. The Tenant must provide the (program administrator) with information about income, assets and other family circumstances that affect the amount the Tenant will pay. The Tenant's Share may change as a result of changes in income or other family circumstances. The Tenant is also responsible for payment of all utilities not included in the rent.

B. Each month the program administrator will make a rental payment to the Landlord on behalf of the Tenant. The monthly payment will be equal to the difference between the approved rent the Landlord is charging and the Tenant's share of the rent.

5. Requirements for Participating Tenants

The Family must:

• supply information about the family's income, assets, and other family circumstances that affect eligibility and the amount of the Tenant's share, and cooperate fully with annual and interim re-examinations;

4 Note: Amend this paragraph to conform with the PJ policy.

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HOME Rental Assistance Coupon (Page Three)

• allow the (program administrator) to inspect the unit at reasonable times and after giving reasonable notice;

• notify the (program administrator) when any person moves in or out of the unit and before vacating the dwelling unit; and

• use the dwelling unit as the family's principal place of residence and solely as a residence for the family.

The Tenant must not sub-lease or assign the lease.

6. Length of Coupon Assistance

Assistance under the HOME Rental Assistance Program is not guaranteed. Assistance may be terminated if:

• at any re-examination the Tenant's income is greater than the published income limit for the program;

• the Tenant is evicted from the assisted unit;

• the Tenant provides false information or commits any fraud in connection with the program, or fails to cooperative with required reexaminations; or .

• funding for the [program administrator's] Rental Assistance Program is terminated.

The [program administrator] will give the Tenant at least 30 days' notice of termination of assistance.

7. Equal Housing Opportunity

If a Tenant has reason to believe that he/she has been discriminated against on the basis of age, race, color, creed, religion, sex, handicap, national origin, or familial status, the Tenant may file a complaint with HUD. HUD has set up a "hot line" to answer questions and take complaints about Fair Housing and Equal Opportunity. The toll-free number is (800) 424-8590.

II ISSUED BY: [grantee]

Name: Signature:

Date: Telephone:

ACCEPTED BY COUPON HOLDER

Name: Signature:

Date: Telephone:


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1. NAME: 2. ID No: DATE:

Family Member Asset DescriptionCurrent Cash Value of

AssetsActual Income from

Assets

$0

$0

Family Members a. Wages/Salaries b. Benefits/Pensions c. Public Assistance d. Other Income e. Asset Income

6. Totals $0.00 $0.00 $0.00 $0.00 $0.006a Total 6b Total 6c Total 6d Total 6e Total

7 $0.00

Signature

For Office Use Only

Income Limit

Income Limit of Household

7. Enter Total of items from 6a through 6e. This is Annual Income ………………………………………

ASSETS

3. Net Cash Value of Assets…………………………

4. Total Actual income from Assets…………………………………………….

Calculating Part 5 Annual Income

5. If line 3 is greater than $5,000, multiply line by .02 (Passbook rate) and enter results here; otherwise, leave blank

ANTICIPATED ANNUAL INCOME

Enter the greater of lines 4 or 5 from above in 6e Total

below

Form 5a -Subsidy Calculation Worksheets (Annual Income Tab) (page 1 of 1)

1 1 $0.00

2 2

3 3 $0.00

4 4

5 5

6 6 $0.00

7 7

8 8

9 9

****FILL IN LINES 10 THROUGH 12 FOR ELDERLY FAMILIES ONLY****

10 10

11

>

>

> 11

12 12

13 13 $0.00

14 14 $0.00

Annual Income

Number of family members (excluding head or spouse) under 18, disabled, or full-time students

Multiply line 2 by $480

Enter the lesser of lines 7 or 8. This is the disability assistance allowance.

Enter total medical expenses

Child care deduction (reasonable child care expenses for children age 12 and under)[If family has disability assistance expense or qualifies as an elderly family, proceed to line 5; otherwise, skip to line 13]

Enter disability assistance expenses

Multiply line 1 by 0.03

Enter $400

Add lines 3, 4, 9, 11, and 12.

Subtract line 13 from line 1. This is Adjusted Income .

Computing Part 5 Adjusted income

Allowable medical expenses:If the household reported no expenses in line 5, enter line 10 minus line 6.If the household reported expenses in line 5, but line 7 is zero, enter line 10 minus (line 6 minus 5)If the household reported expenses in line 7 and line 7 is greater than zero, enter line 10.

Subtract line 6 from line 5. If negative, enter -0-

Enter amount earned by family member enabled to work as a result of disability assistance expenses

Form 5b -Subsidy Calculation Worksheets (Adjusted Income Tab) (page 1 of 1)

15 15 $0.00

16 16 $0.00

17 17

18 18

19 19

20 20

21 21 $0.00

22 22 $0.00

23 23

24 24 $0.00

Calculating Total Tenant Payment (TTP) and PJ Subsidy Rental Certificate Model

30% of Monthly Adjusted Income (line 14 divided by 12) multiplied by 0.30

10% of Gross Monthly Income (line 1 divided by 12) multiplied by 0.30

Welfare Rent

TOTAL TENANT PAYMENT (greater of lines 15, 16, or 17)[If family has disability assistance expense or qualifies as an elderly family, proceed to line 5; otherwise, skip to line 13]

Contract Rent to Owners

Utility Allowance

Gross Rent (line 19 plus line 20)

Tenant Rent (line 18 minus line 20)

Utility Reimbursement to Tenant (line 20 minus line 18 only if line 20 is greater than line 18).

PJ Payment to Owner (line 19 minus line 22)

If line 20 is greater than line 18, enter zero, and enter the difference in line 23.

Form 5c -Subsidy Calculation Worksheets (Total Tenant Payment Tab) (page 1 of 1)

Form 6 - Sample Request for Unit Approval (page 1 of 1)

APPENDIX 4

HOME RENTAL ASSISTANCE PROGRAM REQUEST FOR UNIT APPROVAL

TENANT NAME & APPLICATION NO. LANDLORD NAME NO. OF BEDROOMS

UNIT NO. & ADDRESS LANDLORD'S ADDRESS

Telephone No.

INSTRUCTIONS:

This form should be completed by the Tenant and the Landlord to request the (program administrator's) approval of the unit for which the Tenant has elected to receive rental assistance.

Landlord: Please read the sample Lease Addendum and information about Housing Quality Standards provided in the Tenant's Rental Packet. After the Tenant submits this request to the (program administrator), a staff member will contact you to arrange for an inspection. The (program administrator) is not responsible for any part of the rent prior to unit approval and execution of the HOME Coupon Contract. Please attach a copy of your proposed lease to this form.

Tenant: With the Landlord, fill out this form completely and return it to: Do not sign a lease until the (program administrator) has inspected and approved .the unit.

(1) Type of Unit: 0 Single Family 0 Semi-detached/Row House 0 GardenlWalk up o Elevator/High Rise 0 Mobile Home Date Constructed:

(2) Most recent rent charged: Were the same utilities/appliances included in the rent: 0 Yes 0 No

(3) Utilities and Appliances Provided by Owner

Heating (fuel type: 0 Cooking (fuel type: 0 Electric 0 Hot Water (fuel type: 0 Water 0 Refrigerator 0 Range 0 Trash Collection 0

Provided by Tenant

o o o o o o o o

OWNER CERTIFICATION: By executing this request, the owner agrees that the required Lease Addendum is acceptable and certifies that: (1) the information provided on the form is accurate and true; (2) the proposed unit is not assisted or covered by any other federally funded rental subsidy contract; (3) the unit currently meets Housing Quality Standards (or will be brought to HQS standard before the Rental Assistance Contract is executed; and (4) this unit is made available, managed, and operated regardless of race, color, creed, religion, sex, national origin, handicap, or familial status.

Tenant Name (Type or Print): Landlord Name (Type of Print):

(Signature/Date) (Signature/Date)


mattiam

Typewritten Text

mattiam

Typewritten Text

mattiam

Typewritten Text

mattiam

Text Box

papajohj

Text Box

Previous editions are obsolete Page 1 of 8 form HUD-52580 (3/2001)ref Handbook 7420.8

Inspection Checklist U.S. Department of Housing OMB Approval No. 2577-0169and Urban Development (Exp. 04/30/2014)

Housing Choice Voucher Program Office of Public and Indian Housing

Public reporting burden for this collection of information is estimated to average 0.50 hours 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. This agency may notconduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number .

Assurances of confidentiality are not provided under this collection.

This collection of information is authorized under Section 8 of the U.S. Housing Act of l937 (42 U.S.C. 1437f). The information is used to determineif a unit meets the housing quality standards of the section 8 rental assistance program.

Privacy Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form bySection 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f). Collection of the name and address of both family and the owner is mandatory. Theinformation is used to determine if a unit meets the housing quality standards of the Section 8 rental assistance program. HUD may disclose this informationto Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions. It will not be otherwise disclosed orreleased outside of HUD, except as permitted or required by law. Failure to provide any of the information may result in delay or rejection of family participation.

Name of Family Tenant ID Number Date of Request (mm/dd/yyyy)

Inspector Neighborhood/Census Tract Date of Inspection (mm/dd/yyyy)

Type of Inspection

Initial Special ReinspectionDate of Last Inspection (mm/dd/yyyy) PHA

A. General Information

Inspected Unit Year Constructed (yyyy) HousingType (check as appropriate)

Single Family Detached

Duplex or Two Family

Row House or Town HouseLow Rise: 3, 4 Stories,Including Garden Apartment

High Rise; 5 or More StoriesManufactured HomeCongregateCooperativeIndependent GroupResidenceSingle Room Occupancy

Shared Housing

Other

Full Address (including Street, City, County, State, Zip)

Number of Children in Family Under 6

Owner

Name of Owner or Agent Authorized to Lease Unit Inspected Phone Number

Address of Owner or Agent

B. Summary Decision On Unit (To be completed after form has been filled out

PassFailInconclusive

Number of Bedrooms for Purposesof the FMR or Payment Standard

Number of Sleeping Rooms

Inspection Checklist

ItemNo. 1. Living Room

YesPass

NoFail

In-Conc. Comment

Final ApprovalDate (mm/dd/yyyy)

1.1 Living Room Present

1.2 Electricity

1.3 Electrical Hazards

1.4 Security

1.5 Window Condition

1.6 Ceiling Condition

1.7 Wall Condition

1.8 Floor Condition

Form 7 - HUD HQS Inspection Checklist (page 1 of 8)


* Room Codes: 1 = Bedroom or Any Other Room Used for Sleeping (regardless of type of room); 2 = Dining Room or Dining Area;3 = Second Living Room, Family Room, Den, Playroom, TV Room; 4 = Entrance Halls, Corridors, Halls, Staircases; 5 = Additional Bathroom; 6 = Other

Item

No.1. Living Room (Continued) Yes

Pas

No

Fail

In-

Conc. Comment

Final Approval

Date (mm/dd/yyyy)

1.9 Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?

Not Applicable

2. Ki tchen

2.1 Kitchen Area Present

2.2 Electricity


2.4 Security



2.7 Wall Condition

2.8 Floor Condition

2.9 Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?

Not Applicable

2.10 Stove or Range with Oven

2.11 Refrigerator

2.12 Sink2.13 Space for Storage, Preparation, and Serving

of Food3. Bathroom

3.1 Bathroom Present

3.2 Electricity


3.4 Security



3.7 Wall Condition

3.8 Floor Condition

3.9

3.10

Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?

Not Applicable

Flush Toilet in Enclosed Room in Unit

3.11 Fixed Wash Basin or Lavatory in Unit

3.12 Tub or Shower in Unit

3.13 Ventilation


Item No. 4. Other Rooms Used For Living and HallsComment


4.1 Room Code* and (Circle One) (Circle One)Room Location Right/Center/Left Front/Center/Rear ____Floor Level

4.2 Electricity/Illumination4.3 Electrical Hazards

4.4 Security4.5 Window Condition

4.6 Ceiling Condition4.7 Wall Condition

4.8 Floor Condition4.9 Lead-Based Paint

Are all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?

4.10 Smoke Detectors4.1 Room Code* and (Circle One) (Circle One)

Room Location Right/Center/Left Front/Center/Rear ____Floor Level

4.9 Lead-Based Paint


4.10 Smoke Detectors

4.1 Room Code* andRoom Location

4.2 Electricity/Illumination




4.8 Floor Condition

4.9 Lead-Based Paint


In-Conc.

YesPass

NoFail

Right/Center/Left Front/Center/Rear ____Floor Level(Circle One) (Circle One)

Not Applicable

Not Applicable





4.8 Floor Condition

Not Applicable



ItemNo.

4. Other Rooms Used For Living and Halls YesPass

NoFail

In-Conc. Comment


4.1 Room Code* and (Circle One) (Circle One)Right/Center/Left Front/Center/Rear ____Floor LevelRoom Location



4.4 Security



4.7 Wall Condition



Not Applicable

4.10 Smoke Detectors4.1 Room Code* and (Circle One) (Circle One)

Room Location Right/Center/Left Front/Center/Rear ____Floor Level4.2 Electricity/Illumination


4.4 Security



4.7 Wall Condition



Not Applicable

4.10 Smoke Detectors5. All Secondary Rooms

(Rooms not used for living)

5.1 None Go to Part 6

5.2 Security

5.3 Electrical Hazards5.4 Other Potentially Hazardous

Features in these Rooms



Item 6. Building ExteriorNo.

6.1 Condition of Foundation

6.2 Condition of Stairs, Rails, and Porches

6.3 Condition of Roof/Gutters

6.4 Condition of Exterior Surfaces

6.5 Condition of Chimney

6.6 Lead Paint: Exterior SurfacesAre all painted surfaces free of deterioratedpaint?

If not, do deteriorated surfaces exceed 20square feet of total exterior surface area?

Not Applicable

6.7 Manufactured Home: Tie Downs

7. Heating and Plumbing

7.1 Adequacy of Heating Equipment

7.2 Safety of Heating Equipment

7.3 Ventilation/Cooling7.4 Water Heater

7.5 Approvable Water Supply

7.6 Plumbing

7.7 Sewer Connection8. General Health and Safety

8.4 Garbage and Debris

8.5 Refuse Disposal

8.6 Interior Stairs and Commom Halls

8.7 Other Interior Hazards

8.8 Elevators

8.9 Interior Air Quality

8.10 Site and Neighborhood Conditions

8.11 Lead-Based Paint: Owner's Certification Not Applicable

If the owner is required to correct any lead-based paint hazards at the property including deteriorated paint or other hazards identified by avisual assessor, a certified lead-based paint risk assessor, or certified lead-based paint inspector, the PHA must obtain certification that thework has been done in accordance with all applicable requirements of 24 CFR Part 35. The Lead -Based Paint Owner Certification must bereceived by the PHA before the execution of the HAP contract or within the time period stated by the PHA in the owner HQS violation notice.Receipt of the completed and signed Lead-Based Paint Owner Certification signifies that all HQS lead-based paint requirements have beenmet and no re-inspection by the HQS inspector is required.

Comment

Yes

Pass

No

Fail

In -

Conc.Final Approval

Date (mm/dd/yyyy)

8.1 Access to Unit

8.2 Fire Exits

8.3 Evidence of Infestation



C. Special Amenities (Optional)This Section is for optional use of the HA. It is designed to collect additional information about other positive features of the unit that may be present.Although the features listed below are not included in the Housing Quality Standards, the tenant and HA may wish to take them into consideration indecisions about renting the unit and the reasonableness of the rent.Check/list any positive features found in relation to the unit.

D. Questions to ask the Tenant (Optional)1. Living Room

High quality floors or wall coveringsWorking fireplace or stove Balcony,patio, deck, porch Special windowsor doorsExceptional size relative to needs of familyOther: (Specify)

4. Bath

Special feature shower headBuilt-in heat lampLarge mirrorsGlass door on shower/tubSeparate dressing roomDouble sink or special lavatoryExceptional size relative to needs of familyOther: (Specify)

2. KitchenDishwasherSeparate freezerGarbage disposalEating counter/breakfast nookPantry or abundant shelving or cabinetsDouble oven/self cleaning oven, microwaveDouble sinkHigh quality cabinetsAbundant counter-top spaceModern appliance(s)Exceptional size relative to needs of familyOther: (Specify)

5. Overall Characteristics

Storm windows and doorsOther forms of weatherization (e.g., insulation, weatherstripping) Screen doors or windowsGood upkeep of grounds (i.e., site cleanliness, landscaping,condition of lawn)Garage or parking facilitiesDrivewayLarge yardGood maintenance of building exteriorOther: (Specify)

3. Other Rooms Used for Living

High quality floors or wall coveringsWorking fireplace or stove Balcony,patio, deck, porch Special windowsor doorsExceptional size relative to needs of familyOther: (Specify)

6. Disabled Accessibility

Unit is accessible to a particular disability.Disability

NoYes



1. Does the owner make repairs when asked? Yes No 2. How many people live there? _____

3. How much money do you pay to the owner/agent for rent? $ ____________

4. Do you pay for anything else? (specify) __________________________________________________________________

5. Who owns the range and refrigerator? (insert O = Owner or T = Tenant) Range ______ Refrigerator _____ Microwave __

6. Is there anything else you want to tell us? (specify) Yes No



E. Inspection Summary/Comments (Optional)Provide a summary description of each item which resulted in a rating of "Fail" or "Pass with Comments."Tenant ID Number Inspector Date of Inspection (mm/dd/yyyy) Address of Inspected Unit

Type of Inspection Initial Special Reinspection

Item Number Reason for "Fail" or "Pass with Comments" Rating

Continued on additional page Yes No


LEAD PAINT INSPECTION REPORT Addendum to the HQS Inspection Report

Owners Name: ________________________________________________________________________

Property Address: __________________________________________ Date Built: _______________

Agency: _________________________________ Renter Name:_______________________________

Renter Children (Circle one) Yes No

The above property has been identified as older than 1978 and will be subject to a visual assessment for lead-paint issues.

The following information is to be completed by a certified HQS Inspector at the time of a home inspection:

1. Are there any signs of deteriorated paint inside or outside the housing structure?

Yes No

2. Are there any signs of peeling, chipping, chalking, cracking, holes in walls, damaged substrates? Yes No If yes, indicate below where this appears _______________________________________________________________________________

_______________________________________________________________________________

3. Are there any signs of visible dust, debris, and residue as part of a risk assessment or

clearance examination? Yes No If yes, indicate below where this appears _______________________________________________________________________________

_______________________________________________________________________________

If the answers to both 1 & 2 are no, no further assessment is required and the property can be considered cleared of any lead-paint hazard. If any of the above questions are answered with a yes, then a full lead-base paint assessment is required. Please indicate below, clearance of the property or whether a full assessment is required: The above property is cleared of any lead paint hazard ______ ______ Yes No

OR A full lead paint assessment is required: ______ ______ Yes No ____________________________________________________ _____________________ Name Company Date

Form 8 - Lead-Based Paint Visual Inspection Report (page 1 of 1)

Form 9 - Rent Reasonableness Certification (page 1 of 1) UPDATED: 11/13/12

RENT REASONABLENESS CHECKLIST AND CERTIFICATION

Proposed Unit Unit #1 Unit #2 Unit #3

Address

Number of Bedrooms

Square Feet

Type of Unit/Construction

Housing Condition

Location/Accessibility

Amenities Unit: Site: Neighborhood:

Age in Years

Utilities (type)

Unit Rent Utility Allowance Gross Rent

Handicap Accessible?

CERTIFICATION:

A. Compliance with Payment Standard

____________________ _____________ __________________ Proposed Contract Rent + Utility Allowance = Proposed Gross Rent

Proposed gross rent can not exceed Fair Market Rent (FMR) payment standard. STUDIO 1-BEDROOM 2-BEDROOM 3-BEDROOM 4-BEDROOM FY 2013 $659 $766 $912 $1,344 $1,615

Gross Rent is: [ ] Equal to or Less than FMR [ ] Exceeds FMR B. Rent Reasonableness Based upon a comparison with rents for comparable units, I have determined that the proposed rent for the unit [ ] is reasonable [ ] is not reasonable.

Name: Signature: Date:

Form 10 - Landlord Tenant Law Brochure (page 1 of 1)

LANDLORD-TENANT LAW

TABLE OF CONTEN TS

'Vho Is Coyered By the L.."l.w. ............................. 2-Exceptions ........................................................................... 2-Rights of All Tenants ...................................................... 3

Moving In ......................................................................... 3 Types of Rental Agreements. ...................................... 3 Illegal Provisions ill Rental Agreements ............ .4 Deposits and Other Fees ............................................... 5 Refundable Deposits ....................................................... 5 Nonrefundable Fees. ....................................................... 5

" 'hile You're Renting ............................................. 6 Landlord's Responsibilities .......................................... 6 Tenant 's Responsibilit ies. ............................................. 7 If the Landlord Wants to Make Changes ............. .8 If the Property is Sold ................................................... .8 Landlord's Access to the Rental .............................. .9 If the Rental Needs Repairs ......................................... 9 Illegal Act ions of a Landlord ..................................... .1 1

Moving Out ....................................................................... 13 Proper Notice to Leave .................................................. .13 Return of Deposits ........................................................... .14 Evictions ............................................................................... .14 Abandonment .................................................................... .16

For Further Assistance ........................................... 17

W HO IS COVERED BY THE L,\W?

Most tenants who rent a place to liye come under the state's Residential Landlord-Tenant Act . However, certain renters are specifically excluded from the law. Furthermore, all tenants have rights under other state laws - even those who are not covered by the Resident ial LandlordTenant Act.

Exceptions Those who are generally not covered by the Residential Landlord-Tenant Act are:

• Mobile home owners who rent space in a mobile home park. These individuals are usually covered by the state's Manufactured! Mobile Home Landlord-Tenant Act (RCW 59.20). This act applies only to situations where a manufactured home owner rents a lot space, or "pad," for their home in a manufactured housing community or park. Renter~ of both a space and a mobile home are usmlly coyered by the Residential Landlord-Tenant Act.

• Residents in hotels and motels.

• Residents of public or private medical, religious, educational, recreat ional or correctional institutions.

• Tenants with an earnest money agreement to purchase the dwelling.

• Tenants who lease a single-family dwelling with an option to purchase, if the tenant's attorney has approved the lease on its face.

2 WASHINGTON

Form 11 - Lead Based Paint Brochure (page 1 of 1)

Form 12 - Lead Based Paint EPA Disclosure Form (page 1 of 1)

Disclosure of Information on lead-Based Paint and/ or lead-Based Paint Hazards

lead Warning Statement Housing built before 1978 may contain lead-/Ja5ed paint Lead from paint paint Chips, and dt6t ron pose health hazards if not managed properly. Lead exposure is especially hannful to young children and pregnant women. 8efore renting pre-1978 housing, lessors must clisc/ose the presence of known leaa-based paint and/or lead-oosl!cl paint hazards in the dwelling. Lessees must also receive a fI!cIerally approved pamphlet on lead poisoning prevention.

l essor"s Disclosure

(a) Presence of lead-based paint and/ or lead-based paint hazards (check (I) or M belo..,!):

00 __ Known lead-based paint and/ or lead-based paint hazards are present in the lmusing (eXpla·1I1).

[iij __ Lessor has no knowledge of lead·biJsed paint and/or lead·biJsed paint IliJZards in tile housing.

(b) Records and reports available to the lessor (check (I) or [iij belo..,!):

00 __ Lessor has provided tile lessee with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the lmusing Oist doruments belo..,!).

[iij __ Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in tile housing.

l essee·s Acknowledgment [initiaO

(q Lessee has received copies of all information listed above.

(d) ___ Lessee has received tile pampillet Proted Your Family from Lead in Your Home.

Agenfs Acknowledgment [initiaO

(e) Agent Ilas informed the lessor of tile lesso(s obligations under 42 U.s.c. 4852d and is a..,/are of Ilis/her responsibility to ensure compliance.

Certification of Accuracy

TIle following parties have reviewed the information above and certify, to the best of their knowledge. lIlat the information they have provided is true and accurate.

Lessor Date

Lessee Date

Agent Date

LEASE ADDENDUM

TENANT

LANDLORD UNIT NO. & ADDRESS

This lease addendum adds the following paragraphs to the Lease between the Tenant and Landlord referred to above. A. Purpose of the Addendum. The lease for the above-referenced unit is being amended to

include the provisions of this addendum because the Tenant has been approved to receive rental assistance under the _______________ HOME Rental Assistance Program. Under the Rental Assistance Program, the ___________________ will make monthly payments to the Landlord on behalf of the Tenant.

The Lease has been signed by the parties on the condition that the ____________ and

Landlord will promptly execute a HOME Rental Assistance Contract. This Lease shall not become effective unless the Contract has been executed by both the Landlord and the _________________, effective the first day of the term of the Lease.

B. Conflict with Other Provisions of the Lease. In case of any conflict between the provisions

of this Addendum and other sections of the Lease, the provisions of this Addendum shall prevail.

C. Terms of the Lease. The term shall begin on and shall continue until: (1) the

Lease is terminated by the Landlord in accordance with applicable state and local Tenant/Landlord laws; (2) the Lease is terminated by the Tenant in accordance with the Lease or by mutual agreement during the term of the Lease; or (3) termination of the HOME Rental Assistance Program Contract by the __________________.

D. Rental Assistance Payment. Each month the __________________ will make a rental

assistance payment to the Landlord on behalf of the Tenant. This payment shall be credited by the Landlord toward the monthly rent payable by the Tenant. The balance of the monthly rent shall be paid by the Tenant.

E. Security Deposit (1) The (Tenant/ ______________) has deposited $________ with the

Landlord as a Security Deposit. The Landlord will hold this security deposit during the period the Tenant occupies the dwelling unit under the Lease. The Landlord shall comply with state and local laws regarding interest payments on security deposits.

(2) After the Tenant has moved from the dwelling unit, the Landlord may, subject to state and local laws, use the security deposit, including any interest on the deposit, as reimbursement for rent or any other amounts payable by the tenant under the Lease. The Landlord will give the Tenant a written list of all items charged against the security deposit and the amount of each item. After deducting the amount used as reimbursement to the Landlord, the Landlord shall promptly refund the full amount of the balance to the (Tenant/___________).

Form 13 - Lease Addendum (page 1 of 3)

F. Utilities and Appliances. The utilities and appliances listed in Column 1 are provided by the Landlord and included in the rent. The utilities and appliances listed in Column 2 below are not included in the rent and are paid separately by the Tenant.

UTILITY/APPLIANCE Included in Rent Tenant Paid

Garbage Collection

Water/Sewer

Heating Fuel (specify)

Lights, electric

Cooking Fuel (specify)

Other (specify)

Refrigerator

Stove/Range

G. Household Members. Household members authorized to live in this unit are listed below.

The Tenant may not permit other persons to join the Household without notifying the __________________ and obtaining the Landlord's permission. Household members:

H. Housing Quality Standards. The Landlord shall maintain the dwelling unit, common areas,

equipment, facilities and appliances in decent, safe, and sanitary condition (as determined by Section 8 Housing Quality Standards).

I. Termination of Tenancy. The Landlord may evict the Tenant following applicable state and

local laws. The landlord must provide the Tenant with at least 30 days' written notice of the termination. The Landlord must notify the ______________ in writing when eviction proceedings are begun. This may be done by providing the ________________ with a copy of the required notice to the Tenant.

J. Prohibited Lease Provision. Any provision of the Lease which falls within the classifications

below shall not apply and not be enforced by the Landlord. (1) Confession of Judgment. Consent by the Tenant to be sued, to admit guilt, or to a

judgment in favor of the landlord in a lawsuit brought in connection with the Lease. (2) Treatment of Property. Agreement by the Tenant that the Landlord may take or hold

the Tenant's property, or may sell such property without notice to the Tenant and a court decision on the rights of the parties.

(3) Excusing the Landlord from Responsibility. Agreement by the Tenant not to hold the Landlord or Landlord's agent legally responsible for any action or failure to act, whether intentional or negligent.

(4) Waiver of Legal Notice. Agreement by the Tenant that the Landlord may institute a lawsuit without notice to the Tenant.

(5) Waiver of Court Proceedings for Eviction. Agreement by the Tenant that the Landlord may evict the Tenant Family (i) without instituting a civil court proceedings in which the Family has the opportunity to present a defense, or (ii) before a decision by the court on the rights of the parties.


(6) Waiver of Jury Trial. Authorization to the Landlord to waive the Tenant's right to a trial by jury.

(7) Waiver of Right to Appeal Court Decision. Authorization to the Landlord to waive the Tenant's right to appeal a court decision or waive the Tenant's right to sue to prevent a judgment from being put into effect.

(8) Tenant Chargeable with Cost of Legal Actions Regardless of Outcome of the Lawsuit. Agreement by the Tenant to pay lawyer's fees or other legal costs whenever the Landlord decides to sue, whether or not the Tenant wins.

K. Nondiscrimination. The Landlord shall not discriminate against the Tenant in the provision

of services, or in any other manner, on the grounds of age, race, color, creed, religion, sex, handicap, national origin, or familial status.

TENANT SIGNATURES LANDLORD SIGNATURES

By: (Type or Print Name of Tenant Representative)

LANDLORD NAME:

(Signature/Date)

By: (Type or Print Name of Landlord Representative)

By: (Type or Print Name of Tenant Representative)

(Signature/Date)

(Signature/Date)


Form 14 - Sample TBRA Rental Assistance Contract (page 1 of 5)

APPENDIX 8

HOME RENTAL ASSISTANCE CONTRACT

LANDLORD NAME & ADDRESS UNIT NO. & ADDRESS TENANT NAME

Telephone No.

This HOME Rental Assistance Contract ("ContractU) is entered into between the "City of Anytown, Department of " (program administrator) and the Landlord identified above. This Contract applies only to the Tenant family and the dwelling unit identified above.

1. TERM OF THE CONTRACT

The term of this Contract shall begin on 1 and end no later than ______ 2

The Contract automatically terminates on the last day of the term of the Lease.

2. SECURITY DEPOSIT3

A. The (program administrator) will pay a security deposit to the Landlord in the amount of The Landlord will hold this security deposit during the period the Tenant

occupies the dwelling unit under the Lease. The Landlord shall comply with state and local laws regarding interest payments on security deposits.

B. After the Tenant has moved from the dwelling unit, the Landlord may, subject to state and local law, use the security deposit, including any interest on the deposit, as reimbursement for rent or any other amounts payable by the Tenant under the Lease. The Landlord will give the Tenant a written list of all items charged against the security deposit and the amount of each item. After deducting the amount used as reimbursement to the Landlord, the Landlord shall promptly refund the full amount of the balance to the [Tenant/program administrator].

C. The Landlord shall immediately notify the (program administrator) when the Tenant has moved from the Contract unit.

3. RENT AND AMOUNTS PAYABLE BY TENANT AND (program administrator)

A Initial Rent. The initial total monthly rent payable to the Landlord for the first twelve months of this Contract is "+" _______ •

B. Rent Adjustments. With no less than _4 days' notice to the Tenant and the (program administrator), the owner may propose a reasonable adjustment to be effective no earlier than the 13th month of this Contract. The proposed rent may be rejected by either the Tenant or the (program administrator). The Tenant may reject the proposed rent by providing the Landlord

1 Insert the first day of the term of the Lease.

2 The maximum allowable length of a HOME Coupon Contract is two years.

3 Modify the paragraph based on PJ policy.

4 Insert the number of days notice the owner must provide of a rent increase. At least 60 days is recommended to enable the program administrator 30 days to review the rent and still enable the landlord to give the tenant 30 days notice.


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HOME Rental Assistance Contract (Page Two)

with 30 days' written notice of intent to vacate. If the program administrator rejects the proposed rent, the program administrator must give both the Tenant and the Landlord 30 days' notice of intent to terminate the Contract.

C. Tenant Share of the Rent. Initially, and until such time as both the Landlord and the Tenant are notified by the (program administrator), the Tenant's share of the rent shall be

$_ - - ---

D. Program Administrator Share of the Rent. Initially, and until such time as both the Landlord and Tenant are notified by the (program administrator), the (program administrator's) share of the rent shall be $ . Neither the (program administrator) nor HUD assumes any obligation for the Tenant's rent, or for payment of any claim by the Owner against the Tenant. The (program administrator's) obligation is limited to making rental payments on behalf of the Tenant in accordance with this Contract.

E. Payment Conditions. The right of the owner to receive payments under this Contract shall be subject to compliance with all of the provisions of the Contract. The Landlord shall be paid under this Contract on or about the first day of the month for which the payment is due. The Landlord agrees that the endorsement on the check shall be conclusive evidence that the Landlord received the full amount due for the month, and shall be a certification that:

1. the Contract unit is in decent, safe and sanitary condition, and that the Landlord is providing the services, maintenance and utilities agreed to in the Lease.

2. the Contract unit is leased to and occupied by the Tenant named above in this Contract. 3. the Landlord has not received and will not receive any payments as rent for the Contract

unit other than those identified in this Contract. 4. to the best of the Landlord's knowledge, the unit is used solely as the Tenant's principal

place of residence.

F. Overpayments. If the (program administrator) determines that the Landlord is not entitled to any payments received, in addition to other remedies, the (program administrator) may deduct the amount of the overpayment from any amounts due the Landlord, including the amounts due under any other Rental Assistance Coupon Contract. .

4. HOUSING QUALITY STANDARDS AND LANDLORD-PROVIDED SERVICES

A. The Landlord agrees to maintain and operate the Contract unit and related facilities to provide decent, safe and sanitary housing in accordance with 24 CFR Section 882.109, including all of the services, maintenance and utilities agreed to in the Lease.

B. The (program administrator) shall have the right to inspect the Contract unit and related facilities at least annually, and at such other times as may be necessary to assure that the unit is in decent, sate, and sanitary condition, and that required maintenance, services and utilities are provided.

C. If the (program administrator) determines that the Landlord is not meeting these obligations, the program administrator shall have the right, even if the Tenant continues in occupancy, to terminate payment of the (program administrator's) share of the rent andlor terminate the Contract.

5. TERMINATION OF TENANCY

The Landlord may evict the Tenant following applicable state and local laws. The Landlord must give the Tenant at least 30 days' written notice of the termination and notify the (program administrator) in writing when eviction proceedings are begun. This may be done by providing the (program administrator) with a copy of the required notice to the tenant.


HOME Rental Assistance Contract (Page Three)

6. FAIR HOUSING REQUIREMENTS

A. Nondiscrimination. The Landlord shall not, in the provision of services or in any other manner, discriminate against any person on the grounds of age, race, color, creed, religion, sex, handicap, national origin, or familial status, The obligation of the Landlord to comply with Fair Housing Requirements insures to the benefit of the United States of America, the Department of Housing and Urban Development, and the (program administrator), any of which shall be entitled to involve any of the remedies available by law to redress any breach or to compel compliance by the Landlord.

B. Cooperation in Quality Opportunity Compliance Reviews. The Landlord shall comply with the (program administrator) and with HUD in conducting compliance reviews and complaint investigations pursuant to all apphcable civil rights statutes, Executive Orders and all related rules and regulations.

7. (Program administrator) AND HUD ACCESS TO LANDLORD RECORDS

A, The Landlord shall provide any information pertinent to this Contract which the (program administrator) or HUD may reasonably require,

B. The Landlord shall permit the (program administrator) of HUD, or any of their authorized representatives, to have access to the premises and, for the purposes of audit and examination, to have access to any books, documents, papers, and records of the Landlord to the extent necessary to determine compliance with this Contract.

8. RIGHTS OF (Program administrator) IF LANDLORD BREACHES THE CONTRACT

A. Any of the following shall constitute a breach of the Contract:

(1) If the Landlord has violated any obhgation under this Contract; or

(2) If the Landlord has demonstrated any intention to violate any obligation under this Contract; or

(3) If the Landlord has committed any fraud or made any false statement in connection with the Contract, or has committed fraud or made any false statement in connection with any Federal housing assistance program.

B. The PHA's right and remedies under the Contract include recovery of overpayments, termination or reduction of payments, and termination of the Contract. If the (program administrator) determines that a breach has occurred, the program administrator may exercise any of its rights or remedies under the Contract. The (program administrator) shall notify the Landlord in writing of such determination, including a brief statement of the reasons for the determination. The notice by the PHA to the landlord may require the Landlord to take corrective action by a time prescribed in the notice,

C. Any remedies employed by the (program administrator) in accordance with this Contract shall be effective as provided in a written notice by the (program administrator) to the Landlord. The (program administrator's) exercise or non-exercise of any remedy shall not constitute a waiver of the right to exercise that or any other right or remedy at any time,


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HOME Rental Assistance Contract (Page Four)

9. PHA RELATION TO THIRD PARTIES

A. The (program administrator) does not assume any responsibility for, or liability to, any person injured as a result of the Landlord's action or failure to act in connection with the implementation of this Contract, or as a result of any other action or failure to act by the Landlord.

8. The Landlord is not the agent of the (program administrator) and this Contract does not create or affect any relationship between the (program administrator) and any lender to the Landlord, or any suppliers, employees, contractors or subcontractors used by the Landlord in connection with this Contract.

C. Nothing in this Contract shall be construed as creating any right of the Tenant or a third party (other than HUD) to enforce any provision of this Contract or to asses any claim against HUD, the (program administrator) or the Landlord under this Contract.

10. CONFLICT OF INTEREST PROVISIONS

A. No employee of the (program administrator) who formulates policy or influences decisions with respect to the Rental Assistance Program, and no public official or member of a goveming body or state of local legislator who exercise his functions or responsibilities'with respect to the program shall have any direct or indirect interest during this person's tenure, or for one year thereafter, in this contract or in any proceeds or benefits arising from the Contract or to any benefits which may arise from it.

11. TRANSFER OF THE CONTRACT

The Landlord shall not transfer in any form this Contract without the prior written consent of the (program administrator). The (program administrator) shall give its consent to a transfer if the transferee agrees in writing (in a form acceptable to the (program administrator» to comply with all terms and conditions of this Contract.

12. ENTIRE AGREEMENT: INTERPRETATION

A. This Contract contains the entire agreement between the Landlord and the program administrator. No changes in this Contract shall be made except in writing signed by both the Landlord and the (program administrator).

8. The Contract shall be interpreted and implemented in accordance with HUD requirements.


HOME Rental AssIstance Contract (Page Five)

13. WARRANTY OF LEGAL CAPACITY AND CONDITION OF UNIT

A. The Landlord warrants the unit is in decent, safe, and sanitary condition as defined in 24 CFR Section 882.109, and that the Landlord has the legal right to lease the dwelling unit covered by this Contract during the Contract term.

B. The party, if any, executing this Contract on behalf of the Landlord hereby warrants that authorization has been given by the Landlord to execute it on behalf of the Landlord.

Landlord Name (Type or Print): (Program administrator) Representative (Type of Print):

(Signature/Date) (Signature/Date)

WARNING: 18 U.S.C. 1001 provides, among other things, that whoever knowingly and willingly makes or uses a document or writing containing any false, fictitious, or fraudulent statements or entries, in any matter within the jurisdiction of any department or agency of the United States, shall be fined not more than $10,000, or imprisoned for not more than five years, or both.

LANDLORD'S CHECK TO BE MAILED TO: SS NO. _____________ _

SIGNATURE OF OWNER DATE

SIGNATURE OF OWNER DATE


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Tenant Based Rental Assistance Tenant, Rents and Low-Income Occupancy

Name of Project: ___________________________________ # Total Home Assisted Units: __________

Project Address: ___________________________________ # of Units Vacant: ________

Reporting Period: ___________________________________ Total Number of Units in Project: ___________

Owner/Manager: ___________________________________

# Bed

rooms Tenant Name

Total Rent

Tenant contribution

Subsidized Amount

Type of

household

% of median income

Hispanic? Race Family Size

Subsidy Type

Tenant Contract

Contract Term

Contract end date

Disability Special Needs

Exit Status

Completed by: __________________________

Date: ____________________________

Signature __________________________________

Form 15 - Tenant Rents and Low Income Occupancy (page 1 of 2)

Coding Instructions for Completing Tenant, Rents and Low-Income Occupancy Monitoring Form

# of bedrooms Enter number of bedrooms, use 0 for studio Tenant Name Enter tenant name Total Rent Enter total monthly rent amount Tenant Contribution Enter total that tenant pays toward rent Subsidized Amount Enter total amount of rent that is subsidized Type of Household Enter 1 for single person, non-elderly

Enter 2 for an elderly tenant Enter 3 for a single parent Enter 4 for two parents Enter 5 for other

% of median income Enter percentage of median income, see attached Income Limits

Hispanic? Enter Yes or No Race Enter 11 for White

Enter 12 for Black/African American Enter 13 for Asian Enter 14 for American Indian/Alaska Native Enter 15 for Native Hawaiian/Other Pacific Islander Enter 16 for American Indian/Alaska Native and White Enter 17 for Asian and White Enter 18 for Black/African American and White Enter 19 for American Indian/Alaska Native and Black/African American Enter 20 for Other multi-racial

Family Size Enter number of people in household Subsidy Type Enter type of subsidy: HOME, State, Section 8, other Tenant Contract

Enter “T”: if subsidy is paid to tenant Enter “O” if subsidy is paid to owner

Contract Term Enter length of contract term Contract end date Enter date that contract ends with tenant Disability/Special Needs Enter Y if tenant is disabled or has special needs

Enter N if tenant is not disabled and does not have special needs

Exit Status Enter reason for why tenant no longer in program

Form 15 - Tenant Rents and Low Income Occupancy (page 2 of 2)

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