Preliminary Application for HCV (Section 8) Rental Assistance | Northwestern Regional Housing Authority

Complete the application packet for processing. You do not have to see anyone to apply for rental assistance. NWRHA manages assisted housing and administers rental assistance programs in Alleghany, Ashe, Avery, Mitchell, Watauga, Wilkes, and Yancey Counties. You may only apply in one of the seven counties we serve. Eligibility for these programs varies and is based on income, household composition, and criminal background check.

Because of limited funding, our program has a waiting list in all counties. The length of the waiting list and the time before assistance can be provided will vary depending on your current situation. Completing the attached sheets and answering all questions will determine your placement on the waiting list.

The application process:

This Preliminary Application is used to determine initial program eligibility and to place your name on the waiting list.
When your name comes up on the waiting list, you will be asked to complete a Final Application, which provides our office with updated and accurate information. This information is used to determine final program eligibility. When you complete the final application, you will also be required to verify your citizenship status, provide birth certificates (a state issued document), and social security cards for all household members, and verify your family's gross annual income.

Please see below for important instructions on how to complete the application and other important information to prevent delays in the acceptance of your application.

Fair Housing Act: A federal law which prohibits discrimination in housing based on race, color, religion, sex, handicap, familial status and national origin.

Should you have any questions, please call or write.

INSTRUCTIONS: Please review the application carefully and answer all questions fully and accurately. If you cannot fit all of the information in the space provided, include it in the text area at the bottom. False statements or information are grounds for denial of the application or termination of assistance.

You can only apply in one of our seven counties: Alleghany, Ashe, Avery, Mitchell, Watauga, Wilkes, and Yancey.
You must complete the HUD-9886 Authorization for the Release of Information/Privacy Act Notice and HUD-52675 Form-Debts Owed to Public Housing Agencies and Terminations. All members 18 and over must sign a separate form. Contact the office for additional forms.
Optional: You have the right to include as part of your application the name, address, telephone number and other relevant information of a family member, friend, or social, health, advocacy or other organization for the Housing Authority to contact to help resolve issues that may arise during tenancy or to assist in providing special care of service you may require as a tenant. See SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING form.

YOUR APPLICATION WILL BE DENIED IF ANY OF THE FOLLOWING APPLY:

Illegible Applications: If NWRHA cannot read your application it will be returned to you to be completed again legibly.
Incomplete Applications: The application will be returned to you with the areas marked for additional information. Your application will be considered only when all required information is provided.
Over-Income: The programs administered by NWRHA have varying income requirements. You will be considered over-income if your household income is greater than the program requirements and therefore ineligible for further consideration. You may reapply if your income falls below the eligibility limit.
Money Owed: If you have an outstanding debt with NWRHA, another housing authority, or any private landlord as a result of prior participation in any federal housing program, your application will be denied until we have documentation that it is paid in full or a repayment agreement has been signed.
Custody of Dependents: If you are including a dependent as part of your household who is a member of another household assisted by NWRHA, you are required to provide documentation showing you are the custodial parent/guardian at least 51% of the time. Acceptable documents are court custody orders, or a notarized statement from the guardian.
Pre-applications may be removed from the waiting list if any of the following are determined; Drug or violent criminal activity within the last five years, registered sex offender, persons convicted of manufacturing or producing methamphetamine, if any member has been evicted/terminated from a federally assisted housing program. It is the responsibility of the applicant to contact the housing authority office in writing to report any changes in address, family composition, change of income, or any other change that may affect their status.
Applicants will receive a letter within 15 business days after NWRHA receives and processes the application confirming your placement on the waiting list or a denial letter of ineligibility.

Anyone who knowingly commits fraud by providing false statements or information with the intent to deceive in order to receive or continue to receive assistance under one of the programs administered by NWRHA will be subject to denial of his/her application or the termination of assistance. NWRHA is required by federal law to investigate all allegations of fraud. NWRHA is also required to report instances of fraud to state and federal authorities for further investigation and possible prosecution. Incomplete applications will be held for 30 days before destroying.

Field Office

Name of Head of Household

Present Mailing Address

Address

Address 2

City

State

ZIP Code

Street Address (if different)

Street Address

Address

Address 2

City

State

ZIP Code

Home Phone

Cell Phone

Message Number

Message Contact

Marital Status

Household Members

Head of Household

Full Name

Relationship to Head

Gender

Date of Birth

Race

Hispanic

Full Time Student

Each additional household member requires a date of birth and social security number.

Additional Household Member 1

Full Name

Relationship to Head

Gender

Date of Birth

Race

Hispanic

Full Time Student

Additional Household Member 2

Full Name

Relationship to Head

Gender

Date of Birth

Race

Hispanic

Full Time Student

Additional Household Member 3

Full Name

Relationship to Head

Gender

Date of Birth

Race

Hispanic

Full Time Student

Additional Household Member 4

Full Name

Relationship to Head

Gender

Date of Birth

Race

Hispanic

Full Time Student

Additional Household Member 5

Full Name

Relationship to Head

Gender

Date of Birth

Race

Hispanic

Full Time Student

Additional Household Member 6

Full Name

Relationship to Head

Gender

Date of Birth

Race

Hispanic

Full Time Student

Additional Household Member 7

Full Name

Relationship to Head

Gender

Date of Birth

Race

Hispanic

Full Time Student

Are all household members eligible citizens of the United States?

Do you or any member of the household require an accommodation for a disability?

Have you ever used another name other than your current name?

If yes, who?

What prior names?

Do you anticipate any additions to the household due to pregnancy, marriage, other?

If yes, which?

If yes, when?

Household Gross Income

Member 1

Member Receiving Income

Source of Income

Amount/Hours per Week

Amount

Per

If you are reporting an hourly amount, about how many hours per week do you work?

Member 2

Member Receiving Income

Source of Income

Amount/Hours per Week

Amount

Per

If you are reporting an hourly amount, about how many hours per week do you work?

Member 3

Member Receiving Income

Source of Income

Amount/Hours per Week

Amount

Per

If you are reporting an hourly amount, about how many hours per week do you work?

Member 4

Member Receiving Income

Source of Income

Amount/Hours per Week

Amount

Per

If you are reporting an hourly amount, about how many hours per week do you work?

Member 5

Member Receiving Income

Source of Income

Amount/Hours per Week

Amount

Per

If you are reporting an hourly amount, about how many hours per week do you work?

Does anyone outside of the household pay for any bills or contribute money to the household?

If yes, name/explain

Amount

Have you ever received rental assistance or lived in public housing?

If yes, where?

When?

Have you or any household member ever been evicted from federally assisted housing?

If yes, list place and date

Have you or any household member ever committed fraud while living in federally assisted housing or been required to repay money for knowingly misrepresenting information?

If yes, list Housing Authority

Amount

Does any household member owe money to a Housing Authority or Public Housing Agency for any reason?

If yes, explain

Amount

Have you or any other household member ever been arrested, charged, and/or convicted for a crime other than a traffic violation?

If yes, please specify ALL charges (including pending charges)

Has any household member been charged/convicted in the last 5 years for any drug related criminal activity?

If yes, please specify ALL charges

Are you or any household member currently participating in a drug rehabilitation program?

Are you or any household member required to register as a sex offender in any state?

If yes, who

State

Homeless Preference: Are you currently staying in (check all that apply):

a homeless or domestic violence shelter

a hotel due to being homeless

a tent, camper, vehicle, or outside

a housing for the mentally ill

Substandard Unit: Does the unit you current live in (check all that apply):

endanger the safety and well-being of your family due to defects that require rebuilding or repair

have working indoor plumbing

have a usable indoor flushable toilet

have a usable bathtub or shower

have adequate and safe electrical source

have a kitchen

been declared by an agency unfit to live in

Rent Burden

Are you currently paying rent to a landlord?

Do you wish to remain in the unit?

When did you begin renting?

How much do you pay each month for rent?

What type of unit?

Select the utilities you pay out of pocket:

Electric

Heat

Cooking

Water heating

Air conditioning

Water/Sewer

Trash collection

Heat main source

Cooking main source

Water heating source

Do you own the range?

Do you own the refrigerator?

What is your gross monthly income?

What is your average monthly electric bill?

What is your main source of heat?

What is your average heating bill if not electric heat?

How much do you pay for garbage collection monthly?

Domestic Violence (check all that apply)

You are currently living in a unit with someone who engages in domestic violence against you or another family member.

You have left your unit within the last 3 months due to someone in your unit engaging in domestic violence against you or another family member.

Involuntarily Displaced: Have you had to leave the unit you were recently living in due to (check all that apply):

a natural disaster, fire or flood

a state or county public improvement plan such as a new highway or bridge

the landlord no longer renting the unit on the rental market

the owner wanting it for their own personal use

the owner selling the unit

any other legally authorized act that would withdraw the unit from the rental market

relocating because of providing law enforcement with information regarding criminal activity in your neighborhood and fearing for your safety for reporting it

hate crimes, which are actual threats of physical violence or intimidation based on the seven protected classes

a member of the household not being able to access the critical elements of the unit (such as the bathroom/bedroom) due to immobility or an impairment

Veteran Status: Are you an eligible veteran of the U.S. Armed Forces, holding an honorable discharge?

I DO HEREBY CERTIFY THAT ALL INFORMATION I HAVE PROVIDED IS COMPLETE AND ACCURATE.

Optional Contact Person or Organization: Would you like to identify 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?

HUD form (PDF)

Signature