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WOOMI10.11 WA <br />Documents Checklist for the Emergency Housing Voucher Program <br />Public Housing Authority Application <br />This checklist expires 1213112021 <br />The following documents are required in order to submit a complete application to the Public Housing <br />Authority (PHA). Please note that additional documentation may be requested at the discretion of the PHA. It is <br />strongly encouraged that all required documentation be submitted prior to admission to the program. <br />Required PHA Forms <br />❑ Tenant Information Form (All sections completed or marked N/A if not applicable) <br />❑ Declaration of214Status <br />❑ What you should know about EIV <br />❑ Debts owed to Public Housing Authorities and Terminations <br />❑ Authorization forthe Release of Information/Privacy Act Notice <br />❑ Supplement to Application for Federally Assisted Housing <br />Identification (For all household members) * <br />❑ Social Security Cards <br />❑ CA State Driver's License or Photo ID <br />❑ Eligible Citizenship Documentation, such as Birth Certificate, Resident Alien Card/Alien Number, or <br />Certificate of Naturalization <br />* If unavailable at time of referral, per PIH Notice 2021-15, the PHA will accept a statement certifying Social <br />Security Number, Date of Birth, and/or Citizenship. If client provides PHA self -certification, client must provide <br />applicable verification, of SSN or citizenship within 180 days or verification of date of birth or disability status <br />within 90 days of admission to the program. Failure to do so may result in termination from the program. <br />Unearned Income (All forms of unearned income must be disclosed for all household members)** <br />For all unearned income types, please provide the most recent benefit statement unless otherwise noted <br />❑ Social Security/SSI <br />❑ Pension <br />❑ Unemployment(EDD) <br />❑ Food Stamps and/or Cash Aid (TANF/AFDC) <br />❑ Disability <br />❑ Veteran's Benefit <br />❑ Worker's Compensation <br />❑ Child Support— CSS statement or similar governmental statement, divorce decree, or statement from paying <br />party certifying amount paid <br />❑ Alimony— divorce decree or statement from paying party certifying amount paid <br />❑ Contributions to you or yourfamily— letter from contributing party certifying monthly gross amount paid <br />❑ other <br />City Council <br />31 — 29 7/20/2021 <br />Page 22 of 29 <br />