Laserfiche WebLink
<br /> <br />Paperwork Reduction Notice: Public reporting burden for this collection of information is estimated to average 7 minutes <br />per response. This includes the time for respondents to read the document and certify, and any recordkeeping burden. This <br />information will be used in the processing of a tenancy. Response to this request for information is required to receive <br />benefits. The agency may not collect this information, and you are not required to complete this form, unless it displays <br />a currently valid OMB control number. The OMB Number is 2577-0266, and expires 04/30/2023. <br />NOTICE TO APPLICANTS AND PARTICIPANTS OF THE FOLLOWING HUD RENTAL ASSISTANCE PROGRAMS: <br />Public Housing (24 CFR 960) <br />Section 8 Housing Choice Voucher, including the Disaster Housing Assistance Program (24 CFR 982) <br />Section 8 Moderate Rehabilitation (24 CFR 882) <br />Project-Based Voucher (24 CFR 983) <br /> <br />The U.S. Department of Housing and Urban Development maintains a national repository of debts owed to Public <br />Housing Agencies (PHAs) or Section 8 landlords and adverse information of former participants who have voluntarily or <br />involuntarily terminated participation in one of the above-listed HUD rental assistance programs. This information is <br />maintained within HUD’s Enterprise Income Verification (EIV) system, which is used by Public Housing Agencies (PH As) <br />and their management agents to verify employment and income information of program participants, as well as, to <br />reduce administrative and rental assistance payment errors. The EIV system is designed to assist PHAs and HUD in <br />ensuring that families are eligible to participate in HUD rental assistance programs and determining the correct <br />amount of rental assistance a family is eligible for. All PHAs are required to use this system in accordance with HUD <br />regulations at 24 CFR 5.233. <br /> <br />HUD requires PHAs, which administers the above-listed rental housing programs, to report certain information at the <br />conclusion of your participation in a HUD rental assistance program. This notice provides you with information on what <br />information the PHA is required to provide HUD, who will have access to this information, how this information is used <br />and your rights. PHAs are required to provide this notice to all applicants and program participants and you are <br />required to acknowledge receipt of this notice by signing page 2. Each adult household member must sign this form. <br /> <br />What information about you and your tenancy does HUD collect from the PHA? <br />The following information is collected about each member of your household (family composition): full name, date of <br />birth, and Social Security Number. <br /> <br />The following adverse information is collected once your participation in the housing program has ended, whether you <br />voluntarily or involuntarily move out of an assisted unit: <br /> <br />1. Amount of any balance you owe the PHA or Section 8 landlord (up to $500,000) and explanation for balance owed <br />(i.e. unpaid rent, retroactive rent (due to unreported income and/ or change in family composition) or other charges <br />such as damages, utility charges, etc.); and <br />2. Whether or not you have entered into a repayment agreement for the amount that you owe the PHA; and <br />3. Whether or not you have defaulted on a repayment agreement; and <br />4. Whether or not the PHA has obtained a judgment against you; and <br />5. Whether or not you have filed for bankruptcy; and <br />6. The negative reason(s) for your end of participation or any negative status (i.e., abandoned unit, fraud, lease <br />violations, criminal activity, etc.) as of the end of participation date. <br />U.S. Department of Housing and Urban Development <br />Office of Public and Indian Housing <br /> <br />DEBTS OWED TO PUBLIC HOUSING AGENCIES AND TERMINATIONS <br />OMB No. 2577-0266 Expires 04/30/2023 <br />08/2013 Form HUD-52675 <br />Page 16 of 29 <br />EXHIBIT 2