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<br />Documents Checklist for the Emergency Housing Voucher Program <br />Public Housing Authority Application <br />This checklist expires 12/31/2021 <br /> <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 /> <br />Tenant Information Form (All sections completed or marked N/A if not applicable) <br />Declaration of 214 Status <br />What you should know about EIV <br />Debts owed to Public Housing Authorities and Terminations <br />Authorization for the 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 /> <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 /> <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 /> <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 your family – letter from contributing party certifying monthly gross amount paid <br />Other__________________________________ ___ <br />Page 22 of 29 <br />EXHIBIT 2