HomeMy WebLinkAboutItem 31 - Emergency Housing Vouchers Joint Council/Housing Authority
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Item # 31
City of Santa Ana
20 Civic Center Plaza, Santa Ana, CA 92701
Staff Report
July 20, 2021
TOPIC: Emergency Housing Vouchers
AGENDA TITLE:
Approve Appropriation Adjustments Recognizing Housing Assistance Payments in the
Amount of $1.3 million and $488,616 in Administrative Funds to Administer Eighty-Nine
New Emergency Housing Vouchers; Authorize the City to Enter into a Memorandum of
Understanding with the Orange County Continuum of Care; Approve an Update to the
Housing Choice Voucher Administrative Plan; Authorize the City Manager to Execute a
Future Agreement with a Service Provider to Provide Housing Search Assistance
RECOMMENDED ACTION
CITY COUNCIL ACTION
1. Approve an appropriation adjustment recognizing Emergency Housing Voucher
Housing Assistance Payments funds in the amount of $1,316,892 in revenue account
(No. 17918002-52011) and appropriating same to expenditure account (Nos.
17918760-69158) to administer eighty-nine new vouchers.
2. Approve an appropriation adjustment recognizing Emergency Housing Voucher
Preliminary Administrative funds ($35,600), Administrative funds ($141,516) and
Service Fees ($311,500) in the total combined amount of $488,616 in revenue
account (No. 18018002-various) and appropriating same to expenditure account
(Nos. 18018760-various) to administer eighty-nine new vouchers.
HOUSING AUTHORITY ACTION
1. Authorize the Executive Director of the Housing Authority to execute a Memorandum
of Understanding with the Orange County Continuum of Care effective July 20, 2021,
subject to non-substantive changes approved by the Executive Director and the
Housing Authority General Counsel.
2. Approve an update to the Housing Choice Voucher Administrative Plan and authorize
submission to the United States Department of Housing and Urban Development.
Emergency Housing Vouchers
July 20, 2021
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3. Authorize the City Manager to execute a future agreement with the Orange County
United Way or another designated Service Provider to utilize Emergency Housing
Voucher Service Fees in an amount not to exceed $311,500 to provide housing search
assistance for Emergency Housing Vouchers issued by the Housing Authority, subject
to non-substantive changes approved by the City Manager and City Attorney.
4. Direct the City Attorney to finalize and authorize the City Manager to enter into
negotiations, execute agreements, and approve any other required actions necessary
with various service providers, contractors, and sub-recipients, who will support the
Housing Authority to issue and lease the eighty-nine Emergency Housing Vouchers,
subject to non-substantive changes approved by the City Manager and City Attorney.
DISCUSSION
On March 11, 2021, the American Rescue Plan Act of 2021 (“ARPA”) was signed into law
and appropriated $5 billion for new incremental Emergency Housing Vouchers (“EHVs”)
across the nation. ARPA included funding for the renewal of these EHVs and fees for the
cost of administering the EHVs and other eligible expenses to prevent, prepare, and
respond to the coronavirus and facilitate the leasing of the EHVs, such as security deposit
assistance and other costs related to the retention and support of participating
owners. As a result, on June 10, 2021, the Housing Authority received a direct allocation
of $1,316,892 in EHV Housing Assistance Payments (“HAP”) funds to assist up to eighty-
nine (89) new voucher holders (Exhibit 1). The Housing Authority also received an
allocation of administrative fee funding for other eligible expenses that are not normally
eligible administrative expenses under the Housing Choice Voucher (“HCV”) program, as
well as standard administrative fees for the cost of administering the EHVs. The
administrative fee funding included a single, one-time preliminary fee of $400 per EHV
allocated to the Housing Authority; a one-time services fee to support the Housing
Authority’s efforts to implement and operate an effective EHV services program that will
best address the needs of EHV eligible individuals and families equal to $3,500 per EHV;
and on-going administrative fees calculated in the same manner as the regular HCV
Program.
Eligibility for these EHVs is limited to individuals and families who are (1) homeless; (2)
at risk of homelessness; (3) fleeing, or attempting to flee, domestic violence, dating
violence, sexual assault, stalking or human trafficking; or (4) recently homeless and for
whom providing rental assistance will prevent the family’s homelessness or having high
risk of housing instability. All individuals and families may only be referred to the Housing
Authority from the Orange County Continuum of Care’s Coordinated Entry System, and
the Housing Authority is prohibited from having a local residency preference for Santa
Ana residents. After September 30, 2023, the Housing Authority may not reissue any
previously leased EHV, regardless of when the assistance for the formerly assisted family
ends or ended.
Emergency Housing Vouchers
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Memorandum of Understanding with Continuum of Care
As a requirement for accepting the EHVs, the Department of Housing and Urban
Development (“HUD”) established a requirement under which the Housing Authority must
enter into a Memorandum of Understanding (“MOU”) with the Orange County Continuum
of Care (“CoC”) to establish a partnership for the administration of the EHVs (Exhibit 2).
The primary responsibility of the CoC under the MOU is to make direct referrals of
qualifying individuals and families to the Housing Authority from the Coordinated Entry
System list. The CoC is responsible for determining whether the family qualifies under
one of the four eligibility categories for EHVs. Additionally, this CoC and designated
service providers assists the Housing Authority to offer or make connections to supportive
services for families that are referred to the Housing Authority, including, but not limited
to, short- or long-term case management, collecting necessary verifications to support
referrals, housing counseling, housing search assistance and utility deposit assistance.
As a requirement, the Housing Authority must accept referrals for EHVs directly from the
Coordinated Entry (“CE”) System. Accepting direct referrals from the CE System will help
ensure families are able to get assistance quickly and eliminate the administrative burden
on the Housing Authority regarding the determination as to whether the family meets the
definition of a qualifying individual or family for EHV assistance. The MOU is a complete
statement of the responsibilities of the parties and evidence of a commitment of resources
to the EHV program. The MOU includes:
1. The Housing Authority’s and CoC’s commitment to administering the EHVs in
partnership.
2. The goals and standards of success in administering the EHVs.
3. The staff position for each organization that will serve as the lead EHV liaison.
4. A statement that all parties agree to cooperate with any program evaluation efforts
undertaken by HUD, or a HUD-approved contractor, including compliance with
HUD evaluation protocols and data sharing requests.
5. The specific populations eligible for the EHV assistance that will be referred to the
Housing Authority by the CoC or other partnering referral agency.
6. The services, including financial assistance, that will be provided to assist EHV
applicants and participants and who will provide them.
7. The roles and responsibilities of the Housing Authority and CoC, including but not
limited to the CoC making direct referrals of families to the Housing Authority
through the CE system.
The MOU is contingent on approval by the Board of the Orange County CoC. The
Housing Authority has a seat on the Board, but will be conflicted to vote on the item.
Update to HCV Administrative Plan
HUD requires housing authorities that administer an HCV program to have an
Administrative Plan. The purpose of the HCV Administrative Plan is to establish policies
for implementing the HCV program in a manner consistent with HUD requirements and
local goals and objectives contained in the Housing Authority’s 5-Year and Annual Plans.
Emergency Housing Vouchers
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The HCV Administrative Plan defines the Housing Authority’s local policies for the
operation of the HCV program in the context of federal laws and regulations. The
Administrative Plan also informs the public and staff about the Housing Authority’s
policies and explains how the Housing Authority will implement those policies. The HCV
Administrative Plan was last updated and approved by City Council on December 1,
2020.
In order to accept the eighty-nine (89) EHVs and administer the Service Fees that were
provided, HUD requires the Housing Authority to describe its policies for these vouchers
in the HCV Administrative Plan. For example, the eligible uses of the services fee
implemented by the Housing Authority and the parameters/requirements established by
the Housing Authority must be described in the HCV Administrative Plan. In addition,
the Housing Authority’s policy on EHV permissive prohibitions must be described in the
HCV Administrative Plan. The new chapter, also known as a Temporary Policy
Supplement, is attached as Exhibit 3. Following approval by City Council, staff will
incorporate this chapter into the full HCV Administrative Plan and submit the updated
HCV Administrative Plan to HUD. All issues related to the Emergency Housing Vouchers
not addressed in the Administrative Plan are governed by federal regulations, HUD
handbooks and guidebooks, notices and other applicable law.
Agreement with United Way of Orange County or Other Designated Service Provider(s)
In an effort to lease the EHVs with a hard-to-serve population, staff is recommending to
use the $311,500 in Services Fee funds to lease-up each voucher by incentivizing
landlords in the private market to accept the voucher. In the past SAHA has partnered
with the Orange County United Way to engage landlords through WelcomeHomeOC,
the United Way’s landlord incentive program that matches voucher holders with
available units. If/when a contract/s is/are entered into with the Orange County United
Way or another service provider, the Service Fee funds will be utilized to support
incurred costs related to leasing up the new EHVs including property owner signing
bonuses, security deposits, application fees, furnishings, holding fees, moving costs,
utility deposits, renter’s insurance, and a damage mitigation fund. All of the eligible
uses of the Services Fee funding match the exact services provided by Orange County
United Way’s WelcomeHomeOC program.
The Agreement is not attached to the Staff Report because: 1) staff have been working
on the negotiations with the CoC for the MOU that must be complete by July 31, 2021;
and 2) staff have been unable to secure a firm commitment from the Orange County
United Way on the details of an Agreement because their staff has been working to
understand any additional funding sources that could be available to partner with
SAHA’s EHVs.
As the EHVs are a direct response to the COVID-19 federal, state and local emergency,
staff is recommending City Council to direct the City Attorney to finalize and authorize
the City Manager to enter into negotiations, execute agreements, and approve any
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other required actions necessary with various service providers, contractors, and sub-
recipients, who will support the Housing Authority to issue and lease the eighty-nine
Emergency Housing Vouchers. This includes negotiating an Agreement with the
Orange County United Way or other designated service provider(s).
FISCAL IMPACT
Approval of the appropriation adjustment will recognize $1,316,892 in Emergency
Housing Voucher HAP revenue account (No. 17918002-52011) and $488,616 in the
Emergency Housing Voucher Administrative revenue account (No. 18018002-various) for
expenditure as follows:
Fiscal Year Accounting
Unit-Account
Fund
Description
Accounting Unit,
Account
Description
Amount
FY 21-22 17918760-
69158
Emergency
Housing Voucher
HAP
Housing Assistance
Payments $1,316,892
FY 21-22 18018760-
various
Emergency
Housing Voucher
Administrative
Revenue
Preliminary
Administrative funds,
Administrative funds
and Service Fees
$488,616
Total Expenditures $1,805,508
The expenditure-spending plan is only an estimate and subject to change.
Funds in the amount of $311,500 are available in the Emergency Housing Voucher
Administrative Revenue grant, Payment to Subagent account (no. 18018760-various) for
expenditure in the current fiscal year.
EXHIBIT(S)
1. June 10, 2021, EHV Award Letter
2. Memorandum of Understanding with Orange County Continuum of Care
3. EHV Chapter in HCV Administrative Plan
Submitted By: Steven Mendoza, Assistant City Manager
Approved By: Kristine Ridge, City Manager
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
WASHINGTON, DC 20410-5000
OFFICE OF PUBLIC AND INDIAN HOUSING
HOUSING AUTHORITY OF THE CITY OF SANTA ANA
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
Dear Executive Director:
June 10, 2021
This is your public housing agency’s (PHA) Emergency Housing Vouchers (EHV) Award
notification, which is authorized by the American Rescue Plan (ARP) Act of 2021 (Public Law No:
117-2).
Judson Brown
Executive Director
The ARP authorized the Department of Housing and Urban Development (HUD) to allocate
additional vouchers to PHAs through an allocation formula designed to direct emergency housing
vouchers to the PHAs operating in areas where the EHV’s eligible populations have the greatest need
while also considering PHA capacity and the requirement to ensure geographic diversity, including rural
areas. The EHVs are provided to help assist individuals and families who are (1) homeless, (2) at risk
of homelessness, (3) fleeing, or attempting to flee, domestic violence, dating violence, sexual assault,
stalking, or human trafficking, or (4) recently homeless.
Please notice the effective date of your EHV awards based on the category of funding. HUD will
obligate 12 months of Housing Assistance Payments (HAP) and Administrative (Admin) Fee funding to
all eligible PHAs. HAP and Admin Fees are effective on July 1st, and 1/12 of the total HAP and Admin
Fees will be disbursed automatically for July, August, and September 2021. After that, monthly HAP
disbursements will be based on actual EHV HAP expenses and units leased reported in VMS. HUD will
automatically adjust the HAP funding based on actual costs associated with the EHV Awards. If your
PHA needs HAP funds beyond the automatic adjustments, please contact your Financial Analyst at the
Financial Management Center.
Further, the Department will obligate and disburse 100% of the Preliminary Fees in a lump sum
effective June 1, 2021. Services Fees will be obligated for 100% of the units awarded, but HUD will
only disburse 50% of these funds in a lump sum payment, also effective June 1, 2021. Two additional
Service Fee disbursements for 25% of the total obligation will occur when the PHAs had spent 50%
and 100% of the initial lump sum disbursement. If you require the Service Fee disbursement in
advance of the schedule outlined here, please send a request with justification to your Financial Analyst
at the Financial Management Center (FMC).
The following table provides the details for your agency’s EHV award:
$1,316,892
Emergency Housing Vouchers Awarded:
$35,600 $311,500 $141,516
89
Housing Assistance
Payments
Preliminary Fees Service Fees Administrative Fees
Effective: July 1, 2021 Effective: June 1, 2021 Effective: June 1, 2021 Effective: July 1, 2021
www.hud.gov espanol.hud.gov
Danielle L. Bastarache
Deputy Assistant Secretary for
Public Housing and Voucher Programs
Sincerely,
The Financial Management Center (FMC) will provide your agency with an amended Consolidated
Annual Contributions Contract (CACC) that reflects the EHVs new incremental vouchers and funding.
Your agency must follow applicable Housing Choice Voucher (HCV) program requirements, when
administering EHVs, including the regulations at 24 CFR part 982, and the EHV operating requirements
set forth in PIH Notice 2021-15.
Should you have questions about this award, please do not hesitate to contact your FMC
Financial Analyst or email
Finally, PIC and VMS reporting requirements will be provided under separate notification.
EHV@hud.gov.
MEMORANDUM OF UNDERSTANDING
BETWEEN
HOUSING AUTHORITY OF THE CITY OF SANTA ANA (CA093)
AND
ORANGE COUNTY CONTINUUM OF CARE
FOR THE EMERGENCY HOUSING VOUCHER PROGRAM
This Memorandum of Understanding (MOU) has been created and entered into on July 1, 2021, by and
between the Housing Authority of the City of Santa Ana (CA093), a public body, corporate and politic,
henceforth referred to as “PHA”, and Health Care Agency, Office of Care Coordination functioning as the
Administrative Entity and Collaborative Applicant for the Orange County Continuum of Care, henceforth
referred to as “CoC”. The PHA and CoC may be referred to individually as “Party” and collectively as “the
Parties”.
This MOU contains program content and purpose, along with specif ic guidelines for the implementation
and administration of the Emergency Housing Voucher (EHV) programs as provided by the American
Rescue Plan Act of 2021 (ARPA) to address the continued impact of the COVID-19 pandemic on the
economy, public health, state and local governments, individuals, and businesses.
The relationship between PHA and CoC, with regard to this MOU, is based upon the following:
I.The Parties enter into this MOU to further the interests of the CoC by collaboratively working to
meet both Parties’ objectives and/or to comply with federal requirements and obligations.
II.The Parties reaffirm the commitments made to the mutual participants and service providers,
which further contribute to the CoC’s efforts to provide permanent housing solutions and
supportive services for those who are experiencing homelessness or at risk of homelessness in
Orange County.
III.This MOU is authorized and provided pursuant to Notice PIH 2021-15 as issued by the U.S.
Department of Housing and Urban Development (HUD), Office of Public and Indian Housing (PIH),
on May 5, 2021.
IV.This MOU contains the procedural guidelines authorized by both the PHA’s Director and the CoC
Director for the EHV Program, including eligibility verification and referral process utilizing the
Coordinated Entry System (CES) to best use and target the EHVs in Orange County.
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EXHIBIT 2
I. INTRODUCTION
The PHA has received an allocation of EHV to assist individuals and families who are experiencing
homelessness; at risk of experiencing homelessness; fleeing, or attempting to flee, domestic violence,
dating violence, sexual assault, stalking, or human trafficking; or were recently homeless and for
whom providing rental assistance will prevent homelessness or having high risk of housing instability.
The PHA is required to enter into a MOU with the CoC to establish a partnership for the administration
of the EHVs. The primary responsibility of the CoC under the MOU is to make direct referrals of
qualifying participants to the PHA. The MOU is a complete statement of the responsibilities of the
parties and evidence of a commitment of resources to the EHV program.
II. PURPOSE
The purpose of this MOU is to support the efficient and effective lease up of each EHV allocated to
the PHA no later than June 30, 2022, and ongoing lease up of any turnover vouchers through
September 30, 2023, by receiving appropriate referrals from the CES.
III. TERM
The term of this MOU shall be effective July 1, 2021, and remain active until September 30, 2023.
The Parties shall be obligated to perform such duties as would normally extend beyond this term,
including but not limited to, obligations with respect to reporting and confidentiality.
IV. MUTUAL RESPONSIBILITIES
a. Parties commit to administering the EHVs in accordance with all program requirements in
Notice PIH 2021-15.
b. Parties agree that a strong level of communication and coordination among the Parties is
necessary to ensure program success and adherence to program requirements.
i. Parties shall establish a mutually convenient regular meeting schedule and
communication methods for the EHV process.
ii. Parties shall provide an update of referred matches, application status, lease up
status and available vouchers.
c. Parties agree to maintain lead EHV liaisons as follows:
HOUSING AUTHORITY OF THE CITY OF SANTA ANA
Lead Name: Judson Brown
Title: Housing Division Manager
Email: jbrown@santa-ana.org
Phone Number: 714-667-2241
Address:
City of Santa Ana
Community Development Agency
20 Civic Center Plaza
Santa Ana, CA 92702
ORANGE COUNTY CONTINUUM OF CARE
Lead Name: Doug Becht
Title: Director of Operations
Email: dbecht@ochca.com
Phone Number: 714-834-2323
Address:
OC Health Care Agency
Office of Care Coordination, Continuum of Care
405 W. 5th St, Ste 658, Santa Ana, CA 92701
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EXHIBIT 2
V. ELIGIBILITY
a. EHV eligibility is limited to individuals and families who are (1) homeless; (2) at risk of
homelessness; (3) fleeing, or attempting to flee, domestic violence, dating violence, sexual
assault, stalking, or human trafficking; or (4) recently homeless and for who providing rental
assistance will prevent the family’s homelessness or having high risk of housing instability as
defined in Notice PIH 2021-15.
b. For the purposes of the EHV program, there will be no local residency preference and PHA
referrals will be assigned based on the ratio of available vouchers.
c. Denial of assistance will be limited to the mandatory prohibitions listed in Notice PIH 2021-15
without applying any additional permissive prohibitions.
VI. EHV ALLOCATION
a. Parties agree to allocating all EHVs across the following sub-populations: individuals, families,
veterans, transitional aged youth, move on, re-entry and exiting facilities, and domestic
violence. The parties will work together on identifying the appropriate proportion of vouchers
to be assigned to each sub-population.
b. Parties agree to the following definitions and characterizations of the identified specific
populations and who meet one of the four eligibility categories defined in PIH Notice 2021-
15.
i. Domestic Violence. This allocation refers to individuals and families who are fleeing,
or attempting to flee, domestic violence, dating violence, sexual assault, stalking or
human trafficking.
ii. Re-Entry and Exiting Facilities. This allocation refers to individuals and families who
are exiting a publicly funded institution or component of the system of care, such as
a healthcare facility, a mental health facility, foster care or other youth facility, or
correction program or institution; exited a publicly funded institution or component
of the system of care in the past 90 days; or currently receiving criminal justice
supervision, such as probation or parole.
iii. Move On. This allocation refers to people who are formerly homeless and currently
being assisted through rapid rehousing and permanent supportive housing programs.
Vacancies created through Move On referrals must accept referrals from the CES. The
PHA will have a local residency preference for the rapid rehousing and permanent
supportive housing vacancies that are created through Move On referrals.
iv. Transitional Aged Youth. This allocation refers to individuals and families who are 18-
24 years old.
v. Veterans. This allocation refers to individuals and families with household members
who served in the U.S. Armed Forces, National Guard or Reserves of any discharge
status. Priority will be given to those veteran households who are not eligible for
HUD-VASH and/or need long-term financial assistance to remain stably housed.
vi. Families. This allocation refers to families with at least one minor child, households
with an expectant mother, or households that are working towards reunification with
minor children.
vii. Individuals. This allocation refers to adults who are not a part of a household with
minor children and includes single adults and households comprised of multiple
adults.
c. Turn over EHVs will prioritize households exiting rapid rehousing or permanent supportive
housing programs in need of ongoing rental assistance without intensive supportive services.
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EXHIBIT 2
VII. COC ROLE AND RESPONSIBILITIES
a. CoC will coordinate and consult with the PHA in developing the services and assistance to be
offered under the EHV services fee provided by the PHA and/or their contracted service
provider.
b. CoC is committed to providing the following services through the CES and the OC Health Care
Agency, Office of Care Coordination:
i. Educate CES Access Points and CoC Stakeholders on the EHV program, sub-
populations priorities for EHV distribution and requirements of this housing
opportunity as agreed upon in this MOU.
ii. Coordinate the outreach and referral of eligible households through CES.
iii. Prioritize households using the CES policies and procedures approved by the CoC.
iv. Partner with victim service providers to coordinate referrals through the parallel
system for victim service providers.
v. Refer eligible individuals and families to PHA through CES, including referrals from the
comparable CES for Victim Service Providers.
vi. Centralize the application process through the Office of Care Coordination using the
universal PHA application and collecting minimally required supporting documents,
as detailed and included in ATTACHMENT 2 and 3.
c. CoC will provide supporting documentation to the PHA of the referring agency’s verification
that the referred individuals and families meet one of the four eligible categories for EHV
assistance.
d. CoC will strive to match referred individuals and families to the service provider selected by
the PHA.
e. CoC will comply with the provisions of this MOU.
VIII. PHA ROLES AND RESPONSIBILITIES
a. PHA is committed to providing the following services:
i. Accept referrals from CES for the EHV program as vouchers are available.
ii. Accept direct referrals from outside the CoC CES if:
1. the CES does not have a sufficient number of eligible families to refer to
the PHA, or
2. the CES does not identify individuals or families that may be eligible for
EHV assistance because they are fleeing, or attempting to flee, domestic
violence, dating violence, sexual assault, stalking or human trafficking.
iii. Coordinate and consult with CoC in developing the services and assistance to be
offered under the EHV services fee provided by the PHA and/or their contracted
Service Provider.
iv. Notify applicant, the Office of Care Coordination, CES, and designated supportive
service agencies of application and appointment notices, including intake interviews
and briefing appointments.
v. Provide housing search assistance using available EHV service fee funds and other
funding resources, this includes:
1. Information and training on what to expect in the EHV issuance process
for household.
2. Help household identify potentially available units during their housing
search.
3. Provide transportation assistance and directions to potential units.
4. Conduct owner/landlord outreach and engagement.
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EXHIBIT 2
5. Assist with the completion of rental applications and PHA forms.
6. Help expedite the EHV leasing process for the household.
7. Educate applicants on compliance with rental lease requirements.
vi. PHA may subcontract the housing search assistance activities listed above.
b. PHA will commit a sufficient number of staff and necessary resources to ensure that the
application, certification, voucher issuance, and unit inspection processes are completed in
a timely manner.
c. PHA will comply with the provisions of this MOU.
d. PHA will select the service provider to fulfill the service providers role and responsibilities.
IX. SERVICE PROVIDERS ROLE AND RESPONSIBILITIES
a. Service providers are committed to providing the following services to support participants in
securing housing and stabilizing in housing:
i. Provide lease up assistance, including but not limited to housing search assistance,
housing related fee assistance, and landlord engagement services to eligible
applicants who do not already have access to lease up assistance through other
service providers. Provide a services plan that details the specific services and
engagement to be provided to each household.
ii. Provide between 6-12 months of housing stabilization services to each household.
iii. Assist with submitting requests for tenancy approval and other required lease up
documentation.
iv. Support tenants with maintaining compliance with rental lease requirements and
provide housing stability services for a minimum of 12 months.
v. Assess and refer individuals and families to benefits and supportive services, when
applicable to maintaining housing stability.
b. Service Providers will comply with the provisions of this MOU.
X. PROGRAM EVALUATION
a. The PHA and CoC agree to cooperate with HUD to provide requested data to HUD or HUD-
approved contractor delegated the responsibility of program evaluation protocols established
by HUD or HUD-approved contractor, including possible random assignment procedures.
XI. GENERAL PROVISIONS
In the event there is a need to update this MOU such as to comply with the terms of the EHV Program
funding, but deadlines do not permit such, upon mutual agreement, addendum will be appended to
this MOU.
The Attachments to this MOU are subject to revision at any time after execution of the MOU, upon
written administrative approval from both Parties. The Attachments are only for reference.
This MOU represents the entire understanding of the Parties with respect to the subject matter. No
change, modification, extension, termination or waiver of this MOU, or any of the understandings
herein contained, shall be valid unless made in writing and signed by duly authorized representatives
of the Parties hereto.
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EXHIBIT 2
In Witness Whereof, the agencies hereto agree to the provisions as outlined in this MOU.
Signed by
HOUSING AUTHORITY OF THE CITY OF SANTA ANA (CA093)
Date:
Name: Title:
ORANGE COUNTY CONTINUUM OF CARE
Date:
Name: Title:
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Approved as to form:
Ryan O. Hodge
Assistant Authority Counsel
EXHIBIT 2
ATTACHMENT 1. PROGRAM MILESTONES
The PARTIES will utilize the following goals and milestones as a measure of success in administering the
Emergency Housing Vouchers. These goals and milestones focus primarily on the function of the
Continuum of Care (CoC), the Coordinated Entry System (CE S) and the Public Housing Authority (PHA),
accordingly.
The CoC as described in the Memorandum of Understanding (MOU) is to make direct referrals of
qualifying participants to the PHA through the CES. The CES provides an objective manner to effectively
connect individuals and families experiencing homeless or at risk of homelessness to appropriate services
and housing interventions, with the goal of securing permanent and stable housing in Orange County.
• CES will identify 50% of the referrals within 7 weeks of the effective date of the MOU.
• CES will identify 100% of referrals within 14 weeks of the effective date of the MOU.
• CES will identify replacement referrals within 14 days for any returned matches.
• PHA will make all reasonable efforts to complete EHV processing within 45 days of initial contact
with participant as referred by CES.
• PHA or designee will return ineligible referrals to CES within three (3) business days of determining
ineligibility.
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EXHIBIT 2
TENANT INFORMATION FORM
Please review and complete this form. This information will help us determine your assistance.
Indicate the current status of all adults and children that will live in the housing unit to be assisted. Add new members in the space
provided below, including the full Social Security Number for each. Enter one of the following codes in box 6 to identify the
relationship of each new adult and child listed.
H = Head of Household
S = Spouse (Married)
K = Co-Head (Not Married)
F = Foster Child/Adult
Y = Youth Under 18
E = Full Time Student Over 18
L = Live-in Aide
A = Other Adult
1. Last Name & Sr, Jr, etc.2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation
10. Social Security Number
7. Disabled
NoYesFM
Native Hawaiian/
Other Pacific Islander
9. Race (Check All That Apply)8. Ethnicity (Check One Box)
Not Hispanic/
Latino
Hispanic/
Latino
White
Black/African American
American Indian/Alaska Native
Asian
Telephone Number:
Part 1: Household Information
Telephone Number:
E-mail Address I would like to receive correspondence via e-mail.
Head of Household
Unit Address
Unit City, State, ZIP
Mailing Address (if
different than above)
H
11. Living in Household
NoYes
FM Y N
2
1
4
3
2
5
1. Last Name & Sr, Jr, etc.2. First Name 3. MI 4. Date of Birth 5. Sex
10. Social Security Number
7. Disabled
NoYesFM
Native Hawaiian/
Other Pacific Islander
9. Race (Check All That Apply)8. Ethnicity (Check One Box)
Not Hispanic/
Latino
Hispanic/
Latino
White
Black/African American
American Indian/Alaska Native
Asian
6. Relation
11. Living in Household
NoYes
FM Y N
1 2
1
4
3
2
5
1. Last Name & Sr, Jr, etc.2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation
10. Social Security Number
7. Disabled
NoYesFM
Native Hawaiian/
Other Pacific Islander
9. Race (Check All That Apply)8. Ethnicity (Check One Box)
Not Hispanic/
Latino
Hispanic/
Latino
White
Black/African American
American Indian/Alaska Native
Asian
11. Living in Household
NoYes
FM Y N
1 2
1
4
3
2
5
1. Last Name & Sr, Jr, etc.2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation
10. Social Security Number
7. Disabled
NoYesFM
Native Hawaiian/
Other Pacific Islander
9. Race (Check All That Apply)8. Ethnicity (Check One Box)
Not Hispanic/
Latino
Hispanic/
Latino
White
Black/African American
American Indian/Alaska Native
Asian
11. Living in Household
NoYes
1. Last Name & Sr, Jr, etc.2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation
10. Social Security Number
7. Disabled
NoYesFM
Native Hawaiian/
Other Pacific Islander
9. Race (Check All That Apply)8. Ethnicity (Check One Box)
Not Hispanic/
Latino
Hispanic/
Latino
White
Black/African American
American Indian/Alaska Native
Asian
11. Living in Household
NoYes
1. Last Name & Sr, Jr, etc.2. First Name 3. MI 4. Date of Birth 5. Sex 6. Relation
10. Social Security Number
7. Disabled
NoYesFM
Native Hawaiian/
Other Pacific Islander
9. Race (Check All That Apply)8. Ethnicity (Check One Box)
Not Hispanic/
Latino
Hispanic/
Latino
White
Black/African American
American Indian/Alaska Native
Asian
11. Living in Household
NoYes
Home Work Cell Other______________
Home Work Cell Other______________
1
Page 8 of 29
EXHIBIT 2
TENANT INFORMATION FORM
Account Holder
Attach Additional Sheets if Necessary
If any child or foster child under age six residing in the assisted unit tested positive for an EBL (Elevated Blood Lead Level)
list the first name of each child with an EBL here:
Have you or any member of your household been convicted of drug-related criminal activity for manufacture
or production of methamphetamine on the premises of federally assisted housing?NoYes
Are you or any member of your household subject to a lifetime sex offender registration under a State sex
offender registration program?NoYes6.
1.
4.
5.
Does your family lack a regular nighttime residence, live in a shelter, or other non residential place?NoYes
Do you currently live or have you previously lived in, public housing, housing assisted by the Section 8
program, or any other type of federally subsidized housing?NoYes
1.
Have you or any member of your household been evicted from Public housing, Indian housing, Section 23
housing, or housing assisted by the Section 8 program, for drug-related criminal activity during the past three
years?
NoYes
Do you or any member of your household have a history of controlled substance or alcohol abuse that has
not been abated through rehabilitation?
NoYes
2.
3.
Part 1: Household (Continued)
Part 2: Asset Information
Type of Account Account Number Current Balance
$
Verification Source Name and Address Documentation Attached
NoYes
Account Holder Type of Account Account Number Current Balance
$
Verification Source Name and Address Documentation Attached
NoYes
Account Holder Type of Account Account Number Current Balance
$
Verification Source Name and Address Documentation Attached
NoYes
Account Holder Type of Account Account Number Current Balance
$
Verification Source Name and Address Documentation Attached
NoYes
Account Holder Type of Account Account Number Current Balance
$
Verification Source Name and Address Documentation Attached
NoYes
Review and update household assets held by any family member, irrespective of age. Add new assets in the space provided below.
An asset is any one of the following types without limitation:
401(k) or 403(b)
Bonds
Certificate of Deposit
Checking Account
Individual Retirement Accounts (IRA)
Inheritances
Life Insurance Policies
Money Market Account
Mutual Funds
Pensions
Real Property (land)
Savings Account
Stocks
Trust Funds
Has any member of the family given away or disposed of assets valued at more than $1,000 for
less than fair market value during the past two years?Yes No
Account Status
ClosedOpen
Account Status
ClosedOpen
Account Status
ClosedOpen
Account Status
ClosedOpen
Account Status
ClosedOpen
DOCUMENTATION REQUIRED:Provide 3 current statements showing the value and interest rate of each asset and check the
Documentation Attached box for each asset.
7.
Page 9 of 29
EXHIBIT 2
Part 3: Income Information
Did you file a Federal Income Tax Return last year?NoYes
TENANT INFORMATION FORM
Does anyone living outside your household pay for or provide money for any of your household bills or
living expenses?NoYes
Member Name
Attach Additional Sheets if Necessary
Monthly Income
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Income
NoYes
Member Name Monthly Income
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Income
NoYes
Member Name Monthly Income
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Income
NoYes
Member Name Monthly Income
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Income
NoYes
Member Name Monthly Income
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Income
NoYes
Income Type
1
Income Type
1
Income Type
1
Income Type
Income Type
Member Name Monthly Income
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Income
NoYes
Income Type
Member Name Monthly Income
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Income
NoYes
Income Type
Member Name Monthly Income
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Income
NoYes
Income Type
Review and update the following income information for all family members 18 or older, including income received on behalf of
household members under the age of 18. Check "Fixed" for income that changes annually based on a COLA or Interest Rate. Add
new income sources in the space provided below. An income is any one of the following types without limitation:
Alimony Payments
Child Support
Disability Benefits
Financial assistance to attend school
Food Stamps
Military Pay
Periodic Gifts
Retirement Payments
Self Employment
Social Security Benefits
SSI
Unemployment Benefits
Wages/Salaries
Welfare Benefits
Worker's Compensation
DOCUMENTATION REQUIRED:Provide 4 current and consecutive original pay stubs, payroll summary reports, SSA benefit
verification letters, child support payment stubs, welfare benefit letters and/or printouts, self employment tax statements, or
unemployment benefit notices, and check the Documentation Attached box for each income.
Fixed
Fixed
Fixed
Fixed
Fixed
Fixed
Fixed
Fixed
Page 3
Page 10 of 29
EXHIBIT 2
Page 4
TENANT INFORMATION FORM
I certify that the information on this form is true and complete to the best of my knowledge and belief. I understand that I can be
fined up to $10,000, or imprisoned up to five years if I furnish false or incomplete information.
Date
Part 4: Household Expenses
Member Name Monthly Payment
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Expense
NoYes
Member Name Monthly Payment
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Expense
NoYes
Member Name Monthly Payment
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Expense
NoYes
Member Name Monthly Payment
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Expense
NoYes
Member Name Monthly Payment
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Expense
NoYes
Allowance Type
Allowance Type
Allowance Type
Allowance Type
Allowance Type
Member Name Monthly Payment
$
Verification Source Name and Address
Documentation Attached
NoYes
Current Expense
NoYes
Allowance Type
Does any adult household member (age 18 or older) attend school full time? (If yes, provide current
enrollment and financial aid information from registrar or admissions officer and enter contact
information in the section below.)
NoYes
Does any member of your family have UNREIMBURSED expenses for care of a child age 12 or
younger so that an adult family member can work?NoYes
Review and update the following expense information relating to questions marked as Yes in the lines above.Additional expenses
must be entered in the space provided below.
Does any member of your family have UNREIMBURSED expenses for care of a person with disabilities
so that an adult family member can work?NoYes
ONLY complete the following if the head of household, spouse or co-head is age 62 or older, or has a disability.
NoYes
1.
2.
3.
4.
Part 5: Head of Household Must Sign this Form Certifying Accuracy of Information Provided
Attach Additional Sheets if Necessary
DOCUMENTATION REQUIRED:Provide documentation from Verification Source listing the monthly payment for each expense and
check the Documentation Attached box for each expense.
Does any member of your family have UNREIMBURSED medical expenses (i.e. Medical Insurance
Premiums; Medical, Dental, or Optical Expenses; or Expenses for Prescription/Non Prescription
Medicines (prescribed by a physician))?
Name
Page 11 of 29
DECLARATION OF SECTION 214 STATUS
Notice to applicants and tenants: In order to be eligible to receive the housing assistance
sought, each applicant for or recipient of housing assistance must be lawfully within the
United States. Please read the Declaration statement carefully and sign and return to the
Housing Authority’s Admissions Office. Please feel free to consult with an immigration
lawyer or other immigration expert of your choosing.
I, ___________________________________________ certify, under penalty of perjury, that to
the best of my knowledge, I am lawfully within the United States because:
[ ] I am a citizen by birth, naturalized citizen or national of the United States.
OR:
[ ] I have eligible immigration status and I am 62 years of age or older (attach proof of age).
OR:
[ ] I have eligible immigration status as checked below (see reverse side of this form for
explanations). Attach INS document(s) evidencing eligible immigration status and
signed verification consent form.
[ ] Immigrant status under #1001(a)(15) or 101(a)(20) of the INA
OR:
[ ] Permanent residence under #249 of INA
OR:
[ ] Refugee, asylum or conditional entry status under #207, 208 or 203 of the
INA
OR:
[ ] Parole status under #212(d)(f) of the INA
OR:
[ ] Threat to life of freedom under #243(h) of the INA
OR:
[ ] Amnesty under #254 of the INA
___________________________________ _____________________________
Signature of Family Member Date
[ ] Check box if signature of adult residing in the unit is responsible for a child named on
statement above.
HA: Enter INS/SAVE Primary Verification # ____________________ Date________
Warning: 18 U.S.C. 1001 provides, among other things, that whoever knowingly and
willfully makes or uses a document or writing containing any false, fictitious or fraudulent
statement or entry, in any manner 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.
[See reverse side for footnotes and instructions]
Page 12 of 29
EXHIBIT 2
The following footnotes pertain to noncitizens that declare eligible immigration status in
one of the following categories:
Eligible immigration status and 62 years of age or older: For noncitizens who are 62 years of
age or older or who will be 62 years of age or older and receiving assistance under a Section 214
covered program on June 19, 1995. If you are eligible and elect to select this category, you must
include a document providing evidence of proof of age. No further documentation of eligible
immigration status is required.
Immigrant status under 101(a)(15) or 101(a)(20) of INA: A noncitizen lawfully admitted for
permanent residence, as defined by 101(a)(20) of the Immigration and Nationality Act (INA), as
an immigrant, as defined by 101(a)(15) of the INA
(8 U.S.C. 1101(a)(20) and 1101(a)(15), respectively [immigrant status]. This category includes a
noncitizen admitted under 210 or 210A of the INA (8 U.S.C. 1160 or 1161), [special agricultural
worker status] who has been granted lawful temporary resident status.
Permanent residence under 249 of INA: A noncitizen who entered the U.S. before January 1,
1972, or such later date as enacted by law, and has continuously maintained residence in the U.S.
since then, and who is not ineligible for citizenship, bur who is deemed to be lawfully admitted
for permanent residence as a result of an exercise of discretion by the Attorney General under 249
of the INA (8 U.S.C. 1259) [amnesty granted under INA 249].
Refugee, asylum or conditional entry status under 207, 208 or 203 of INA: A noncitizen who
is lawfully present in the U.S. pursuant to an admission under 207 of the INA (8 U.S.C. 1157)
[refugee status]; pursuant to the granting of asylum (which has not been terminated under 208 of
the INA (8 U.S.C. 1158) [asylum status]; or as a result of being granted conditional entry under
203(a)(7) of the INA (U.S.C. 1153(a)(7) before April 1, 1980, because of persecution or fear of
persecution on account of race, religion or political opinion or because of being uprooted by
catastrophic national calamity [conditional entry status].
Parole status under 212(d)(5) of INA: A noncitizen who is lawfully present in the U.S. as a
result of an exercise of discretion by the Attorney General for emergent reasons or reasons
deemed strictly in the public interest under 212(d)(5) of the INA (8 U.S.C. 1182(d)(5) [parole
status].
.
Threat to life or freedom under 245(a) of INA: A noncitizen who is lawfully present in the
U.S. as a result of the Attorney General’s withholding deportation under 243(h) of the INA (8
U.S.C. 1253(h)) [threat to life or freedom].
Amnesty under 245(a) of the INA: A noncitizen lawfully admitted for temporary or permanent
residence under 245(a) of the INA (8 U.S.C. 1255(a)) [amnesty granted under INA 245(a)].
Instructions to Housing Authority: Following verification of status claimed by persons
declaring eligible immigration status (other than for noncitizens age 62 or older and receiving
assistance on June 19, 1995), the HA must enter INS/SAVE Verification Number and date that
it was obtained. An HA signature is not required.
Instructions to Family Member for Completing Form:On opposite page, print or type first
name, middle initial(s) and last name. Place an “x” in the appropriate boxes. Sign and date at
bottom page. Place an “X” in the box below the signature if the signature is by the adult
residing in the unit who is responsible for the child.
Page 13 of 29
EXHIBIT 2
UU..SS.. DDeeppaarrttmmeenntt ooff HHoouussiinngg aanndd UUrrbbaann DDeevveellooppmmeenntt OOffffiiccee ooff PPuubblliicc aanndd IInnddiiaann HHoouussiinngg ((PPIIHH)) WWWhhaatt YYoouu SShhoouulldd KKnnooww AAbboouutt EEIIVV A Guide for Applicants & Tenants of Public Housing & Section 8 Programs What is EIV? The Enterprise Income Verification (EIV) system is a web-based computer system that contains employment and income information of individuals who participate in HUD rental assistance programs. All Public Housing Agencies (PHAs) are required to use HUD’s EIV system. What information is in EIV and where does it come from? HUD obtains information about you from your local PHA, the Social Security Administration (SSA), and U.S. Department of Health and Human Services (HHS). HHS provides HUD with wage and employment information as reported by employers; and unemployment compensation information as reported by the State Workforce Agency (SWA). SSA provides HUD with death, Social Security (SS) and Supplemental Security Income (SSI) information. What is the EIV information used for? Primarily, the information is used by PHAs (and management agents hired by PHAs) for the following purposes to: 1. Confirm your name, date of birth (DOB), and Social Security Number (SSN) with SSA. 2. Verify your reported income sources and amounts. 3. Confirm your participation in only one HUD rental assistance program. 4. Confirm if you owe an outstanding debt to any PHA. 5. Confirm any negative status if you moved out of a subsidized unit (in the past) under the Public Housing or Section 8 program. 6. Follow up with you, other adult household members, or your listed emergency contact regarding deceased household members. EIV will alert your PHA if you or anyone in your household has used a false SSN, failed to report complete and accurate income information, or is receiving rental assistance at another address. Remember, you may receive rental assistance at only one home! EIV will also alert PHAs if you owe an outstanding debt to any PHA (in any state or U.S. territory) and any negative status when you voluntarily or involuntarily moved out of a subsidized unit under the Public Housing or Section 8 program. This information is used to determine your eligibility for rental assistance at the time of application. The information in EIV is also used by HUD, HUD’s Office of Inspector General (OIG), and auditors to ensure that your family and PHAs comply with HUD rules. Overall, the purpose of EIV is to identify and prevent fraud within HUD rental assistance programs, so that limited taxpayer’s dollars can assist as many eligible families as possible. EIV will help to improve the integrity of HUD rental assistance programs. Is my consent required in order for information to be obtained about me? Yes, your consent is required in order for HUD or the PHA to obtain information about you. By law, you are required to sign one or more consent forms. When you sign a form HUD-9886 (Federal Privacy Act Notice and Authorization for Release of Information) or a PHA consent form (which meets HUD standards), you are giving HUD and the PHA your consent for them to obtain information about you for the purpose of determining your eligibility and amount of rental assistance. The information collected about you will be used only to determine your eligibility for the program, unless you consent in writing to authorize additional uses of the information by the PHA. Note: If you or any of your adult household members refuse to sign a consent form, your request for initial or continued rental assistance may be denied. You may also be terminated from the HUD rental assistance program. What are my responsibilities? As a tenant (participant) of a HUD rental assistance program, you and each adult household member must disclose complete and accurate information to the PHA, including full name, SSN, and DOB; income information; and certify that your reported household composition (household members), income, and expense information is true to the best of your knowledge. February 2010 Page 14 of 29EXHIBIT 2
Remember, you must notify your PHA if a household member dies or moves out. You must also obtain the PHA’s approval to allow additional family members or friends to move in your home prior to them moving in. What are the penalties for providing false information? Knowingly providing false, inaccurate, or incomplete information is FRAUD and a CRIME. If you commit fraud, you and your family may be subject to any of the following penalties: 1. Eviction 2. Termination of assistance 3. Repayment of rent that you should have paid had you reported your income correctly 4. Prohibited from receiving future rental assistance for a period of up to 10 years 5. Prosecution by the local, state, or Federal prosecutor, which may result in you being fined up to $10,000 and/or serving time in jail. Protect yourself by following HUD reporting requirements. When completing applications and reexaminations, you must include all sources of income you or any member of your household receives. If you have any questions on whether money received should be counted as income or how your rent is determined, ask your PHA. When changes occur in your household income, contact your PHA immediately to determine if this will affect your rental assistance. What do I do if the EIV information is incorrect? Sometimes the source of EIV information may make an error when submitting or reporting information about you. If you do not agree with the EIV information, let your PHA know. If necessary, your PHA will contact the source of the information directly to verify disputed income information. Below are the procedures you and the PHA should follow regarding incorrect EIV information. Debts owed to PHAs and termination information reported in EIV originates from the PHA who provided you assistance in the past. If you dispute this information, contact your former PHA directly in writing to dispute this information and provide any documentation that supports your dispute. If the PHA determines that the disputed information is incorrect, the PHA will update or delete the record from EIV. Employment and wage information reported in EIV originates from the employer. If you dispute this information, contact the employer in writing to dispute and request correction of the disputed employment and/or wage information. Provide your PHA with a copy of the letter that you sent to the employer. If you are unable to get the employer to correct the information, you should contact the SWA for assistance. Unemployment benefit information reported in EIV originates from the SWA. If you dispute this information, contact the SWA in writing to dispute and request correction of the disputed unemployment benefit information. Provide your PHA with a copy of the letter that you sent to the SWA. Death, SS and SSI benefit information reported in EIV originates from the SSA. If you dispute this information, contact the SSA at (800) 772–1213, or visit their website at: www.socialsecurity.gov. You may need to visit your local SSA office to have disputed death information corrected. Additional Verification. The PHA, with your consent, may submit a third party verification form to the provider (or reporter) of your income for completion and submission to the PHA. You may also provide the PHA with third party documents (i.e. pay stubs, benefit award letters, bank statements, etc.) which you may have in your possession. Identity Theft. Unknown EIV information to you can be a sign of identity theft. Sometimes someone else may use your SSN, either on purpose or by accident. So, if you suspect someone is using your SSN, you should check your Social Security records to ensure your income is calculated correctly (call SSA at (800) 772-1213); file an identity theft complaint with your local police department or the Federal Trade Commission (call FTC at (877) 438-4338, or you may visit their website at: http://www.ftc.gov). Provide your PHA with a copy of your identity theft complaint. Where can I obtain more information on EIV and the income verification process? Your PHA can provide you with additional information on EIV and the income verification process. You may also read more about EIV and the income verification process on HUD’s Public and Indian Housing EIV web pages at: http://www.hud.gov/offices/pih/programs/ph/rhiip/uiv.cfm. The information in this Guide pertains to applicants and participants (tenants) of the following HUD-PIH rental assistance programs: 1. Public Housing (24 CFR 960); and 2. Section 8 Housing Choice Voucher (HCV), (24 CFR 982); and 3. Section 8 Moderate Rehabilitation (24 CFR 882); and 4. Project-Based Voucher (24 CFR 983) My signature below is confirmation that I have received this Guide. Signature Date Page 15 of 29EXHIBIT 2
Paperwork Reduction Notice: Public reporting burden for this collection of information is estimated to average 7 minutes
per response. This includes the time for respondents to read the document and certify, and any recordkeeping burden. This
information will be used in the processing of a tenancy. Response to this request for information is required to receive
benefits. The agency may not collect this information, and you are not required to complete this form, unless it displays
a currently valid OMB control number. The OMB Number is 2577-0266, and expires 04/30/2023.
NOTICE TO APPLICANTS AND PARTICIPANTS OF THE FOLLOWING HUD RENTAL ASSISTANCE PROGRAMS:
Public Housing (24 CFR 960)
Section 8 Housing Choice Voucher, including the Disaster Housing Assistance Program (24 CFR 982)
Section 8 Moderate Rehabilitation (24 CFR 882)
Project-Based Voucher (24 CFR 983)
The U.S. Department of Housing and Urban Development maintains a national repository of debts owed to Public
Housing Agencies (PHAs) or Section 8 landlords and adverse information of former participants who have voluntarily or
involuntarily terminated participation in one of the above-listed HUD rental assistance programs. This information is
maintained within HUD’s Enterprise Income Verification (EIV) system, which is used by Public Housing Agencies (PH As)
and their management agents to verify employment and income information of program participants, as well as, to
reduce administrative and rental assistance payment errors. The EIV system is designed to assist PHAs and HUD in
ensuring that families are eligible to participate in HUD rental assistance programs and determining the correct
amount of rental assistance a family is eligible for. All PHAs are required to use this system in accordance with HUD
regulations at 24 CFR 5.233.
HUD requires PHAs, which administers the above-listed rental housing programs, to report certain information at the
conclusion of your participation in a HUD rental assistance program. This notice provides you with information on what
information the PHA is required to provide HUD, who will have access to this information, how this information is used
and your rights. PHAs are required to provide this notice to all applicants and program participants and you are
required to acknowledge receipt of this notice by signing page 2. Each adult household member must sign this form.
What information about you and your tenancy does HUD collect from the PHA?
The following information is collected about each member of your household (family composition): full name, date of
birth, and Social Security Number.
The following adverse information is collected once your participation in the housing program has ended, whether you
voluntarily or involuntarily move out of an assisted unit:
1. Amount of any balance you owe the PHA or Section 8 landlord (up to $500,000) and explanation for balance owed
(i.e. unpaid rent, retroactive rent (due to unreported income and/ or change in family composition) or other charges
such as damages, utility charges, etc.); and
2. Whether or not you have entered into a repayment agreement for the amount that you owe the PHA; and
3. Whether or not you have defaulted on a repayment agreement; and
4. Whether or not the PHA has obtained a judgment against you; and
5. Whether or not you have filed for bankruptcy; and
6. The negative reason(s) for your end of participation or any negative status (i.e., abandoned unit, fraud, lease
violations, criminal activity, etc.) as of the end of participation date.
U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
DEBTS OWED TO PUBLIC HOUSING AGENCIES AND TERMINATIONS
OMB No. 2577-0266 Expires 04/30/2023
08/2013 Form HUD-52675
Page 16 of 29
EXHIBIT 2
2
Who will have access to the information collected?
This information will be available to HUD employees, PHA employees, and contractors of HUD and PHAs.
How will this information be used?
PHAs will have access to this information during the time of application for rental assistance and reexamination of
family income and composition for existing participants. PHAs will be able to access this information to determine a
family’s suitability for initial or continued rental assistance, and avoid providing limited Federal housing assistance to
families who have previously been unable to comply with HUD program requirements. If the reported information is
accurate, a PHA may terminate your current rental assistance and deny your future request for HUD rental assistance,
subject to PHA policy.
How long is the debt owed and termination information maintained in EIV?
Debt owed and termination information will be maintained in EIV for a period of up to ten (10) years from the end of
participation date or such other period consistent with State Law.
What are my rights?
In accordance with the Federal Privacy Act of 1974, as amended (5 USC 552a) and HUD regulations pertaining to its
implementation of the Federal Privacy Act of 1974 (24 CFR Part 16), you have the following rights:
1. To have access to your records maintained by HUD, subject to 24 CFR Part 16.
2. To have an administrative review of HUD’s initial denial of your request to have access to your records maintained
by HUD.
3. To have incorrect information in your record corrected upon written request.
4. To file an appeal request of an initial adverse determination on correction or amendment of record request within
30 calendar days after the issuance of the written denial.
5. To have your record disclosed to a third party upon receipt of your written and signed request.
What do I do if I dispute the debt or termination information reported about me?
If you disagree with the reported information, you should contact in writing the PHA who has reported this information
about you. The PHA’s name, address, and telephone numbers are listed on the Debts Owed and Termination Report.
You have a right to request and obtain a copy of this report from the PHA. Inform the PHA why you dispute the
information and provide any documentation that supports your dispute. HUD's record retention policies at 24 CFR Part 908
and 24 CFR Part 982 provide that the PHA may destroy your records three years from the date your participation in the
program ends. To ensure the availability of your records, disputes of the original debt or termination information must be
made within three years from the end of participation date; otherwise the debt and termination information will be
presumed correct. Only the PHA who reported the adverse information about you can delete or correct your record.
Your filing of bankruptcy will not result in the removal of debt owed or termination information from HUD’s EIV system.
However, if you have included this debt in your bankruptcy filing and/or this debt has been discharged by the
bankruptcy court, your record will be updated to include the bankruptcy indicator, when you provide the PHA with
documentation of your bankruptcy status.
The PHA will notify you in writing of its action regarding your dispute within 30 days of receiving your written dispute.
If the PHA determines that the disputed information is incorrect, the PHA will update or delete the record. If the PHA
determines that the disputed information is correct, the PHA will provide an explanation as to why the information is
correct.
This Notice was provided by the below-listed PHA:
I hereby acknowledge that the PHA provided me with the
Debts Owed to PHAs & Termination Notice:
Signature Date
Printed Name
OMB No. 2577-0266 Expires 04/30/2023
08/2013 Form HUD-52675
Page 17 of 29
EXHIBIT 2
2ULJLQDOLVUHWDLQHGE\WKHUHTXHVWLQJRUJDQL]DWLRQIRUPHUD-9886 014 UHI+DQGERRNV
Authorization for the Release of Information/
Privacy Act Notice
WRWKH86'HSDUWPHQWRI+RXVLQJDQG8UEDQ'HYHORSPHQW +8' 20%&21752/180%(5
DQGWKH+RXVLQJ$JHQF\$XWKRULW\ +$ H[S07/31/2021
Persons who apply for or receive assistance under the following
programs are required to sign this consent form:
PHA-owned rental public housing
Turnkey III Homeownership Opportunities
Mutual Help Homeownership Opportunity
Section 23 and 19(c) leased housing
Section 23 Housing Assistance Payments
HA-owned rental Indian housing
Section 8 Rental Certificate
Section 8 Rental Voucher
Section 8 Moderate Rehabilitation
Failure to Sign Consent Form:Your failure to sign the consent
form may result in the denial of eligibility or termination of
assisted housing benefits, or both. Denial of eligibility or termi-
nation of benefits is subject to the HA’s grievance procedures and
Section 8 informal hearing procedures.
Sources of Information To Be Obtained
State Wage Information Collection Agencies. (This consent is
limited to wages and unemployment compensation I have re-
ceived during period(s) within the last 5 years when I have
received assisted housing benefits.)
U.S. Social Security Administration (HUD only) (This consent is
limited to the wage and self employment information and pay-
ments of retirement income as referenced at Section 6103(l)(7)(A)
of the Internal Revenue Code.)
U.S. Internal Revenue Service (HUD only) (This consent is
limited to unearned income [i.e., interest and dividends].)
Information may also be obtained directly from: (a) current and
former employers concerning salary and wages and (b) financial
institutions concerning unearned income (i.e., interest and divi-
dends). I understand that income information obtained from these
sources will be used to verify information that I provide in
determining eligibility for assisted housing programs and the level
of benefits. Therefore, this consent form only authorizes release
directly from employers and financial institutions of information
regarding any period(s) within the last 5 years when I have
received assisted housing benefits.
Authority: Section 904 of the Stewart B. McKinney Homeless
Assistance Amendments Act of 1988, as amended by Section 903
of the Housing and Community Development Act of 1992 and
Section 3003 of the Omnibus Budget Reconciliation Act of 1993.
This law is found at 42 U.S.C. 3544.
This law requires that you sign a consent form authorizing: (1)
HUD and the Housing Agency/Authority (HA) to request verifi-
cation of salary and wages from current or previous employers; (2)
HUD and the HA to request wage and unemployment compensa-
tion claim information from the state agency responsible for
keeping that information; (3) HUD to request certain tax return
information from the U.S. Social Security Administration and the
U.S. Internal Revenue Service. The law also requires independent
verification of income information. Therefore, HUD or the HA
may request information from financial institutions to verify your
eligibility and level of benefits.
Purpose: In signing this consent form, you are authorizing HUD
and the above-named HA to request income information from the
sources listed on the form. HUD and the HA need this information
to verify your household’s income, in order to ensure that you are
eligible for assisted housing benefits and that these benefits are set
at the correct level. HUD and the HA may participate in computer
matching programs with these sources in order to verify your
eligibility and level of benefits.
Uses of Information to be Obtained:HUD is required to protect
the income information it obtains in accordance with the Privacy
Act of 1974, 5 U.S.C. 552a. HUD may disclose information
(other than tax return information) for certain routine uses, such as
to other government agencies for law enforcement purposes, to
Federal agencies for employment suitability purposes and to HAs
for the purpose of determining housing assistance. The HA is also
required to protect the income information it obtains in accordance
with any applicable State privacy law. HUD and HA employees
may be subject to penalties for unauthorized disclosures or im-
proper uses of the income information that is obtained based on the
consent form.Private owners may not request or receive
information authorized by this form.
Who Must Sign the Consent Form: Each member of your
household who is 18 years of age or older must sign the consent
form. Additional signatures must be obtained from new adult
members joining the household or whenever members of the
household become 18 years of age.
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U.S. Department of Housing
and Urban Development
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Item #1879
Page 18 of 29
EXHIBIT 2
2ULJLQDOLVUHWDLQHGE\WKHUHTXHVWLQJRUJDQL]DWLRQIRUPHUD-9886 07/14 UHI+DQGERRNV
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+HDGRI+RXVHKROG 'DWH
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2WKHU)DPLO\0HPEHURYHUDJH'DWH
Consent: I consent to allow HUD or the HA to request and obtain income information from the sources listed on this form for
the purpose of verifying my eligibility and level of benefits under HUD’s assisted housing programs. I understand that HAs that
receive income information under this consent form cannot use it to deny, reduce or terminate assistance without first
independently verifying what the amount was, whether I actually had access to the funds and when the funds were received. In
addition, I must be given an opportunity to contest those determinations.
This consent form expires 15 months after signed.
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Penalties for Misusing this Consent:
+8'WKH+$DQGDQ\RZQHU RUDQ\HPSOR\HHRI+8'WKH+$RUWKHRZQHU PD\EHVXEMHFWWRSHQDOWLHVIRUXQDXWKRUL]HGGLVFORVXUHVRULPSURSHUXVHVRI
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8VHRIWKHLQIRUPDWLRQFROOHFWHGEDVHGRQWKHIRUP+8' LVUHVWULFWHGWRWKHSXUSRVHVFLWHGRQWKHIRUP+8' $Q\SHUVRQZKRNQRZLQJO\RUZLOOIXOO\
UHTXHVWVREWDLQVRUGLVFORVHVDQ\LQIRUPDWLRQXQGHUIDOVHSUHWHQVHVFRQFHUQLQJDQDSSOLFDQWRUSDUWLFLSDQWPD\EHVXEMHFWWRDPLVGHPHDQRUDQGILQHGQRWPRUH
WKDQ
$Q\DSSOLFDQWRUSDUWLFLSDQWDIIHFWHGE\QHJOLJHQWGLVFORVXUHRILQIRUPDWLRQPD\EULQJFLYLODFWLRQIRUGDPDJHVDQGVHHNRWKHUUHOLHIDVPD\EHDSSURSULDWHDJDLQVW
WKHRIILFHURUHPSOR\HHRI+8'WKH+$RUWKHRZQHUUHVSRQVLEOHIRUWKHXQDXWKRUL]HGGLVFORVXUHRULPSURSHUXVH
Privacy Act Notice.Authority: The Department of Housing and Urban Development (HUD) is authorized to collect this information
by the U.S. Housing Act of 1937 (42 U.S.C. 1437 et. seq.), Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), and by the Fair
Housing Act (42 U.S.C. 3601-19). The Housing and Community Development Act of 1987 (42 U.S.C. 3543) requires applicants and
participants to submit the Social Security Number of each household member who is six years old or older. Purpose: Your income and
other information are being collected by HUD to determine your eligibility, the appropriate bedroom size, and the amount your family
will pay toward rent and utilities. Other Uses: HUD uses your family income and other information to assist in managing and monitoring
HUD-assisted housing programs, to protect the Government’s financial interest, and to verify the accuracy of the information you provide.
This information may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory
investigators and prosecutors. However, the information will not be otherwise disclosed or released outside of HUD, except as permitted
or required by law. Penalty: You must provide all of the information requested by the HA, including all Social Security Numbers you,
and all other household members age six years and older, have and use. Giving the Social Security Numbers of all household members
six years of age and older is mandatory, and not providing the Social Security Numbers will affect your eligibility. Failure to provide
any of the requested information may result in a delay or rejection of your eligibility approval.
Page 19 of 29
EXHIBIT 2
OMB Control # 2502-0581
Exp. (02/28/2019)
Supplemental and Optional Contact Information for HUD-Assisted Housing Applicants
SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING
This form is to be provided to each applicant for federally assisted housing
Instructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing,
the name, address, telephone number, and other relevant information of a family member, friend, or social, health, advocacy, or other
organization. This contact information is for the purpose of identifying 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. You may update,
remove, or change the information you provide on this form at any time.You are not required to provide this contact information,
but if you choose to do so, please include the relevant information on this form.
Applicant Name:
Mailing Address:
Telephone No:Cell Phone No:
Name of Additional Contact Person or Organization:
Address:
Telephone No: Cell Phone No:
E-Mail Address (if applicable):
Relationship to Applicant:
Reason for Contact:(Check all that apply)
Emergency
Unable to contact you
Termination of rental assistance
Eviction from unit
Late payment of rent
Assist with Recertification Process
Change in lease terms
Change in house rules
Other: ______________________________
Commitment of Housing Authority or Owner:If you are approved for housing, this information will be kept as part of your tenant file. If issues
arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the
issues or in providing any services or special care to you.
Confidentiality Statement:The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the
applicant or applicable law.
Legal Notification:Section 644 of the Housing and Community Development Act of 1992 (Public Law 102-550, approved October 28, 1992)
requires each applicant for federally assisted housing to be offered the option of providing information regarding an additional contact person or
organization. By accepting the applicant’s application, the housing provider agrees to comply with the non-discrimination and equal opportunity
requirements of 24 CFR section 5.105, including the prohibitions on discrimination in admission to or participation in federally assisted housing
programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on
age discrimination under the Age Discrimination Act of 1975.
Check this box if you choose not to provide the contact information.
Signature of Applicant Date
The information collection requirements contained in this form were submitted to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The
public reporting burden is estimated at 15 minutes 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. Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers
participating in HUD’s assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option to include in the application for occupancy the name,
address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such
information is to facilitate contact by the housing provider with the person or organization identified by the tenant to assist in providing any delivery of services or special care to the tenant and assist with
resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information.
Providing the information is basic to the operations of the HUD Assisted-Housing Program and is voluntary. It supports statutory requirements and program and management controls that prevent fraud,
waste and mismanagement. In accordance with the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless the
collection displays a currently valid OMB control number.
Privacy Statement: Public Law 102-550, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be
used by HUD to protect disbursement data from fraudulent actions.
Form HUD- 92006 (05/09)
Page 20 of 29
EXHIBIT 2
Orange County Housing Authority
S:\Housing Assistance\Residency\Forms\Statement of Facts - Blank 2008-04.doc
Statement of Facts
Warning: It is unlawful to “knowingly and willfully” make any “materially false, fictitious, or fraudulent
statements or representation” to a federal agency. Violations can be punished under Section 2 of the
False Statements Act by a fine and/or imprisonment of not more than 5 years. [18 U.S.C. § 1001]
I certify, under penalty of perjury under the laws of the United States of America and the State of
California, that the above information is true and correct.
Signature Date
Page 21 of 29
EXHIBIT 2
Documents Checklist for the Emergency Housing Voucher Program
Public Housing Authority Application
This checklist expires 12/31/2021
The following documents are required in order to submit a complete application to the Public Housing
Authority (PHA). Please note that additional documentation may be requested at the discretion of the PHA. It is
strongly encouraged that all required documentation be submitted prior to admission to the program.
Required PHA Forms
Tenant Information Form (All sections completed or marked N/A if not applicable)
Declaration of 214 Status
What you should know about EIV
Debts owed to Public Housing Authorities and Terminations
Authorization for the Release of Information/Privacy Act Notice
Supplement to Application for Federally Assisted Housing
Identification (For all household members) *
Social Security Cards
CA State Driver’s License or Photo ID
Eligible Citizenship Documentation, such as Birth Certificate, Resident Alien Card/Alien Number, or
Certificate of Naturalization
* If unavailable at time of referral, per PIH Notice 2021-15, the PHA will accept a statement certifying Social
Security Number, Date of Birth, and/or Citizenship. If client provides PHA self-certification, client must provide
applicable verification, of SSN or citizenship within 180 days or verification of date of birth or disability status
within 90 days of admission to the program. Failure to do so may result in termination from the program.
Unearned Income (All forms of unearned income must be disclosed for all household members)**
For all unearned income types, please provide the most recent benefit statement unless otherwise noted
Social Security/SSI
Pension
Unemployment (EDD)
Food Stamps and/or Cash Aid (TANF/AFDC)
Disability
Veteran’s Benefit
Worker’s Compensation
Child Support – CSS statement or similar governmental statement, divorce decree, or statement from paying
party certifying amount paid
Alimony – divorce decree or statement from paying party certifying amount paid
Contributions to you or your family – letter from contributing party certifying monthly gross amount paid
Other__________________________________ ___
Page 22 of 29
EXHIBIT 2
Earned Income (All forms of earned income must be disclosed for all household members)**
Last three (3) months of consecutive employment check stubs
Cash employment – cash payment history for the last three to six months and most current tax
return or IRS verification of non-filing.
Self-employment verification – - most recent complete tax returns, including schedule C or the last
three to six months payment history
Other________________________________________________________
Assets (All asset information must be disclosed for all household members)**
For purposes of the PHA, an asset includes the following: 401(k)/403(b), bonds, Certificate of Deposit (CD),
checking account, Individual Retirement Account (IRA), inheritances, life insurance policies, money market
accounts, mutual funds, pensions, real property, savings account, stocks, and trust funds
3 months consecutive bank statements for all checking and savings accounts
Most recent statement for all other assets (i.e. IRA, 401(k), CD, stocks, bonds, investments, annuities, etc.)
Life insurance – statement/letter showing cash value/surrender value
Last Income Tax Return Filed, including W-2 (i.e. 1040, 540, 1099 Schedule C) for each person who filed
If any member of the family has disposed of an asset valued at more than $1000 for less than market value
during the past 2 years – provide all documents of sale, transfer bankruptcy, or foreclosures including
documents showing any net monetary gain from the transaction
Other____________________________________ _
Other**
Medical expenses: when medical expenses exceed 3% of your gross annual income - pharmacy
printouts, receipts for services and supplies, premium statements, etc., for the last 12 months
Students, if applicable – class schedule and financial aid information
** If unavailable at time of referral, per PIH Notice 2021-14, the PHA will accept an affidavit attesting to
reported income, assets, expenses, and other factors which would affect an income eligibility determination.
Additionally, applicants may provide documentation that is not dated within 60 days of the PHA’s request. For
example, an SSI benefit letter issued 11/2020 showing the 2021 benefit amount and provided 7/2021 would be
acceptable. To note, the PHA is still required to verify income against EIV data and is required to follow up on
any discrepancies noted between the reported income and EIV data. Any misrepresentation of income
received may result in termination from the program.
If a statement/affidavit is to be provided in lieu of verification at the time of referral, please use the Statement
of Facts form provided in the application packet. Please use a separate form for each adult household member
providing said statement/affidavit and for each category above.
Page 23 of 29
EXHIBIT 2
version 06/25/2021
HOMELESSNESS CERTIFICATION FOR
EMERGENCY HOUSING VOUCHERS
Client Name: Date of Birth:
Number of Adults in Household: Number of Minor Children in Household:
This is to certify the above‐named person’s or household’s current living situation. This certificate must be
completed by an agency recognized by the Continuum of Care (CoC) as having a program designed to serve
persons living on the street or other places not meant for human habitation, appears on the CoC’s Housing
Inventory Chart or is otherwise recognized by the CoC as part of the CoC inventory.
Please check only one section.
Living Situation: place not meant for human habitation (e.g., cars, parks, abandoned buildings,
streets/sidewalks)
The person(s) named above is/are currently living in (or, if currently in hospital or other institution for less than
90 days, was living in immediately prior to hospital/institution admission) a public or private place not
designated for, or ordinarily used as a regular sleeping accommodation for human beings, including a car, park,
abandoned building, bus station, airport, or camp ground.
Living Situation: Emergency Shelter
The person(s) named above is/are currently living in (or, if currently in hospital or other institution for less than
90 days, was living in immediately prior to hospital/institution admission) a supervised publicly or privately
operated shelter.
Living Situation: Recently Homeless
The person(s) named above is/are currently receiving financial and supportive services for persons who are
formerly homeless and were living in emergency shelter or a place not meant for human habitation immediately
prior to program enrollment. Loss of such assistance would result in a return to homelessness.
I certify that that the information reported above is accurate and correct.
Name: Phone #:
Title: Agency:
Signature: Date:
Page 24 of 29
EXHIBIT 2
version 06/25/2021
VICTIM SERVICE PROVIDER CERTIFICATION
FOR EMERGENCY HOUSING VOUCHERS
Client Name: Date of Birth:
Number of Adults in Household: Number of Minor Children in Household:
This is to certify that the above named individual or household meets the definition for persons who are
fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, stalking, or human
trafficking.
Name: Phone #:
Title: Agency:
Signature: Date:
Confidentiality: All information provided concerning the incident(s) of domestic violence, dating violence,
sexual assault, stalking, or human trafficking shall be kept confidential and such details shall not be entered
into any shared database. This information must be protected and must not be disclosed to any other entity or
individual, except to the extent that disclosure is: (i) consented to by the applicant/tenant in writing in a time‐
limited release; (ii) required for use in an eviction proceeding or hearing regarding termination of assistance;
or (iii) otherwise required by applicable law.
Page 25 of 29
EXHIBIT 2
version 06/25/2021
RE‐ENTRY AND INSTITUTIONAL SETTING CERTIFICATION
FOR EMERGENCY HOUSING VOUCHERS
Client Name: Date of Birth:
This is to certify that the above‐named individual’s current or previous residence in an institutional setting.
This certificate must be completed by a representative of an institution or component of the system of care,
such as a health care facility, a mental health facility, foster care or other youth facility, or correction program
or institution. The individual above must also be experiencing homelessness or at‐risk of homelessness as
defined in the McKinney‐Vento Homeless Assistance Act.
Please check the applicable section(s).
Current Living Situation: Institutional Setting
The person named above is currently living in a publicly funded institution, including a foster care home or
foster care group home, hospital or other residential non‐psychiatric medical facility, jail, prison or juvenile
detention facility, long‐term care facility or nursing home, psychiatric hospital or other psychiatric facility, or a
substance abuse treatment facility or detox center, and will be discharged to a community setting.
The expected discharge date for this person is: _________________________
Prior Living Situation: Institutional Setting
In the past 90 days, the person named above was living in an institutional setting, including a foster care home
or foster care group home, hospital or other residential non‐psychiatric medical facility, jail, prison or juvenile
detention facility, long‐term care facility or nursing home, psychiatric hospital or other psychiatric facility, or a
substance abuse treatment facility or detox center.
The discharge date for this person was: _______________________________
Criminal Justice Supervision
The person named above is currently receiving criminal justice supervision such as probation or parole.
I certify that that the information reported above is accurate and correct.
Name: Phone #:
Title: Agency:
Signature: Date:
Page 26 of 29
EXHIBIT 2
ATTACHMENT 5. EMERGENCY HOUSING VOUCHER REFERRAL EMAIL
The Office of Care Coordination on behalf of the Coordinated Entry System (CES) will be facilitating
communication for referrals made to the Emergency Housing Vouchers. The following is a template email
that will be provided to the appropriate Public Housing Authority (PHA) to facilitate the referral and next
steps.
To: PHA
Cc: CES ACCESS POINT; HOUSING SERVICE PROVIDER
Subject: Referral: Emergency Housing Voucher
Unique ID:
Subpopulation:
CES is referring the applicant above to the Emergency Housing Voucher Program. The application and
eligibility documents are available in HMIS. The contact information for the current CES Access Point and
assigned Housing Service Provider are listed below. Please coordinate with the applicant, CES Access Point
and Housing Service Provider to complete the intake process.
CES Access Point:
Housing Service Provider:
Page 27 of 29
EXHIBIT 2
ATTACHMENT 6. EMERGENCY HOUSING VOUCHER REFERRAL WORKFLOW
Emergency Housing Voucher Workflow
PHA or Designee Requests
Referrals from CES
CES Prioritizes & Matches
Appropriate Households
CES Collects Application and
Supporting Documents
CES Refers Applicants to PHA
or Designee & Service Provider PHA or Designee notifies
Applicant and Service
Provider of any Denials or
Pending Documents
Service Provider
Supports Applicant with
Submitting Pending
Documents or
Reasonable
Accommodation Request
as Eligible and
Appropriate
PHA Issues Voucher
PHA Completes Leasing
Process
PHA or Designee Eligibility &
Intake with Applicant &
Service Provider
Page 28 of 29
EXHIBIT 2
Emergency Housing Voucher Program Workflow
The Public Housing Authority (PHA) or Designee will request referrals from the OC Coordinated Entry
System (CES) through the OC Homeless Management Information System (HMIS). One referral will be
requested for every available Emergency Housing Voucher (EHV). CES will provide replacement referrals
for any Applicant who does not complete the application process.
CES will prioritize and match appropriate households based on presumptive eligibility. CES will use the
prioritization process approved by the Orange County Continuum of Care (CoC) Board, as reflected in the
CES policies and procedures. Matches will be made based on the allocations outlined in the EHV
Memorandum of Understanding.
CES will collect applications and supporting documents prior to submitting referrals to the PHA or
Designee. The Applicant will have a maximum of 30 days to upload the minimally required application
and supporting documents to HMIS. CES will decline Applicants in HMIS who do not submit required
documents within 30 days.
CES will refer Applicants to the PHA or Designee and assigned Service Provider by email on an ongoing
basis as complete applications and supporting documents are uploaded to HMIS. The referral will consist
of a statement of presumptive eligibility and a link to the HMIS client record w here all application
documents will be available to download as needed.
PHA or Designee will initiate the eligibility screening and intake with the Applicant and Service Provider.
PHA or Designee will notify the Applicant and Service Provider of any pending documents or denials.
Service Provider will support Applicants with submitting pending documents or reasonable
accommodation requests as eligible and appropriate. PHA or Designee will deny the Applicant in HMIS
after the final notice due date or the end of the appeal period if the voucher will not be issued. PHA or
Designee will make all reasonable efforts to distribute a bi-weekly report of application status to CES and
Service Provider.
PHA issues a voucher and provides an electronic copy to Applicant, Service Provider, and CES. PHA or
Designee will enroll the applicant in HMIS.
Once the voucher is issued, Service Provider will continue to support the Applicant with their housing
search and support the Applicant with submitting the Request for Tenancy Approval (RTA) to PHA.
PHA will complete the unit inspection and leasing process.
Applicant completes move in and is HOUSED. PHA or Designee will enter move in date and exit Applicant
from CES in HMIS.
Page 29 of 29
EXHIBIT 2
Administrative Plan 5/1/21 Page TSP-1
Temporary Policy Supplement
EMERGENCY HOUSING VOUCHERS (EHVs)
INTRODUCTION
On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (ARP) (P.L.
117-2). Section 3202 of the ARP appropriated $5 billion for the creation, administration, and
renewal of new incremental emergency housing vouchers (EHVs) and other eligible expenses
related to COVID-19.
On May 5, 2021, HUD issued Notice PIH 2021-15, which described HUD’s process for
allocating approximately 70,000 EHVs to eligible PHAs and set forth the operating requirements
for PHAs who administer them. Based on criteria outlined in the notice, HUD notified eligible
PHAs of the number of EHVs allocated to their agency, and PHAs were able to accept or decline
the invitation to participate in the program.
PHAs may not project-base EHVs; EHVs are exclusively tenant-based assistance.
All applicable nondiscrimination and equal opportunity requirements apply to the EHV program,
including requirements that the PHA grant reasonable accommodations to persons with
disabilities, effectively communicate with persons with disabilities, and ensure meaningful
access for persons with limited English proficiency (LEP).
This chapter describes HUD regulations and PHA policies for administering EHVs. The policies
outlined in this chapter are organized into seven sections, as follows:
Part I: Funding
Part II: Partnering Agencies
Part III: Waiting List Management
Part IV: Family Eligibility
Part V: Housing Search and Leasing
Part VI: Use of Funds, Reporting, and Financial Records
Except as addressed by this chapter and as required under federal statute and HUD requirements,
the general requirements of the HCV program apply to EHVs.
EXHIBIT 3
Administrative Plan 5/1/21
Page TSP-2
EXHIBIT 3
Administrative Plan 5/1/21
Page TSP-3
PART I: FUNDING
TPS-I.A. FUNDING OVERVIEW
The American Rescue Plan Act of 2021 (ARP) provides administrative fees and funding for the
costs of administering emergency housing vouchers (EHVs) and other eligible expenses defined
in Notice PIH 2021-15. These fees may only be used for EHV administration and other eligible
expenses and must not be used for or applied to other PHA programs or vouchers. The PHA
must maintain separate financial records from its regular HCV funding for all EHV funding.
Housing Assistance Payments (HAP) Funding
ARP funding obligated to the PHA as housing assistance payments (HAP) funding may only be
used for eligible EHV HAP expenses (i.e., rental assistance payments). EHV HAP funding may
not be used for EHV administrative expenses or for the eligible uses under the EHV services fee.
The initial funding term will expire December 31, 2022. HUD will provide renewal funding to
the PHA for the EHVs on a calendar year (CY) basis commencing with CY 2023. The renewal
funding allocation will be based on the PHA’s actual EHV HAP costs in leasing, similar to the
renewal process for the regular HCV program. EHV renewal funding is not part of the annual
HCV renewal funding formula; EHVs are renewed separately from the regular HCV program.
All renewal funding for the duration of the EHV program has been appropriated as part of the
ARP funding.
Administrative Fee and Funding
The following four types of fees and funding are allocated as part of the EHV program:
Preliminary fees support immediate start-up costs that the PHA will incur in implementing
alternative requirements under EHV, such as outreach and coordination with partnering
agencies:
- $400 per EHV allocated to the PHA, once the consolidated annual contributions contract
(CACC) is amended.
- This fee may be used for any eligible administrative expenses related to EHVs.
- The fee may also be used to pay for any eligible activities under EHV service fees (TPS-
I.B).
EXHIBIT 3
Administrative Plan 5/1/21
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Placement fees/expedited issuance reporting fees will support initial lease-up costs and the
added cost and effort required to expedite leasing of EHVs:
- $100 for each EHV initially leased, if the PHA reports the voucher issuance date in
Public Housing Information Center–Next Generation (PIC–NG) system within 14 days of
voucher issuance or the date the system becomes available for reporting.
- Placement fees:
o $500 for each EHV family placed under a HAP contract effective within four months
of the effective date of the ACC funding increment; or
o $250 for each EHV family placed under a HAP contract effective after four months
but less than six months after the effective date of the ACC funding increment.
o HUD will determine placement fees in the event of multiple EHV allocations and
funding increment effective dates.
- Placement/expedited issuance fees only apply to the initial leasing of the voucher; they
are not paid for family moves or to turnover vouchers.
Ongoing administrative fees, which are calculated in the same way as the standard HCV
program:
- PHAs are allocated administrative fees using the full column A administrative fee amount
for each EHV under contract as of the first day of each month.
- Ongoing EHV administrative fees may be subject to proration in future years, based on
available EHV funding.
Services fees, which are a one-time fee to support PHAs’ efforts to implement and operate an
effective EHV services program in its jurisdiction (TPS-I.B):
- The fee is allocated once the PHA’s CACC is amended to reflect EHV funding.
- The amount allocated is $3,500 for each EHV allocated.
EXHIBIT 3
Administrative Plan 5/1/21
Page TSP-5
TPS-I.B. SERVICE FEES
Services fee funding must be initially used for defined eligible uses and not for other
administrative expenses of operating the EHV program. Service fees fall into four categories:
Housing search assistance
Security deposit/utility deposit/rental application/holding fee uses
Owner-related uses
Other eligible uses such as moving expenses or tenant-readiness services
The PHA must establish the eligible uses and the parameters and requirements for service fees in
the PHA’s administrative plan.
PHA Policy
SAHA will enter into an Agreement with a Service Provider to provide the following
services. The eligible uses for service fees include:
Housing search assistance, which may include activities such as, but not limited to,
helping a family identify and visit potentially available units during their housing search,
helping to find a unit that meets the household’s disability-related needs, providing
transportation and directions, assisting with the completion of rental applications and
PHA forms, and helping to expedite the EHV leasing process for the family.
Application fees/non-refundable administrative or processing fees/refundable
application deposit assistance. The PHA may choose to assist the family with some or
all these expenses.
Holding fees are fees an owner requests that are rolled into the security deposit after an
application is accepted but before a lease is signed. The PHA may cover part or all of the
holding fee for units where the fee is required by the owner after a tenant’s application
has been accepted but before the lease signing. The PHA and owner must agree how the
holding fee gets rolled into the deposit, and under what conditions the fee will be
returned. In general, owners need to accept responsibility for making needed repairs to a
unit required by the initial housing quality standards (HQS) inspections and can only
keep the holding fee if the client is at fault for not entering into a lease.
Security deposit assistance. The amount of the security deposit assistance may not
exceed the lesser of two months’ rent to owner, the maximum security deposit allowed
under applicable state and/or local law, or the actual security deposit required by the
owner. The PHA may pay the security deposit assistance directly to the owner or may
pay the assistance to the family. If paid to the family, the PHA will require
documentation that the family paid the security deposit.
EXHIBIT 3
Administrative Plan 5/1/21
Page TSP-6
Utility deposit assistance/utility arrears. The PHA may provide utility deposit
assistance for some or all of the family’s utility deposit expenses. Assistance can be
provided for deposits (including connection fees) required for the utilities to be supplied
by the tenant under the lease. The PHA may pay the utility deposit assistance directly to
the utility company or may pay the assistance to the family. If paid to the family, the
PHA will require documentation the family paid the utility deposit. The PHA will require
the utility supplier or family to return the utility deposit assistance to the PHA at such
time the deposit is returned by the utility supplier (less any amounts retained by the utility
supplier). In addition, some families may have large balances with gas, electric, water,
sewer, or trash companies that will make it difficult if not impossible to establish services
for tenant-supplied utilities. The PHA may also provide the family with assistance to help
address these utility arrears to facilitate leasing. Utility deposit assistance returned to the
PHA will be used for either services fee eligible uses or other EHV administrative costs,
as required by HUD.
Owner recruitment and outreach for EHVs. The PHA may use the service fee funding
to conduct owner recruitment and outreach specifically for EHVs. In addition to
traditional owner recruitment and outreach, activities may include conducting pre-
inspections or otherwise expediting the inspection process, providing enhanced customer
service, and offering owner incentive and/or retention payments.
Owner incentive and/or retention payments. The PHA may make incentive or
retention payments to owners that agree to initially lease their unit to an EHV family
and/or renew the lease of an EHV family.
Payments will be made as a single payment at the beginning of the assisted lease term (or
lease renewal if a retention payment). Owner incentive and retentions payments are not
housing assistance payments, are not part of the rent to owner, and are not taken into
consideration when determining whether the rent for the unit is reasonable.
Moving expenses (including move-in fees and deposits). The PHA may provide
assistance for some or all of the family’s reasonable moving expenses when they initially
lease a unit with the EHV. The PHA will not provide moving expenses assistance for
subsequent moves unless the family is required to move for reasons other than something
the family did or failed to do (e.g., the PHA is terminating the HAP contract because the
owner did not fulfill the owner responsibilities under the HAP contract or the owner is
refusing to offer the family the opportunity to enter a new lease after the initial lease
term, as opposed to the family choosing to terminate the tenancy in order to move to
another unit), or a family has to move due to domestic violence, dating violence, sexual
assault, or stalking.
Tenant-readiness services. The PHA may use fees to help create a customized plan to
address or mitigate barriers that individual families may face in renting a unit with an
EHV, such as negative credit, lack of credit, negative rental or utility history, or to
connect the family to other community resources (including COVID-related resources)
that can assist with rental arrears.
EXHIBIT 3
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Essential household items. The PHA may use services fee funding to assist the family
with some or all of the costs of acquiring essential household items such as tableware,
cooking equipment, beds or bedding, and essential sanitary products such as soap and
toiletries.
Renter’s insurance if required by the lease. The PHA may choose to assist the family
with some or all this cost.
Any services fee assistance that is returned to the PHA after its initial or subsequent use may
only be applied to the eligible services fee uses defined in Notice PIH 2021-15 (or subsequent
notice) or other EHV administrative costs. Any amounts not expended for these eligible uses
when the PHA’s EHV program ends must be remitted to HUD.
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Page TSP-8
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Page TSP-9
PART II: PARTNERING AGENCIES
TPS-II.A. CONTINUUM OF CARE (CoC)
PHAs that accept an allocation of EHVs are required to enter into a Memorandum of
Understanding (MOU) with the Continuum of Care (CoC) to establish a partnership for the
administration of EHVs.
PHA Policy
The PHA has entered into an MOU with the Health Care Agency, Office of Care
Coordination functioning as the Administrative Entity and Collaborative Applicant for
the Orange County Continuum of Care.
TPS-II.B. OTHER PARTNERING ORGANIZATIONS
The PHA may, but is not required to, partner with other organizations trusted by persons
experiencing homelessness, such as victim services providers (VSPs) and other community
partners. If the PHA chooses to partner with such agencies, the PHA must either enter into an
MOU with the partnering agency or the partnering agency may be added to the MOU between
the PHA and CoC.
PHA Policy
The PHA has added other partnering agencies to the MOU between the PHA and CoC
including but not limited to: Service Providers designed by the PHA to fulfill the Service
Providers Role and Responsibilities in the MOU; Service Providers who assist referrals
made to the PHA from the Coordinated Entry System; United Way of Orange County;
and the Housing for Health Orange County Collaborative.
TPS-II.C. REFERRALS
CoC and Partnering Agency Referrals
The primary responsibility of the CoC under the MOU with the PHA is to make direct referrals
of qualifying individuals and families to the PHA. The PHA must generally refer a family that is
seeking EHV assistance directly from the PHA to the CoC or other referring agency for initial
intake, assessment, and possible referral for EHV assistance. Partner CoCs are responsible for
determining whether the family qualifies under one of the four eligibility categories for EHVs.
The CoC or other direct referral partner must provide supporting documentation to the PHA of
the referring agency’s verification that the family meets one of the four eligible categories for
EHV assistance.
EXHIBIT 3
Administrative Plan 5/1/21
Page TSP-10
PHA Policy
The CoC or partnering agency must establish and implement a system to identify EHV-
eligible individuals and families within the agency’s caseload and make referrals to the
PHA. The CoC or other partnering agency must certify that the EHV applicants they refer
to the PHA meet at least one of the four EHV eligibility criteria. The PHA will maintain a
copy of the referral or certification from the CoC or other partnering agency in the
participant’s file along with other eligibility paperwork. Homeless service providers may,
but are not required to, use the certification form found in Exhibit TPS-2 of this chapter.
Victim services providers may, but are not required to, use the certification form found in
Exhibit TPS-3 of this chapter when identifying eligible families who qualify as victims of
human trafficking.
As part of the MOU, the PHA and CoC or other partnering agency will identify staff
positions to serve as lead EHV liaisons. These positions will be responsible for
transmission and acceptance of referrals. The CoC or partnering agency must commit
sufficient staff and resources to ensure eligible individuals and families are identified and
determined eligible in a timely manner.
The PHA liaison responsible for acceptance of referrals will contact the CoC or
partnering agency liaison via email indicating the number of vouchers available and
requesting an appropriate number of referrals. No more than five business days from the
date the CoC or partnering agency receives this notification, the CoC or partnering
agency liaison will provide the PHA with a list of eligible referrals including the name,
address, and contact phone number for each adult individual who is being referred; a
completed release form for each adult family member; and a written certification for each
referral indicating they are EHV-eligible.
Offers of Assistance with CoC Referral
The PHA may make an EHV available without a referral from the CoC or other partnering
organization in order to facilitate an emergency transfer under VAWA in accordance with the
PHA’s Emergency Transfer Plan (ETP) in Chapter 16.
The PHA must also take direct referrals from outside the CoC if:
The CoC does not have a sufficient number of eligible families to refer to the PHA; or
The CoC does not identify families that may be eligible for EHV assistance because they are
fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, stalking or
human trafficking.
If at any time the PHA is not receiving enough referrals or is not receiving referrals in a timely
manner from the CoC or other partner referral agencies (or the PHA and CoC cannot identify any
such alternative referral partner agencies), HUD may permit the PHA on a temporary or
permanent basis to take EHV applications directly from applicants and admit eligible families to
the EHV program in lieu of or in addition to direct referrals in those circumstances.
EXHIBIT 3
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Page TSP-11
PART III: WAITING LIST MANAGEMENT
TPS-III. A. HCV WAITING LIST
The regulation that requires the PHA to admit applicants as waiting list admissions or special
admissions in accordance with admission policies in Chapter 4 does not apply to PHAs operating
the EHV program. Direct referrals are not added to the PHA’s HCV waiting list.
The PHA must inform families on the HCV waiting list of the availability of EHVs by, at a
minimum, either by posting the information to their website or providing public notice in their
respective communities in accordance with the requirements listed in Notice PIH 2021-15.
PHA Policy
The PHA will post information about the EHV program for families on the PHA’s HCV
waiting list on their website. The notice will:
Describe the eligible populations to which EHVs are limited
Clearly state that the availability of these EHVs is managed through a direct
referral process
Advise the family to contact the CoC (or any other PHA referral partner, if
applicable) if the family believes they may be eligible for EHV assistance
The PHA will ensure effective communication with persons with disabilities, including
those with vision, hearing, and other communication-related disabilities in accordance
with Chapter 2. The PHA will also take reasonable steps to ensure meaningful access for
persons with limited English proficiency (LEP) in accordance with Chapter 2 by
translating this information into Spanish and Vietnamese.
TPS-III.B. EHV WAITING LIST
The HCV regulations requiring the PHA to operate a single waiting list for admission to the
HCV program do not apply to PHAs operating the EHV program. Instead, when the number of
applicants referred by the CoC or partnering agency exceeds the EHVs available, the PHA must
maintain a separate waiting list for EHV referrals, both at initial leasing and for any turnover
vouchers that may be issued prior to September 30, 2023.
Further, the EHV waiting list is not subject to PHA policies in Chapter 4 regarding opening and
closing the HCV waiting list. The PHA will work directly with its CoC and other referral agency
partners to manage the number of referrals and the size of the EHV waiting list.
EXHIBIT 3
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Page TSP-12
TPS-III.C. PREFERENCES
EHV Waiting List Preferences
With the exception of a residency preference, the PHA may choose, in coordination with the
CoC and other referral partners, to establish separate local preferences for EHVs. The PHA may,
however, choose to not establish any local preferences for the EHV waiting list.
PHA Policy
No local preferences have been established for the EHV waiting list.
EXHIBIT 3
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Page TSP-13
PART IV: FAMILY ELIGIBLTY
TPS-IV.A. OVERVIEW
The CoC or referring agency determines whether the individual or family meets any one of the
four eligibility criteria described in Notice PIH 2021-15 and then refers the family to the PHA.
The PHA determines that the family meets other eligibility criteria for the HCV program, as
modified for the EHV program and outlined below.
TPS-IV.B. REFERRING AGENCY DETERMINATION OF ELIGIBLITY
In order to be eligible for an EHV, an individual or family must meet one of four eligibility
criteria:
Homeless as defined in 24 CFR 578.3;
At risk of homelessness as defined in 24 CFR 578.3;
Fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, stalking (as
defined in Notice PIH 2021-15), or human trafficking (as defined in the 22 U.S.C. Section
7102); or
Recently homeless and for whom providing rental assistance will prevent the family’s
homelessness or having high risk of housing instability as determined by the CoC or its
designee in accordance with the definition in Notice PIH 2021-15.
As applicable, the CoC or referring agency must provide documentation to the PHA of the
referring agency’s verification that the family meets one of the four eligible categories for EHV
assistance. The PHA must retain this documentation as part of the family’s file.
EXHIBIT 3
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Page TSP-14
TPS-IV.C. PHA SCREENING
Overview
HUD waived 24 CFR 982.552 and 982.553 in part for the EHV applicants and established
alternative requirement for mandatory and permissive prohibitions of admissions. Except where
applicable, PHA policies regarding denials in Chapter 3 of this policy do not apply to screening
individuals and families for eligibility for an EHV. Instead, the EHV alternative requirement
listed in this section will apply to all EHV applicants.
The mandatory and permissive prohibitions listed in Notice PIH 2021-15 and in this chapter,
however, apply only when screening the individual or family for eligibility for an EHV. When
adding a family member after the family has been placed under a HAP contract with EHV
assistance, the regulations at 24 CFR 982.551(h)(2) apply. Other than the birth, adoption, or
court-awarded custody of a child, the PHA must approve additional family members and may
apply its regular HCV screening criteria in Chapter 3 in doing so.
Mandatory Denials
Under alternative requirements for the EHV program, mandatory denials for EHV applicants
include:
24 CFR 982.553(a)(1)(ii)(C), which prohibits admission if any household member has ever
been convicted of drug-related criminal activity for manufacture or production of
methamphetamine on the premises of federally assisted housing.
24 CFR 982.553(a)(2)(i), which prohibits admission to the program if any member of the
household is subject to a lifetime registration requirement under a state sex offender
registration program.
The PHA must deny admission to the program if any member of the family fails to sign and
submit consent forms for obtaining information as required by 24 CFR 982.552(b)(3) but should
notify the family of the limited EHV grounds for denial of admission first.
PHA Policy
While the PHA will deny admission to the program if any adult member (or head of
household or spouse, regardless of age) fails to sign and submit consent forms, the PHA
will first notify the family of the limited EHV grounds for denial of admission as part of
the notice of denial that will be mailed to the family.
EXHIBIT 3
Administrative Plan 5/1/21
Page TSP-15
Permissive Denial
Notice PIH 2021-15 lists permissive prohibitions for which the PHA may, but is not required to,
deny admission to EHV families. The notice also lists prohibitions that, while allowable under
the HCV program, may not be used to deny assistance for EHV families.
If the PHA intends to establish permissive prohibition policies for EHV applicants, the PHA
must first consult with its CoC partner to understand the impact that the proposed prohibitions
may have on referrals and must take the CoC’s recommendations into consideration.
PHA Policy
In consultation with the CoC, the PHA will apply permissive prohibition to the screening
of EHV applicants. Determinations using permissive prohibitions will be made based on
an individualized assessment of relevant mitigating information in accordance with
policies in Section 3-III.E.
The PHA will establish the following permissive prohibitions:
If the PHA determines that any household member is currently engaged in, or has
engaged in within the previous 12 months:
Violent criminal activity
Other criminal activity that may threaten the health, safety, or right to
peaceful enjoyment of the premises by other residents or persons residing
in the immediate vicinity
If the family engages in or threatens abusive or violent behavior toward PHA
personnel.
The PHA will also deny assistance to household members already receiving assistance
from another program in accordance with Section 9.h. of Notice PIH 2021-15.
Prohibitions based on criminal activity for the eligible EHV populations regarding drug
possession will be considered apart from criminal activity against persons (i.e., violent
criminal activity).
EXHIBIT 3
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In compliance with PIH 2021-15, the PHA will not deny an EHV applicant admission
regardless of whether:
Any member of the family has been evicted from federally assisted housing in the
last five years;
A PHA has ever terminated assistance under the program for any member of the
family;
The family currently owes rent or other amounts to the PHA or to another PHA in
connection with Section 8 or public housing assistance under the 1937 Act;
The family has not reimbursed any PHA for amounts paid to an owner under a
HAP contract for rent, damages to the unit, or other amounts owed by the family
under the lease;
The family breached an agreement with the PHA to pay amounts owed to a PHA,
or amounts paid to an owner by a PHA;
The family would otherwise be prohibited admission under alcohol abuse
standards established by the PHA in accordance with 24 CFR 982.553(a)(3);
The PHA determines that any household member is currently engaged in or has
engaged in during a reasonable time before the admission, drug-related criminal
activity.
EXHIBIT 3
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Page TSP-17
TPS-IV.D. INCOME VERIFICATION AT ADMISSION
Self-Certification at Admission
The requirement to obtain third-party verification of income in accordance with Notice PIH
2018-18 does not apply to the EHV program applicants at admission, and alternatively, PHAs
may consider self-certification the highest form of income verification at admission. As such,
PHA policies related to the verification of income in Section 7-I.B. do not apply to EHV families
at admission. Instead, applicants must submit an affidavit attesting to their reported income,
assets, expenses, and other factors that would affect an income eligibility determination.
Additionally, applicants may provide third-party documentation that represents the applicant’s
income within the 60-day period prior to admission or voucher issuance but is not dated within
60 days of the PHA’s request.
PHA Policy
Any documents used for verification must be the original (not photocopies) and dated
within the 60-day period prior to admission. The documents must not be damaged,
altered, or in any way illegible.
Printouts from webpages are considered original documents.
Any family self-certifications must be made in a format acceptable to the PHA and must
be signed by the family member whose information or status is being verified.
The PHA will incorporate additional procedures to remind families of the obligation to
provide true and complete information in accordance with Chapter 14. The PHA will
address any material discrepancies (i.e., unreported income or a substantial difference in
reported income) that may arise later. The PHA may, but is not required to, offer the
family a repayment agreement in accordance with Chapter 16. If the family fails to repay
the excess subsidy, the PHA will terminate the family’s assistance in accordance with the
policies in Chapter 12.
Applicants may provide income verifications that are not dated within 60 days of the
PHA’s request. For example, an SSI benefit letter issued 11/2020 showing the 2021
benefit amount and provided 7/2021 would be acceptable.
EXHIBIT 3
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Recently Conducted Income Determinations
PHAs may accept income calculations and verifications from third-party providers or from an
examination that the PHA conducted on behalf of the family for another subsidized housing
program in lieu of conducting an initial examination of income as long as:
The income was calculated in accordance with rules outlined at 24 CFR Part 5 and within the
last six months; and
The family certifies there has been no change in income or family composition in the interim.
PHA Policy
The PHA will accept income calculations and verifications from third-party providers
provided they meet the criteria outlined above.
The family certification must be made in a format acceptable to the PHA and must be
signed by all adult family members whose information or status is being verified.
At the time of the family’s annual reexamination the PHA must conduct the annual
reexamination of income as outlined at 24 CFR 982.516 and PHA policies in Chapter 11.
EIV Income Validation
Once HUD makes the EIV data available to PHAs under this waiver and alternative requirement,
the PHA must:
Review the EIV Income and Income Validation Tool (IVT) reports to confirm and validate
family-reported income within 90 days of the PIC submission date;
Print and maintain copies of the EIV Income and IVT Reports in the tenant file; and
Resolve any income discrepancy with the family within 60 days of the EIV Income or IVT
Report dates.
Prior to admission, PHAs must continue to use HUD’s EIV system to search for all household
members using the Existing Tenant Search in accordance with PHA policies in Chapter 3.
If a PHA later determines that an ineligible family received assistance, the PHA must take steps
to terminate that family from the program in accordance with Chapter 12.
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TPS-IV.E. SOCIAL SECURITY NUMBER AND CITIZENSHIP STATUS
VERIFICATION
For the EHV program, the PHA is not required to obtain and verify SSN documentation and
documentation evidencing eligible noncitizen status before admitting the family to the EHV
program. Instead, PHAs may adopt policies to admit EHV applicants who are unable to provide
the required SSN or citizenship documentation during the initial eligibility determination. As an
alternative requirement, such individuals must provide the required documentation within 180
days of admission to be eligible for continued assistance, pending verification, unless the PHA
provides an extension based on evidence from the family or confirmation from the CoC or other
partnering agency that the family has made a good-faith effort to obtain the documentation.
If a PHA determines that an ineligible family received assistance, the PHA must take steps to
terminate that family from the program.
PHA Policy
The PHA will admit EHV applicants who are unable to provide the required SSN or
citizenship documentation during the initial eligibility determination. These individuals
must provide the required documentation in accordance with policies in Chapter 7 within
180 days of admission. The PHA may provide an additional 60-day extension based on
evidence from the family or confirmation from the CoC or other partnering agency that
the family has made a good-faith effort to obtain the documentation.
If the PHA determines that an ineligible family received assistance, the PHA will take
steps to terminate that family from the program in accordance with policies in
Chapter 12.
TPS-IV.F. AGE AND DISABILITY VERIFICATION
PHAs may accept self-certification of date of birth and disability status if a higher level of
verification is not immediately available. If self-certification is used, the PHA must obtain a
higher level of verification within 90 days of admission or verify the information in EIV.
If a PHA determines that an ineligible family received assistance, the PHA must take steps to
terminate that family from the program.
PHA Policy
The PHA will accept self-certification of date of birth and disability status if a higher
form of verification is not immediately available. The certification must be made in a
format acceptable to the PHA and must be signed by the family member whose
information or status is being verified. If self-certification is accepted, within 90 days of
admission, the PHA will verify the information in EIV or through other third-party
verification if the information is not available in EIV. The PHA will note the family’s file
that self-certification was used as initial verification and include an EIV printout or other
third-party verification confirming the applicant’s date of birth and/or disability status.
If the PHA determines that an ineligible family received assistance, the PHA will take
steps to terminate that family from the program in accordance with policies in
Chapter 12.
EXHIBIT 3
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Page TSP-20
TPS-IV.G. INCOME TARGETING
The PHA must determine income eligibility for EHV families in accordance with 24 CFR
982.201 and PHA policy in Chapter 3; however, income targeting requirements do not apply
for EHV families. The PHA may still choose to include the admission of extremely low-income
EHV families in its income targeting numbers for the fiscal year in which these families
are admitted.
PHA Policy
The PHA will not include the admission of extremely low-income EHV families in its
income targeting numbers for the fiscal year in which these families are admitted.
EXHIBIT 3
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PART V: HOUSING SEARCH AND LEASING
TPS-V.A. INITIAL VOUCHER TERM
Unlike the standard HCV program, which requires an initial voucher term of at least 60 days,
EHV vouchers must have an initial search term of at least 120 days. PHA policies on extensions
as outlined in Section 5-II.E. will apply.
PHA Policy
All EHVs will have an initial term of 120 calendar days.
The family must submit a Request for Tenancy Approval and proposed lease within the
120-day period unless the PHA grants an extension.
TPS-V.B. HOUSING SEARCH ASSISTANCE
The PHA must ensure housing search assistance is made available to EHV families during their
initial housing search. The housing search assistance may be provided directly by the PHA or
through the CoC or another partnering agency or entity.
At a minimum, housing search assistance must:
Help individual families identify potentially available units during their housing search,
including physically accessible units with features for family members with disabilities, as
well as units in low-poverty neighborhoods;
Provide transportation assistance and directions to potential units;
Conduct owner outreach;
Assist with the completion of rental applications and PHA forms; and
Help expedite the EHV leasing process for the family
EXHIBIT 3
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PHA Policy
As identified in the MOU between the PHA and CoC, the following housing search
assistance will be provided to each EHV family:
The PHA will:
Provide directions to potential units as part of the EHV briefing packet
Expedite the EHV leasing process for the family to the extent practicable
and in accordance with policies in this chapter
The PHA will enter into an Agreement with a Service Provider to:
Conduct owner outreach in accordance with policies in Chapter 13
At least every 30 days, conduct proactive check-ins via email and
telephone with families who are searching with an EHV and remind them
of their voucher expiration date
Assign a dedicated landlord liaison for EHV voucher families
The CoC designated service provider will:
Help families identify potentially available units during their housing
search, including physically accessible units with features for family
members with disabilities, as well as units in low-poverty neighborhoods
Provide transportation assistance to potential units
Assist the family with the completion of rental applications and
PHA forms
TPS-V.C. HQS PRE-INSPECTIONS
To expedite the leasing process, PHAs may pre-inspect available units that EHV families may be
interested in leasing in order to maintain a pool of eligible units.
PHA Policy
To expedite the leasing process, the PHA may pre-inspect available units that EHV
families may be interested in leasing to maintain a pool of eligible units. If an EHV
family selects a unit that passed a HQS pre-inspection (without intervening occupancy)
within 45 days of the date of the Request for Tenancy Approval, the unit may be
approved provided that it meets all other conditions under 24 CFR 982.305.
The family will be free to select his or her unit.
When a pre-inspected unit is not selected, the PHA will make every effort to fast-track
the inspection process, including adjusting the normal inspection schedule for any
required reinspections.
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Administrative Plan 5/1/21
Page TSP-23
TPS-V.D. INITIAL LEASE TERM
Unlike in the standard the HCV program, EHV voucher holders may enter into an initial lease
that is for less than 12 months, regardless of the PHA policy in Section 9-I.E., Term of
Assisted Tenancy.
TPS-V.E. PORTABILITY
The normal HCV portability procedures and requirements outlined in Chapter 10 generally apply
to EHVs. Exceptions are addressed below.
Nonresident Applicants
Under EHV, applicant families may move under portability even if the family did not have legal
residency in the jurisdiction of the initial PHA when they applied, regardless of PHA policy in
Section 10-II.B.
Billing and Absorption
A receiving PHA cannot refuse to assist an incoming EHV family, regardless of whether the
PHA administers EHVs under its own ACC.
If the EHV family moves under portability to another PHA that administers EHVs under its
own ACC:
- The receiving PHA may only absorb the incoming EHV family with an EHV (assuming
it has an EHV voucher available to do so).
- If the PHA does not have an EHV available to absorb the family, it must bill the initial
PHA. The receiving PHA must allow the family to lease the unit with EHV assistance
and may not absorb the family with a regular HCV when the family leases the unit.
- Regardless of whether the receiving PHA absorbs or bills the initial PHA for the family’s
EHV assistance, the EHV administration of the voucher is in accordance with the
receiving PHA’s EHV policies.
If the EHV family moves under portability to another PHA that does not administer EHV
under its own ACC, the receiving PHA may absorb the family into its regular HCV program
or may bill the initial PHA.
EXHIBIT 3
Administrative Plan 5/1/21
Page TSP-24
Family Briefing
In addition to the applicable family briefing requirements at 24 CFR 982.301(a)(2) as to how
portability works and how portability may affect the family’s assistance, the initial PHA must
inform the family how portability may impact the special EHV services and assistance that may
be available to the family.
The initial PHA is required to help facilitate the family’s portability move to the receiving PHA
and inform the family of this requirement in writing, taking reasonable steps to ensure
meaningful access for persons with limited English proficiency (LEP).
PHA Policy
In addition to following PHA policy on briefings in Chapter 5, as part of the briefing
packet for EHV families, the PHA will include a written notice that the PHA will assist
the family with moves under portability.
For limited English proficient (LEP) applicants, the PHA will provide interpretation
services in accordance with the PHA’s LEP plan (See Chapter 2).
Coordination of Services
If the portability move is in connection with the EHV family’s initial lease-up, the receiving
PHA and the initial PHA must consult and coordinate on the EHV services and assistance that
will be made available to the family.
PHA Policy
For EHV families who are exercising portability, when the PHA contacts the receiving
PHA in accordance with Section 10-II.B. Preapproval Contact with Receiving PHA, the
PHA will consult and coordinate with the receiving PHA to ensure there is no duplication
of EHV services and assistance.
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Administrative Plan 5/1/21
Page TSP-25
Services Fee
Standard portability billing arrangements apply for HAP and ongoing administrative fees for
EHV families.
For service fees funding, the amount of the service fee provided by the initial PHA may not
exceed the lesser of the actual cost of the services and assistance provided to the family by the
receiving PHA or $1,750, unless the initial PHA and receiving PHA mutually agree to change
the $1,750 cap. Service fees are paid as follows:
If the receiving PHA, in consultation and coordination with the initial PHA, will provide
eligible services or assistance to the incoming EHV family, the receiving PHA may be
compensated for those costs by the initial PHA, regardless of whether the receiving PHA
bills or absorbs.
If the receiving PHA administers EHVs, the receiving PHA may use its own services fee and
may be reimbursed by the initial PHA, or the initial PHA may provide the services funding
upfront to the receiving PHA for those fees and assistance.
If the receiving PHA does not administer EHVs, the initial PHA must provide the services
funding upfront to the receiving PHA. Any amounts provided to the receiving PHA that are
not used for services or assistance on behalf of the EHV family must promptly be returned by
the receiving PHA to the initial PHA.
Placement Fee/Issuance Reporting Fee
If the portability lease-up qualifies for the placement fee/issuance reporting fee, the receiving
PHA receives the full amount of the placement component of the placement fee/issuing reporting
fee. The receiving PHA is eligible for the placement fee regardless of whether the receiving PHA
bills the initial PHA or absorbs the family into its own program at initial lease-up. The initial
PHA qualifies for the issuance reporting component of the placement fee/issuance reporting fee,
as applicable.
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Administrative Plan 5/1/21
Page TSP-26
TPS-V.F. PAYMENT STANDARDS
Payment Standard Schedule
For the EHV program, HUD has waived the regulation requiring a single payment standard for
each unit size. Instead, the PHA may, but is not required to, establish separate higher payment
standards for EHVs. Lower EHV payment standards are not permitted. If the PHA is increasing
the regular HCV payment standard, the PHA must also increase the EHV payment standard if it
would be otherwise lower than the new regular HCV payment standard. The separate EHV
payment standard must comply with all other HCV requirements with the exception of the
alternative requirements discussed below.
Further, if the PHA chooses to establish higher payments standards for EHVs, HUD has
provided other regulatory waivers:
Defining the “basic range” for payment standards as between 90 and 120 percent of the
published Fair Market Rent (FMR) for the unit size (rather than 90 to 110 percent).
Allowing a PHA that is not in a designated Small Area FMR (SAFMR) area or has not opted
to voluntarily implement SAFMRs to establish exception payment standards for a ZIP code
area above the basic range for the metropolitan FMR based on the HUD published SAFMRs.
The PHA may establish an exception payment standard up to 120 percent (as opposed to 110
percent) of the HUD published Small Area FMR for that ZIP code area. The exception
payment standard must apply to the entire ZIP code area.
- The PHA must notify HUD if it establishes an EHV exception payment standard based
on the SAFMR.
PHA Policy
The PHA will not establish a higher payment standard amount for EHVs. The PHA will
use the same payment standards for HCV and EHV.
Rent Reasonableness
All rent reasonableness requirements apply to EHV units, regardless of whether the PHA has
established an alternative or exception EHV payment standard.
Increases in Payment Standards
The requirement that the PHA apply increased payment standards at the family’s first regular
recertification on or after the effective date of the increase does not apply to EHV. The PHA
may, but is not required to, establish an alternative policy on when to apply the increased
payment standard, provided the increased payment standard is used to calculate the HAP no later
than the effective date of the family’s first regular reexamination following the change.
PHA Policy
The PHA will not establish an alternative policy for increases in the payment standard.
PHA policy in Section 11-III.B. governing increases in payment standards will apply to
EHV.
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Administrative Plan 5/1/21
Page TSP-27
TPS-V.G. TERMINATION OF VOUCHERS
After September 30, 2023, a PHA may not reissue EHVs when assistance for an EHV-assisted
family ends. This means that when an EHV participant (a family that is receiving rental
assistance under a HAP contract) leaves the program for any reason, the PHA may not reissue
that EHV to another family unless it does so no later than September 30, 2023.
If an applicant family that was issued the EHV is unsuccessful in finding a unit and the EHV
expires after September 30, 2023, the EHV may not be reissued to another family.
All EHVs under lease on or after October 1, 2023, may not under any circumstances be reissued
to another family when the participant leaves the program for any reason.
An EHV that has never been issued to a family may be initially issued and leased after
September 30, 2023, since this prohibition only applies to EHVs that are being reissued upon
turnover after assistance to a family has ended. However, HUD may direct PHAs administering
EHVs to cease leasing any unleased EHVs if such action is determined necessary by HUD to
ensure there will be sufficient funding available to continue to cover the HAP needs of currently
assisted EHV families.
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Administrative Plan 5/1/21
Page TSP-28
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Administrative Plan 5/1/21
Page TSP-29
PART VI: USE OF FUNDS, REPORTING, AND FINANCIAL RECORDS
EHV funds allocated to the PHA for HAP (both funding for the initial allocation and HAP
renewal funding) may only be used for eligible EHV HAP purposes. EHV HAP funding
obligated to the PHA may not be used for EHV administrative expenses or the other EHV
eligible expenses under this notice. Likewise, EHV administrative fees and funding obligated to
the PHA are to be used for those purposes and must not be used for HAP.
The appropriated funds for EHVs are separate from the regular HCV program and may not be
used for the regular HCV program but may only be expended for EHV eligible purposes. EHV
HAP funds may not roll into the regular HCV restricted net position (RNP) and must be tracked
and accounted for separately as EHV RNP. EHV administrative fees and funding for other
eligible expenses permitted by Notice PIH 2021-15 may only be used in support of the EHVs
and cannot be used for regular HCVs. EHV funding may not be used for the repayment of debts
or any amounts owed to HUD by HUD program participants including, but not limited to, those
resulting from Office of Inspector General (OIG), Quality Assurance Division (QAD), or other
monitoring review findings.
The PHA must comply with EHV reporting requirements in the Voucher Management System
(VMS) and Financial Data Schedule (FDS) as outlined in Notice PIH 2021-15.
The PHA must maintain complete and accurate accounts and other records for the program and
provide HUD and the Comptroller General of the United States full and free access to all
accounts and records that are pertinent the administration of the EHVs in accordance with the
HCV program requirements at 24 CFR 982.158.
EXHIBIT 3