HSC Rental Assistance Application

  • 1 Current HSC Rental Assistance Application Page 1
  • 2 HSC Rental Assistance Application Page 2
  • 3 HSC Rental Assistance Application Page 3
  • 4 HSC Rental Assistance Application Page 4
  • 5 Complete

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En Español: www.unitedwaydgco.org/form/hsc-raa-espanol

Information message

You must fit one of the following requirements AND have an income of less than 30% Annual Median Income (AMI) to qualify for the available funding. 

  • You have moved because of economic reasons two or more times within the last 60 days;
  • You are living in the home of another because of economic hardship;
  • You have been notified in writing that your right to occupy your current housing or living situation will be terminated within 21 days( this could include any written communication, not just a legal eviction notice from the court);
  • You are currently living in a hotel or motel that you are paying for;
  • You live in a studio apartment with more than two people or in a larger housing unit with more than 1.5 residents per room;
  • You are exiting a publicly funded institution or system or care, such as a health-care facility, a mental health facility, foster care or other youth facility, or correction program or institution.
  • You are fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member, including a child, that has either taken place within the individual's or family's primary nighttime residence or has made the individual or family afraid to return to their primary nighttime residence.

*Note: we no longer have any funding for security deposit assistance.

Application for Funding (Check one)

Determination of eligibility and appropriate program will be based on household income and qualifying factors. With the current available funding, you must fit one the following requirements AND have an income of less than 30% Annual Median Income (AMI) to qualify.
 

  • You have moved because of economic reasons two or more times within the last 60 days;
  • You are living in the home of another because of economic hardship;
  • You have been notified in writing that your right to occupy your current housing or living situation will be terminated within 21 days (this could include any written communication, not just a legal eviction notice from the court);
  • You are currently living in a hotel or motel that you are paying for;
  • You live in a studio apartment with more than two people or in a larger housing unit with more than 1.5 residents per room;
  • You are exiting a publicly funded institution or system or care, such as a health-care facility a mental health facility, foster care or other youth facility, or correction program or institution.
  • You are fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member, including a child, that has either taken place within the individual's or family's primary nighttime residence or has made the individual or family afraid to return to their primary nighttime residence.

Income Requirements: Income must be affected by COVID-19.
If the household income is below 30% Average Median Income (AMI) because of COVID-19, the family is eligible for the Rental Assistance Grant Program. If the household made over 80% AMI before income was affected by COVID-19, the applicants not eligible for this program.

2021 AMI by Household Size

Household Size       30% AMI Max Household Income
1                                 $17,750
2                                 $20,300
3                                 $22,850
4                                 $26,500
5                                 $31,040
6+                               $35,580

Rental Assistance is based on a particular household’s circumstances and needs, and will consider part-time income, unemployment, access to stimulus resources, rental cost reasonableness, and landlord agreements. Tenants must commit to programming and being provided all available resources.
Rental Rate Maximums: The HSC will use Fair Market Rent as the basis for the maximum amount a landlord can be reimbursed monthly through the combination of tenant resources and program assistance payments.

Housing Type      Studio 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom
'20 Fair Market :  $693   $733            $930            $1,342        $1,633

Landlord Commitments: To be paid through these COVID-19 funds, Landlords must agree to accept the above listed Fair Market Rent, agree to waive late fees during the Program Payment commitment period and agree to not evict the tenant for COVID-19 caused arrears as long as the tenant is making due payments arranged through a payment plan with the program and following all other lease requirements. Landlord, tenant and program will sign an agreement with the payment plan terms and period.

Tenant commitments: Tenants commit to prioritize paying rent above all other expenses, which would include a minimum of 30% of their monthly gross COVID-19 adjusted income. Income includes all unemployment, severance, stimulus checks and tax returns. Tenants agree to participate in budgeting, meeting via phone during COVID-19 and in person when allowed, and working to access additional resources for food and utility assistance so that an emphasis can be placed on remaining housed and avoid predatory debt.

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I am currently housed/have a lease
Eviction Status
Hispanic/Latino?
How do you identify?
Is one of the following agencies working with you on this aplication?

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Fair Market Rent (FMR) for your current rental is 693

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Fair Market Rent (FMR) for your current rental is 733

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Fair Market Rent (FMR) for your current rental is 930

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Fair Market Rent (FMR) for your current rental is 1342

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Fair Market Rent (FMR) for your current rental is 1633

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Are there dependents in the household? If so how many?
Address of unit where funds will be used