ALL CHECKED ITEMS BELOW MUST BE SUBMITTED TO THIS OFFICE WITHIN 2 WEEKS OF TODAY'S DATE.

1. Verification on letterhead stating your date of hire, hourly wage, and hours worked per week OR 6 consecutive pay stubs.
2.  Current Social Security, SSI award letter, SSP letter 
3. Child support letter and 6 stubs OR Alimony letter
4. Verification of Veteran's benefits OR Pension letter 
5. Unemployment benefit letter
6. Workman's Compensation benefit letter
7. TANF computer printout (Public Assistance budget/ Food stamp budget) 
8. Self-Employment, most recent Federal Tax Return with Schedule C, 1099 
9. 6 most recent bank statements for any Checking and/or Savings accounts 
10. Trust, Bonds, Stocks, Treasury bills - send verification
11. Lump Sum payments from an inheritance, Lottery winnings or Insurance settlements.
12. Certificate of Deposit (CD) or Money Market documentation or statements
13. Interest in real property - copy of current tax bill and appraisal
14. Notarized childcare statement (for children under age 13)
15. Full - Time School Statement
16. Birth Certificate and/or Social Securi ty cards for all household members
17. Doctors note stating fully disabled
18. Verification of health insurance premiums
19. Doctors bills from the prior year (see housing specialist for information)
20. Prescriptions-printout from pharmacy for any received in the past 2 years
21. Out of pocket medical expenses for the previous year (i.e. paid receipts)
22. 6 recent rent receipts OR a statement from the  landlord verifying rent paid to date
23. Utility bills (electric, oil, gas, water, sewer, garbage)
24. Signed Income Tax return for all adults in household (W-2's & 1099 needed)
25. Notarized Affidavit of Non Employment for head of household

Sources of Lead-Based Paint

The interiors of older homes end apartments often have layers of lead­ based point on the walls, ceilings, window sills, doors and door frames.

Lead-based paint and primers may also have been used on outside porches, railings, garages, fire escapes and lamp posts. When the paint chips, flakes or peels off there may be real danger for babies and young children. Children may eat paint chips or chew on painted railings, window sills or other items when parents are not around.

Children can also ingest lead even if they do not specifcally  eat paint chips. For example, when children play in an area where there are loose point chips or dust particles containing lead, they may get particles on their hands, put their hands into their mouths, a dangerous amount of lead.

Hazards or Lead-Based Paint

Lead poisoning is dangerous - especially to children under the age of seven (7). It can eventually cause mental retardation, blindness and even death.

Symptoms of Lend- Based Paint Poisoning

Ha your child been especially cranky or irritable? ls he or she eating normally? Does your child have stomach aches and vomiting? Does he or she complain about headaches? Is your child unwilling to play? These may be signs of lead poisoning;. Many times though, there are no symptoms at all. Because there are no symptoms does not mean that you should not be concerned If you believe your child has been exposed to lead-based paint.

Advisability and Availability of Blood Lead Level Screening

If you suspect that your child has eaten chips of paint or someone told you this, you should take your child to the doctor or clinic for testing. If the test shows that your child has an elevated blood lead level, treatment is available. Contact   your doctor or local health department for help or more Information. Lead screening and treatment are available through the Medicaid Program for those who are eligible. !f your child is identified as having an elevated blood lead level, you should immediately notify the Community Development or other agency to which you or your landlord is applying for rehabilitation assistance so the necessary steps can be taken to test your unit for lead-based paint hazards. If your unit does have lead-based paint. you may be eligible for assistance to abate that hazard.

Precautions to Take to Prevent Lead - Based Point Poisoning

You can avoid lead -based paint poisoning by performing some preventive maintenance. Look at the walls. ceilings, doors, door frames and window sills. Are there places where the paint is peeling, flaking, chipping, or powdering? If so, there are some things you can do Immediately to protect your child:

Cover all furniture and appliances;

Dust containing lead can be a health hazard . Do not vacuun loose paint. Sweep and damp mop ; Sweep up all loose pieces of paint and plaster and put them in a bag or wrap them in a newspaper. Put these packages in a trash can. Do not burn them.

Do not leave paint chips on the floor or window sills. Damp mop floors and window sills in and around the work area  to remove all dust and paint  particles. Keeping these areas clear of paint chips, dust and dirt is easy and very important, and;

Do not allow loose paint to remain within your children's

reach since children may pick loose paint off the lower part of the walls.

Homeowner Maintenance and Treatment of Lead-Based Paint Hazards

As a homeowner, you should take the necessary steps to keep your home in good shape. Water leaks. from faulty plumbing, defective roofs and exterior holes or breaks may admit rain and dampness into the interior of your home. These conditions damage walls and ceilings and cause paint to peel, crack or flake. These conditions should be corrected immediately. Before repainting, all surfaces that are peeling, cracking, chipping, or loose should be thoroughly cleaned by scraping or brushing the loose paint form the surface then repainted with two (2) coats of non-leaded paint. Instead of scraping and repainting, the surface may be covered with other material such as wallboard, gypsum, or paneling.

Beware that when lead-based paint is removed by scraping or sanding, a dust cloud is created which may be hazardous. The dust can enter the body either by breathing it or swallowing it. The use of heat or paint removers could create a vapor or fume which may poisoning if inhaled over a long period of time. Whenever possible, the removal of lead-based paint should take place when there are no children or pregnant persons on the premises. Simply painting over the defective lead-based paint surfaces does not eliminate the hazard. Remember that you as an adult play a major role in the prevention of lead poisoning. Your actions and awareness about the lead problem can make a big difference.

Tenant and Homebuyer Responslbllities

You should immediately notify the management office or agency through which you are purchasing your home if the unit has flaking, chipping, powdering, or peeling paint, water leaks from plumbing, or a defective roof. You should cooperate with that office's efforts to repair the unit.

To all Tenants and Applicants

The Violence Against Women Act (VAWA) provides protections for victims of domestic

violence, dating violence, sexual assault, or stalking. VAWA protections are not only available to women, but are available equally to all individuals regard less of sex, gender identity, or sexual orientation. ² The U.S. Department of Housing and Urban Development (HUD) is the Federal agency that oversees that the Housing Choice Voucher Program is in compliance with VAWA.

This notice explains your rights under VA WA. A HUD- approved certification form is attached to this notice. You can fill out this form to show that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking, and that you wish to use your rights under VAWA. "

Protections for Applicants

If you otherwise qualify for assistance un der the Housing Choice Voucher Program, you can not be denied admission or denied assistance because you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking.

Purpose of Form: The Violence Against Women Act ("YAWA")  protects applicants,  tenants, and program participants in certain HUD programs from being evict ed, denied housing assistance,  or terminated from housing assistance  based on acts of domestic  violence, dating violence, sexual assault, or stalking against them. Despite the name of this law, VA WA protection is available t o  victims of domestic violence, elating violence, sexual assault, and stalking, regard less of sex, gender identity, or sexual orientation.

Use of This Optional Form: If you are seeking VAWA protections  from your  housing  provider, your housing provider may give you a written request that asks you to submit documentation  about the incident or incidents of domestic viole nce, dating violence, sexual assault, or stalking.

In response to this request, you or someone on your behalf may complete this optional form and submit it to your housing provider, or you may submit one of the following types of third-party documentation:

( I ) A document signed by you and an employee, agent, or volunteer of a victim service provider, an attorney, or medical professional, or a mental health professional (collectively, " professional") from whom you have sought assistance relating to domestic violence, elating violence, sexual assault, or stalking, or the effects of abuse. The document must specify, under penalty of perjury, that the

professional believes the incident or incidents of domestic violence, elating violence , sexual assault, or

sta lking occurred and meet the definition o f " domestic violence ," " elating violence," "sexual assault," or "stalking" in HU D's regulations at 24 CFR 5 .2003.

(2)  A record of a Federal, State, tribal, territorial or loc al law enforcement agency, court, or admi nistrat ive agency; or

(3)  At the discretion of the housing provider, a statement or other evidence provided by the applicant or ten ant.

Submission of Documentation: The time period to submit documentation is  14 business days from  the elate that you receive a ·written request  from your housing provider asking that you provide  documentation of the occurrence of domestic violence, dating violence, sexual assault, or stalking. Your housing provider may, but is not required to, extend the time period to submit the documentation, if you request an extension of the time period. If  the requested information is not received within 14 business clays of when you received the request for the documentation, or any extension of the date provided by your housing provider, your housing provider does not need to grant you any of the VAWA protections. Distribution or issuance of this form does not serve as a written request for certification.

Confidentiality: All information provided to your housing provider concerning the incident(s) of

domestic violence, elating violence, sexual assault, or stalking s hall be kept confidential and such details

shall not be entered into any shared database. Employees of your housing provider are not to have  access to these details  unless  to grant or deny VAWA protections  to you, and such employees may not disclose this information to any other entity or individual, except to the extent that disclosure is : (i) consented to by you in writi ng in a time- limited release; (ii) required for use in an evict io n proceeding or hear ing

regarding termination of assistance; or (iii ) otherwise required by applicable law.

Form l l UD -538:2

Protections for Tenants

If you are receiving assistance under the Community Development Corporation's ("CDCLI") Housing Choice Voucher Program, you may not be denied assistance, terminated from participation, or be evicted from your rental housing because you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking.

Also, if you or an affiliated individual of yours is or has been the victim of domestic violence, dating violence, sexual assault, or stalking by a member of your household or any guest, you may not be denied rental assistance or occupancy rights under the Housing Choice Voucher Program solely on the basis of criminal activity directly relating to that domestic violence, dating violence, sexual assault, or stalking.

Affiliated individual means your spouse, parent, brother, sister, or child, or a person to whom you stand in the place of a parent or guardian (for example, the affiliated individual is in your care, custody, or control); or any individual, tenant, or lawful occupant living in your household.

Removing the Abuser or Perpetrator from the Household

CDCLI may divide (bifurcate) your lease in order to evict the individual or terminate the assistance of the individual who has engaged in criminal activity (the abuser or perpetrator) directly relating to domestic violence, dating violence, sexual assault, or stalking.

If CDCLI chooses to remove the abuser or perpetrator, CDCLI may not take away the rights of eligible tenants to the unit or otherwise punish the remaining tenants. If the evicted abuser or perpetrator was the sole tenant to have established eligibility for assistance under the program, CDCLI must allow the tenant who is or has been a victim and other household members to

remain in the unit for a period of time, in order to establish eligibility under the program or under another HUD housing program covered by VAWA, or, find alternative housing.

In removing the abuser or perpetrator from the household, CDCLI must follow Federal, State,

and local eviction procedures. In order to divide a lease, CDCLI may, but is not required to, ask you for documentation or certification of the incidences of domestic violence, dating violence, sexual assault, or stalking.

Moving to Another Unit

Upon your request, CDCLI may permit you to move to another unit, subject to the availability of other units, and still keep your assistance. In order to approve a request, CDCLI may ask you to provide documentation that you are requesting to move because of an incidence of domestic

violence, dating violence, sexual assault, or stalking. If the request is a request for emergency transfer, the housing provider may ask you to submit a written request or fill out a form where you certify that you meet the criteria for an emergency transfer under VA WA. Th e criteria are:

(1)   You are a victim of domestic violence, dating violence, sexual assault, or stalking. If your housing provider does not already have documentation that you are a victim of domestic violence, dating violence, sexual assault, or stalking, your housing provider may ask you for such documentation, as described in the documentation section below.

(2)  You expressly request the emergency transfer. Your housing provider may

choose to require that you submit a form, or may accept another written or oral request.

(3)   You reasonably believe you are threatened with imminent harm from

reason to fear that if you do not receive a transfer you would suffer violence in the very near future.

OR

You are a victim of sexual assault  and  the  assault  occurred  on  the  premises during the  90-calendar-day  period  before  you  request  a  transfer.  If  you  are  a victim of sexual assault, then in addition to qualif yi ng for an emergency transfe r because you reasonably believe you are threatened with imminent harm from further violence if you remain in your unit, you may qualify for an emergency transfer if the sexual assault occurred on the premises of the property from which you are seeking your transfer, and that assault happened within the 90-calendar­ day period before you expressly request the transfer.

CDCLI will keep confidential requests for emergency transfers by victims of domestic violence , dating violence, sexual assault, or stalking, and the location of any move by such victims and their families.

CDC LI' s emergency transfe r plan provides further information on emergency transfers, and CDCLI must make a copy of its emergency transfer plan ava ilable to you if you ask to see it.

Documenting You Are or Have Been a Victim of Domestic Violence, Dating Violence, Sexual Assault or Stalking

CDCLI can, but is not required to, ask you to provide documentation to "ce rtify" that you are or have been a victim of domestic violence, dating violence , sexual assault, or stalking. Such request from CDCLI must be in writing, and CDCLI must give you at least 14 business days (Saturdays, Sundays, and Federal holidays do not count) from the day you receive the request to

provide the documentation. CDCLI, but does not have to, extend the deadline for the submission of documentation upon your request.

You can provide one of the following to CDCLI as documentation. It is your choice which of the following to submit if CDCLl asks you to provide documentation that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking.

•        A complete H UD-approved certification form given to you by CDCLI with this notice, that documents an incident of domestic violence, dating violence, sexual assault, or

stalking. The form will ask for your name, the date, time, and location of the incident of domestic violence , dating violence , sexual assault, or stalking, and a description of the

incident. The certification form provides for including the name of the abuser or perpetrator if the name of the abuse r or perpetrator is known and is safe to provide.

•        A record of a Federal, State, tribal, territorial, or local law enforcement agency, court, or administrative agency that documents the incident of domestic violence, dat ing violence, sexual assault, or stalking. Examples of such records in clude police reports, protective orders, and restraining orders, among others.

•        A statement, which you must sign, along with the signature of an employee, agent, or volunteer of a victim service provider, an attorney, a medic al professional or a mental health professional (collectively, " professional" ) fro m whom you sought assistance in addressing domestic violence, dating violence, sexual assault, or stalking, or the effects of abuse, and with the professional selected by you attesting under penalty of perjury that he or she believes that the incident or incidents of domestic violence, dating violence, sexual assault, or stalking are grounds for protection.

•        Any other statement or evidence tha t CDCLI has agreed to accept.

If you fail or refuse to provide one of these documents within the 14 business days, CDCLI does not have to provide you with the protections contained in this notice.

If CDC LI receives confl icting evidence that an incident of domestic violence, dating violence, sexual assault, or stalking has been committed (such as certification forms from two or more members of a household each claiming to be a victim and naming one or more of the o ther

petitioning household members as the abuser or perpetrator) , CDCLI has the right to request that you provide third-party documentation within thirty 30 calendar days in order to resolve the