Landlord Mitigation Reimbursement Claim Submission Form

This form is required for each claim related to reimbursement for repairs to a rental unit to pass a rental subsidy program inspection and for claims against tenant damages. All required sections and attachments must be completely filled in accurately/ attached to be submitted.

Do not close the application page until you receive a confirmation email.


You are required to have a SWV number to enter a claim. If you do not have one, complete the form and follow the instructions found by visiting this site: https://des.wa.gov/sites/default/files/public/documents/HRPayroll/SACS/SWV-Reg-W9.pdf?=e4e77
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Include the street number and name, city, state and zipcode


Leave blank if there is not property name.


Include the street number and name, city, state and zipcode


Leave blank if there is no unit number.




If multiple tenants, list the primary subsidized tenant.












Enter the total value of the claim that you are submitting.


Please include any additional information that will be helpful in evaluating your claim.


Each of the following must be attached one at a time. File size not to exceed 30mb per attachment and no more that 10 total attachments (combine documents and photos if possible).

> Proof of subsidy
> Subsidy inspection report
> Executed original term rental agreement
> A completed move-in condition report signed by landlord and tenant
> Tenant ledger showing unpaid rents and collection of the security deposit
> Notices sent to tenant for unpaid balances being claimed.
> Before and after photos of damages with description that are included on this claim
> Copies of all repair invoices/receipts included in this claim.

Verify each attachment below.










Submitter's Certificate: The individual signing this voucher below warrants they have the authority to do so as authorized and on behalf of the entity identified in the Owner section above. The individual signing below certifies under penalty of perjury that the information, attachments and totals listed herein are true, honest and proper charges for remedy required for damages caused by the tenant(s) listed on this application.






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