Hardship and Exception Requests

Hardship and Exception Requests

10.16.2024: Please note that review of all hardships and exceptions may take up to 5 business days due to current staffing levels. If this is URGENT, please email Kelsey Beckmeyer directly once you submit this form - kelsey.beckmeyer@kcrha.org. Otherwise, you will receive a response within the 5 day time period.

Organization*

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Program Type*

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Fund Source(s)*

Please select what fund source(s) this request relates to:

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Request Type*

Please select what type of request this is:

NOTE: For RRH or YET & Nav/Div, please check the hardship request if related to the rental subsidy extension or emergency rental assistance

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Hardship Request Reason*

Participant requires rental assistance after 12 months.

2nd Move Request

Participant exited rental subsidy but needs emergency rental assistance during the 2-month follow-up period.

Rental Subsidy Adjustment

YHDP: Participant requires rental assistance after 3 months (YET) or 4 months (Nav/Div).

Participant HMIS ID*

DO NOT INCLUDE NAMES

Months and Year for Hardship Request*

Please note: approvals can be made for up to 3 months at a time.

Number of months of previously subsidized rent:*

Subsidy amount requested with this exception:*

Monthly Rent Amount:

Is the participant currently employed?*

Yes

If no, when was the last month/yr. of employment?*

If their job ended during their subsidy, please include date and reason job ended:*

Does the participant currently have income?*

Yes

If yes, what is the monthly income?*

If no income and participant is able to pay portion of the rent - what is the source and amount?*

Please briefly explain the circumstances which led to the request for rental assistance hardship.*

Briefly describe what steps are being taken to increase participants’ housing stability (ex: move to more affordable unit, get roommate, live with family/friends, increase income, other).

DO NOT INCLUDE NAMES

Describe rent stabilization plan and progress toward income goals.*

For example, if unemployed apply for X jobs/week, meet with Career LaunchPad by X date, etc.

DO NOT INCLUDE NAMES

Please provider a brief history of Case Manager contact over the last 3 months including, # of meetings/contacts, form of contacts (ex. in person, phone, email, or text).*

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Has a hardship been previously requested for this participant?

Yes

If yes, please explain:*

If other, please describe:*

Briefly describe the circumstances for the exception request.*

If the request if for more than one reason, please be sure to include the circumstances for each exception you are requesting.

DO NOT INCLUDE NAMES

Name of Person Submitting Request:*

Email of Person Submitting Request:*

Email of Program Supervisor/Manager*

Agreement and Signature

By submitting this form, I affirm that I or another staff member reviewed this request with the participant, the participant consented to this request, and my responses are true and complete to the best of my knowledge.

Send me a copy of my responses