You are responsible to reveal all criminal convictions as described below. A criminal conviction is any offense that you plead no contest, guilty, or not guilty, but were found guilty by a court and which there is a record. If you are not certain, ask for clarification.

Housing Choice Voucher Program A family is issued a housing voucher and is then responsible for finding a suitable housing unit in the private market where the owner agrees to rent under the program. This unit may include the family's present residence. Rental units must meet minimum standards of health and safety, as determined by AMHA. A housing subsidy is paid to the landlord directly by AMHA on behalf of the participating family. The family then pays the difference between the actual rent charged by the landlord and the amount subsidized by the program. Family payment amount is based on income and voucher bedroom size is determined in accordance with the HCVP Administrative Plan. An average wait time is currently 2+ years from date of application.

Public Housing FAMILY properties are designed for families/individuals and include 1, 2, 3 and 4 bedroom units. The Housing Authority will assign bedroom size based on criteria as established in our Admissions and Continued Occupancy Policy (ACOP). SENIOR properties are designed for families/individuals in which the head of household is 62 years or older. Some may accept families that do not meet this age criteria, if the head, co-head or spouse is handicapped/disabled. These include up to 2 bedroom apartments. Again, the bedroom size will be assigned by AMHA according to our ACOP. Both FAMILY and SENIOR housing are managed and maintained by AMHA. Rent calculations for these units are based on income. Security Deposit is $50.00 with the exception of Edgewood Village, which is based on income. Offers for housing are based on family composition and bedroom size. Units are located in Summit County. If you refuse an offer for housing in this program, you will be re-sequenced on the Wait List for that property. An average wait time is currently 2+ years from date of application.

Multi-Family Housing (LHA) LHA FAMILY properties are designed for families/individuals and include 1, 2, 3 and 4 bedroom units. There is a requirement of one household member per bedroom MINIMUM. Our LHA SENIOR property is designed for families/individuals in which the head of household is 62 years or older or handicapped/disabled and includes Studio, 1, and 2, bedroom apartments. Again, there is a requirement of one household member per bedroom MINIMUM. Both FAMILY and SENIOR housing are managed and maintained by AMHA. Rent and Security Deposit Calculations for these units are based on income. Offers for housing are based on family composition and bedroom size. Units are located in Akron and Barberton. If you refuse an offer for housing in this program, you will be re-sequenced on the Wait List for that property. An average wait time is currently 2+ years from date of application.

No Subsidy- Market Rent Market-rate apartments and single family homes include 2, 3 and 4 bedroom units and are located in Akron and Barberton. There is no subsidy associated with these units and Rent and Security Deposit is based on the market rate calculated by AMHA. Subsidy Vouchers are accepted. By signing below, you acknowledge that you understand that rent for these units is NOT INCOME-BASED unless you have a Subsidy Voucher. An average wait time is currently 2+ years from date of application.

All applicants:

1) I understand that the purpose of this Interview is to determine eligibility for one or more of AMHA's housing programs.

2) I understand AMHA's requirement for me to report any changes that occur during my application process. If my income, household composition, contact information or housing status changes I will report those changes to AMHA. I understand that the changes may affect my eligibility for housing and my placement on applicable wait lists.

3) I understand that my failure to report changes may result in the withdrawal of my application. My failure to report changes may also result in the withdrawal of any offer of housing made by AMHA that is based on outdated information.

4) Failure to maintain any utilities or appliances that I am responsible for, per my lease agreement, may result in termination from my housing program.

5) I understand that if I have previously lived in AMHA housing, I must pay any past due balance owed to AMHA before I will be offered housing.

For subsidized properties owned and managed by AMHA:

6) I understand that my security deposit and first month's rent are due on the date that I sign my lease and receive my keys.

7) I may be expected to pay my first month's rent and security deposit within one week of acceptance or sooner. (Time may vary depending on availability of the unit.)

8) If I will be responsible for utilities in my new house/apartment, I understand that I will be required to have service in my name on the date that I sign my lease.

9) Rent is based on 30% of my household's gross income. My security deposit may vary depending on property.

For Non-subsidized units owned or managed by AMHA (334 Properties, Washington Square, and SOME Edgewood units):

10) Rent and security deposit are NOT based on income, and will not be adjusted if my income changes.

For Housing Choice Voucher recipients:

11) Rent is based on my household's gross income. My security deposit may vary depending on property.

Federal and Ohio laws state that qualified individuals with disabilities shall not be discriminated against and shall be assured an equal opportunity to participate in the housing programs, activities, and services offered by the Akron Metropolitan Housing Authority (AMHA). An individual with a disability may request a reasonable accommodation by completing the Request for Reasonable Accommodation and Authorization for Release of Information form and submitting it to the RA Coordinator at 100 West Cedar Street, Akron, Ohio 44307. Alternative means of requesting reasonable accommodations can be arranged upon request.

Reasonable accommodations may include, but are not limited to, the following categories:

1) A change in AMHA policies and procedures

2) A repair or change in your apartment

3) A repair or change to some other part of the property

4) A change in location

5) A change in the way AMHA communicates with you

The determination of reasonable accommodation is an interactive process which may include consultation with the individual seeking an accommodation, his/her medical professional, and/or his/her designee. An accommodation must be both reasonable and have an identifiable and substantial relationship to the individual's disability. All requests are reviewed on a case-by-case basis.

In determining whether a request for accommodation is reasonable, the following questions will be considered:

· Is there an identifiable relationship or nexus between the request and disability?

· Is an alternative accommodation possible?

· Does the request pose a direct threat to others?

· Is the request a fundamental alteration of the nature of AMHA services and/or programs?

· Does the request pose an undue financial and administrative burden?

If additional information or verification of disability-related information is needed, including additional medical verification, you will be contacted to discuss your request.

AMHA will provide the decision in writing or, where appropriate, in another format accessible to the individual requesting the accommodation. If the applicant wishes to appeal the decision, he/she may do so, in writing, within ten (10) days of the date the decision letter was sent to the applicant.

For questions, contact the AMHA RA Coordinator at 330-376-9788 or 330-762-9631 (Ohio Relay: 1-800-750-0750 TTY/TTD)

You will receive one of two letters:

1) Application Decision - This letter will inform you of our decision regarding the preference points you have applied for, and your eligibility determination. You may receive more than one Decision Letter, depending on how many programs you have applied for.

• Preferences - When you originally applied for housing, you answered questions that helped us determine where you should be placed on the wait list by assigning preference points to your application. When you came in for your eligibility determination, we asked you to provide documentation related to those points. Based on that documentation and our criteria, we determined whether you are truly eligible for the points previously assigned. This letter will identify any points that we have determined you are ineligible for.

• Eligibility - This section indicates the outcome of your eligibility determination. Depending on the programs that you have applied for, we will review your criminal background, rental history, income, and any balances you may owe to AMHA. This information will determine whether you are eligible for the various AMHA programs. All Wait Lists will be Included on this letter. Each individual Wait List that you have applied for will be marked as follows:

1. A= Approved. Your application has been approved for housing. Your status will be changed to "approved" for the appropriate wait lists. When your name reaches near the top of the list we will contact you to take the next step in the process. Depending on your household's preference points and the number of vacancies at the properties you have applied for, you may remain on the wait list for an extended amount of time.
2. D = Disapproved. You are not eligible for this specific Wait List at this time. This letter will explain the reason for this denial. It will also provide instructions for requesting a hearing/meeting in the event that you disagree with AMHA's decision. If your appeal request is received in writing by the deadline date, a hearing/meeting will be scheduled with a hearing officer. At that time you will be able to explain your circumstances in more detail. The hearing officer will consider all information provided in order to determine if the denial of your application can be overturned. This decision is final.
3. U = Undetermined. We need more information to make a decision regarding your eligibility for this specific Wait List. A letter will be attached explaining what we need.

2) Fingerprint Request — We need more information to determine eligibility. Your criminal background check cannot be approved or denied with the information that we have received. This letter will give you the opportunity to come to AMHA to have your fingerprints taken so that we can obtain more information from law enforcement agencies. This letter will contain a deadline by which you must comply with our request for fingerprints. If you do not complete this step, your application will be denied without further review. If you do comply with this step, we will place your file on hold until we receive those results back. At that time, your file will then be reviewed for eligibility.

All changes from this point forward must be reported in writing immediately. Your preference points are determined by information you provide to us and can affect your placement on the wait lists you have applied for.

Make sure that your telephone number and address is up to date at all times. People have missed a chance at housing because their number was not current.

Please call AMHA’s Application Status Line at (330) 252-9284 to verify that your application is still active.

I hereby authorize the release to the Akron Metropolitan Housing Authority (AMHA) any information which they may request to determine suitability for AMHA Housing. Information may include, but is not limited to, records maintained by employers, landlords, banks, credit agencies, courts, and law enforcement agencies. I hereby waive any privileges I may have to said information only to the extent necessary to permit the release of this information to AMHA. AMHA may obtain a consumer report from a consumer reporting agency (C.R.A.)

AMHA is using a federal crime database to search your background. YOU MAY BE REQUIRED TO RETURN FOR FINGERPRINTING. If, after reviewing his/her identification record, the subject thereof believes that it is incorrect or incomplete in any respect and wishes changes, corrections or updating of the alleged deficiency, he/she should make application directly to the agency which contributed the questioned information. The subject of a record may also direct his/her challenge as to the accuracy or completeness of any entry on his/her record to the Assistant Director of the FBI Identification Division, Washington, D.C. 20537-9700. The FBI will then forward the challenge to the agency which submitted the data requesting that agency to verify or correct the challenged entry. Upon the receipt of an official communication directly from the agency which contributed the original information, the FBI Identification Division will make any changes necessary in accordance with the information supplied by that agency.

SECTION 1091 TITLE 18 U.S. CODE PROVIDES CRIMINAL PENALTIES FOR ANY MISREPRESENTATION OR FALSE STATEMENTS. FAILURE TO DISCLOSE CONVICTIONS WILL CAUSE YOU TO BE DEEMED INELIGIBLE, OR AN EVICTION ACTION SHALL BE PROCESSED AGAINST YOU. "Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8).** Violation of these provisions are cited as violations of 42 U.S.C. Section **408 (a) (6), (7) and (8).**