Housing Stability Program Claim Portal

Housing Stability Program Claim Portal

This form is to be completed only by a property owner/manager who has enrolled in Housing Stability Program prior to the claim.

This form must be completed within 30 days from lease signing for the bonus and 30 days from lease termination for reimbursement of repairs and damages.
All sections that are required and attachments must be completed accurately for reimbursement.
Please do not use autofill as this creates input errors.
Repairs and Damage must be beyond normal, reasonable wear and tear, and in excess of the security deposit during a tenant’s first or second year of residency caused by the tenant or guests of the tenant. *
Only submit one claim per tenant household.

If you have questions email Jessica Macy at jmacy@allyouthflourish.org or call ‪(660) 460-6521‬.

Type of Claim*

Select

Claimant (Property Owner/Manager) Name*

Name of Person Completing the Form*

If different than the property owner's name.

Claimant's Mailing Address*

The address you use for your business, NOT the location of the rental unit.

Claimant's Phone Number*

Phone

Property Name

For example, the name of an apartment complex. Can be left blank.

Property Address*

Location of the rental unit. Include the street number and name, city, state and zipcode

Tenant's Last Name*

Tenant's First Name*

Tenant's Last Known Address*

If no address is known use this claims' rental property street address.

Tenant's Last Known Phone*

Phone

Tenant's Last Know Email Address

Amount of Security Deposit*

Amount of Claim*

Describe Claim

Repairs and damage must be beyond normal, reasonable wear and tear. There is an expected deterioration that normally occurs based upon the everyday use of the unit without negligence, carelessness, accident, or misuse of the premises by the tenant, their households, or guests.

Examples of everyday wear and tear include but are not limited to: worn, faded, or scuffed carpet/flooring; small nail holes, chips, smudges, scrapes, or cracks in the walls/wallpaper; dirty or loose grout; warped floors, doors or window; loose doorknobs; worn appliances; water stains.

File Attachments

Executed Original Term Rental Lease
Move-In and/or Out Report Signed by Landlord and Tenant
Tenant Ledger Showing Security Deposit
Photos of Damages - before and after
Invoice(s) for Repairs

Files can also be emailed to jmacy@allyouthflourish.org

Drag and drop files here or

Additional Information

Please include any additional information or notes that you feel are relevant to the payment of this request.

Electronic Signature for Verification*

Submitter's Certificate: The individual typing their name below warrants they have the authority to do so as authorized and on behalf of the entity identified in the Calimant 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.

Send me a copy of my responses

Privacy Notice|Report Abuse

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.