Zip Codes of Opportunity Vacancy Loss Payment Request Form

A vacancy loss payment will be paid to the owner/agent for up to one-month's contract rent of the previous tenant. AMHA will make the vacancy payment to the owner if:

1. The owner/agent gives AMHA written notice within 10 business days certifying the family has vacated the unit and the date when the family has moved out;

2. The owner/agent re-leases the unit to a new voucher family within 3 months of the move-out date; and

3. The request is submitted within 30 days after the new tenant moves in.

Vacancy loss payments can be requested for one of two reasons:

1. The unit is located in an eligible zip code: 44056, 44067, 44087, 44141, 44202, 44221, 44223, 44224, 44236, 44264, 44286, 44301, 44319, 44321, 44333 and 44685.

2. There are extenuating circumstances (a deceased tenant with no remaining household member to assume the lease OR a move due to VAWA). The owner must supply proof of the circumstances as needed.

Owner Name

Owner Email

You will receive a notification to this email address when your request has been approved or denied.

Which category does the unit qualify under?

Property Address:

Property City

Property Zip Code:

Unit is Vacant as of:

mm/dd/yyyy

Previous Tenant's Name:

Previous Tenant's Contract Rent:

Date the Unit was Ready to be Leased:

mm/dd/yyyy

Date the Unit was Re-Occupied:

All vacancy claims must be submitted within thirty (30) days after the new move-in for payments to be approved.

mm/dd/yyyy

New Tenant's Name:

Electronic Signature - Type your FULL NAME

I/We certify that the above information given to the Akron Metropolitan Housing Authority is accurate and complete to the best of my/our knowledge and belief.

I am requesting a vacancy payment for up to 1 month’s contract rent of the previous tenant.

Date

mm/dd/yyyy

Send me a copy of my responses

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