AMHA Full Application

You should only complete this form if AMHA has contacted you and asked you to do so. If you are receiving an error when trying to submit your form, try a different browser (Google Chrome, Firefox, etc.) or using a different computer/device.

 
 
 
 

You'll find this number in the upper right hand corner of your Eligibility Determination Interview letter.

 
 

We may need to contact you for additional information, so please provide your email address. If you don't have an email address, please put n/a.

 

List the full address for where you are currently staying including CITY, STATE, and ZIP CODE.

 
 

Someone we may contact if we cannot reach you. Please list name AND phone number.

 

 

Household Composition

 

Please list your: 1. Name 2. Last 4 of SSN 3. Sex 4. Relationship to you 5. Birth date 6. Race 7. Ethnicity 8. Is this person disabled?

 
 
 
 
 
 

Letter/case plan from Children's Services is required.

 
 

 

Eligibility Screening

 
 
 
 

 

Income Checklist

Be sure to include ALL income for every member of your household. If you need more space for additional income, there will be room at the end of this section to add more income.

 

Please provide 2 current months of pay stubs for each job.

 

 
 

 

Such as plasma donation, ride share services, food delivery, bottle/can collecting, yard work, baby sitting, car repair, scrap iron, garage sales, etc. Please provide Schedule C or other proof of income.

 

 

Please provide a copy of the current award letter.

 
 

 

Please provide a current award letter or a print-out from the DJFS portal showing the benefit amount.

 

 

Please provide a 12 month print-out or proof of no payment for ALL child support cases.

 

 

Please provide proof of the current benefit amount.

 
 

 

Please provide 3 current and consecutive pay stubs.

 

 
 

 

Please provide a current award letter.

 

 
 

 
 

 

Asset Checklist

All questions apply to every member of your household.

 

Examples of assets include checking and savings accounts, trust funds, real estate, stocks, bonds, certificates of deposit, mutual funds, money market funds, pensions that you are not withdrawing from, whole life insurance policies, personal investment items such as coin or stamp collections, etc. The annual income from your net assets (as defined in 24 CFR Part 5) will be included in the total gross income for this household.

 
 
 
 
 

 

Deductions Checklist

All questions apply to every member of your household.

 

Please provide a current school schedule listing the student's credit hours.

 

Documentation of completion date required.

 

 

Please provide proof of payment for childcare.

 

 
 

Proof of disability required.

 
 

 
 

 

Housing Situation

 
 

Choose all that apply.

 
 
 

NOTE: SOME properties do NOT allow pets. It is the applicant's responsibility to ask about the pet policy at each property they have applied for.

 

 

Document Attachment

Please attach proof of ALL income, expenses, and assets that you marked above.


Also attach proof of your living situation and household member's identification documents.

 
Drop your files here
 

 

Applicant Certifications

Please review each statement and choose "Yes" that you have read and understand the statement. If you have any questions regarding the certifications, please contact the Housing Placement Department.

 

I/We certify that the information given to AMHA on household composition, income, net family assets, and allowance/deductions is accurate and complete to the best of my/our knowledge and belief. I/We understand that false statements or information are punishable under federal law. I/We also understand that false statements or information are grounds for termination of housing assistance or termination of tenancy. *After verification by this housing agency, the information will be submitted to the Department of Housing and Urban Development through TRACS (Tenant Rental Assistance Certification System) on form HUD-50059 or PIC (PIH Information Center) on form HUD-50058, a computer generated facsimile of the form. See the Federal Privacy Act Statement for more information about its use.

 

I understand that I am required to report within 10 days of my knowledge, in writing, any changes in income and household composition. Failure to report this information may result in owing AMHA back rent and/or the termination of my subsidy.

 

If you believe you have been discriminated against, you may call the Fair Housing and Equal Opportunity National Toll Free Hotline at 800-424-8590. AMHA does not discriminate on the basis of disability status, in the admission or access to, or the treatment or employment in, its federally assisted programs and activities. The AMHA Reasonable Accommodation Coordinator (AMHA, voice: 330-762-9631, TTY: 1-800-750-0750) has been designated to coordinate compliance with the non-discrimination requirements contained in the Department of Housing and Urban Development's regulations implementing Section 504 (24 CFR, Part 8 dated June 2, 1988).

 

The Department of Housing and Urban Development (HUD) is authorized to collect this information by the U.S. Housing Act of 1937 (42 U.S.C. 1437 et. seq.), Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), and by the Fair Housing Act (42 U.S.C. 3601-19). The Housing and Community Development Act of 1987 (42 U.S.C. 3543) requires applicants and participants to submit the Social Security Number of each household member who is six years old or older.


Purpose: Your income and other information are being collected by HUD to determine your eligibility, the appropriate bedroom size, and the amount your family will pay toward rent and utilities.


Other Uses: HUD uses your family income and other information to assist in managing and monitoring HUD-assisted housing programs, to protect the Government’s financial interest, and to verify the accuracy of the information you provide.


This information may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory

investigators and prosecutors. However, the information will not be otherwise disclosed or released outside of HUD, except as permitted

or required by law.


Penalty: You must provide all of the information requested by the HA, including all Social Security Numbers you, and all other household members age six years and older, have and use. Giving the Social Security Numbers of all household members six years of age and older is mandatory, and not providing the Social Security Numbers will affect your eligibility. Failure to provide any of the requested information may result in a delay or rejection of your eligibility approval.


 

 

REMINDER

Your eligibility application is NOT COMPLETE until you also return the forms that were mailed to you with your eligibility appointment letter.


When you submit this form you MUST also follow the link to complete additional documents.

 

 

I/We certify that the above information given to the Akron Metropolitan Housing Authority on household composition, income, net family assets, allowances and deductions is accurate and complete to the best of my/our knowledge and belief. I/We also understand that giving false statements or information can be grounds for termination of housing assistance and is punishable under Federal or State criminal law.

 

If no, please re-type your name on the Electronic Signature line.