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We are glad that you have chosen to apply for housing assistance with the Osceola Housing Authority. We are an EQUAL HOUSING PROVIDER. All persons will be treated fairly and equally without regard to race, color, religion, sex, familial status, disability, national origin or source of income.
Please keep this page with your application – it will help you follow the process we use to determine if you are eligible for housing assistance, and provides important directions for filling out the application, and the information you must provide us before we can make any determinations.

AN OVERVI6666666EW OF OUR PROCESS

  1. When you have completed this application, you’ll bring it back to our office, along with a copy of the following documents for every prospective resident who will be listed on the Lease:
    • Birth Certificate ****Must be original Birth Certificate
    • Driver’s License or Photo I.D.
    • Social Security Card ****Must be original Social Security Cards
    • Proof of Income – check stubs, Social Security letter, unemployment if not working, child support if children on application, as well as DHS for TEA or Food Stamps
  2. We will then process your application, which will include conducting local and national criminal and financial background checks, and verifying your documentation.
  3. If we determine that you are eligible for housing assistance, we’ll put you on our Waiting List. If we determine that you aren’t, or may not be eligible for housing assistance, we’ll call you or send you a letter explaining why we cannot provide you housing assistance, or we’ll try to resolve the problem we’ve identified.
  4. When you move to the top of the Waiting List, and a dwelling unit becomes available, we’ll contact you to let you know that we’re ready to offer you housing assistance. IT IS EXTREMELY IMPORTANT THAT YOU KEEP A CURRENT PHONE NUMBER AND ADDRESS ON FILE WITH US – OTHERWISE, YOU MAY MISS OUT ON THE OPPORTUNITY TO RECEIVE HOUSING ASSISTANCE FROM US.
  5. If we are able to contact you and you are ready to make your move, we will schedule a move-in date for you.
  6. Before your scheduled move-in date it is your responsibility to set up new, or confirm the transfer of your exiting electric and gas (if your home will have gas service) accounts. You cannot move in until you have made arrangements for utility services to your new home. You must provide us proof that you have the necessary service(s) before your move-in day.
  7. On your move-in day, we’ll go over your Lease Agreement in detail. Allow enough time to do that, and to complete the necessary HUD paperwork. MAKE SURE YOU BRING YOUR FULL SECURITY DEPOSIT, MOWING FEE AND FIRST MONTH’S RENT WITH YOU! We will conduct a move-in inspection of your new home to make sure everything’s ready, and then we’ll give you your keys, and that’s that!

IMPORTANT INFORMATION ABOUT YOUR HOUSING ASSISTANCE APPLICATION

Please read these instructions carefully and follow them closely. If your application is incomplete, we will not be able to process it. This application is valid for all public housing units operated by the Osceola Housing Authority (OHA).

  1. To be qualified for housing assistance, the person signing the application must:
    • Be a “family” as defined in the OHA’s Admission and Continued Occupancy Policy. Please contact OHA if you are not sure if you meet the definition of “family”
    • Meet HUD’s requirements for citizenship and immigration status;
    • Have an Annual Income, at the time of admission that does not exceed the income limits established by HUD. You can review these limits at the OHA administrative office;
    • Provide documentation of Social Security numbers for all family members, or certify that they do not have Social Security numbers for a valid reason
    • Meet or exceed the Applicant Selection Criteria;
    • Pay any money owed to OHA or any other Public Housing Authority
    • Not have had a Lease terminated by OHA or any other Public Housing Authority within the last 12 months;
    • Provide previous three landlords name, address, telephone number. Failure to do so will result in denial of application.
    • Be able and willing to completely comply with OHA’s Lease Agreement
    • Not have any family members engaged in any criminal activity, or perpetrated any domestic violence that would threaten the health, safety or right to peaceful enjoyment of premises by other residents;
    • Not have any family members engaged in any drug-related criminal activity.
  2. If and when your application is judged to be complete, it will be entered onto the Waiting List in the order received. OHA’s Waiting List is processed in order, according to:
    • Unit type
    • Unit size
    • OHA admission preferences
  3. When you reach the top of the Waiting List, you will be made one offer for a unit of the size and type we’ve determined you need. If you accept the offer, OHA will prepare a Lease Agreement for you to sign. If you refuse our offer of housing assistance without good cause (as determined solely by OHA), you will be moved to the bottom our Waiting List and the date of your application will be changed to the date of your refusal of our offer. If you refuse our offer three times, you’ll be removed from our Waiting List and won’t be allowed to re-apply for housing assistance for 12 months.
  4. If you have disabilities, you may request our assistance in completing your application.
  5. OHA will conduct a local and national criminal and financial background check on everyone included on your application that is 18 years of age or older.

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Applicant's Email Address:

The following information is gathered for statistical purposes only. It will have no bearing on OHA’s consideration of your application for housing assistance. Please check all applicable boxes.

The following information is gathered about you and all family members who will be living with you. Beginning with yourself, complete a section for all family members, as well as foster children and live-in aides (if needed for the care of a family member or yourself). REMEMBER: no one except the people you list here can live with you in your home!

HAVE YOU BEEN DISPLACED?

ARE YOU EMPLOYED OR IN TRAINING?

For every adult member of your family who is employed, please enter the name, address and telephone number of a person who can verify this. If an adult member of your family has been employed in the past, but isn’t now, please the name of the business and dates of employment. If adult members of your family have never been employed, enter “Never Employed”. Do this for every adult member of your family.

ARE YOU A FULL TIME STUDENT?

WHAT INCOME DO YOU HAVE?

You have already indicated who among your family members are employed. Now you need to tell what income is earned from that employment if any, and about all other sources of income for your family. This includes all earnings and benefits from AFDC/TANF, Social Security, SSI, SSID, Unemployment, Worker’s Compensation, Child Support, Alimony, Baby Sitting, Cleaning Houses or any other source. As an Example, you might indicate “Wages = $150 per week, SSI = $200 per month”.

GENERAL HOUSING INFORMATION

We need to know about where you are living now, and where you’ve previously lived. You must provide complete information about your previous addresses and landlords; this is required in order for us to process your application for housing assistance. YOU MUST DISCLOSE WHETHER YOU’VE LIVED IN FEDERALLY-ASSISTED HOUSING BEFORE (Public Housing or Section 8). FAILURE TO DO SO WILL RESULT IN DENIAL OF YOUR APPLICATION.

If you have not owned or rented your own apartment or home before, please provide us with three creditors you have had credit with:

CRIMINAL AND CREDIT BACKGROUND CHECKS

We conduct local criminal background checks through the Osceola Police Department, and national criminal and credit background checks on you and every one of your family members 18 years or older. The results of these checks are a significant factor in our consideration of your application for housing assistance. Please answer the following questions truthfully:

DO YOU OWN A PET?

OHA has a very strict policy regarding pets in our homes. If you wish to have a pet in your home, you will have to follow that policy exactly. You will be required to pay an additional pet deposit of $195.00, $95.00 of which is non-refundable. You will be required to read, understand and sign the pet policy prior to our signing a Lease Agreement with you.

FOR OUR USE

CERTIFICATIONS AND SIGNATURES

I/we certify that all the statements on this application are true to the best of my/our knowledge and belief, and understand that all the statements will be verified. I/we authorize the release of information to the Osceola Housing Authority by my/our employer(s), the Department of Public Assistance, the Social Security Administration, and/or other business or government agencies. I/we understand that any false statement made on this application will be cause for me/us to be denied housing assistance.

Warning: 18 U.S.C. 1001 provides, among other things that whoever knowingly and willfully makes or uses a document or writing containing false, fictitious or fraudulent statements or entry in any manner within the jurisdiction of a department or an agency of the United States shall be fined not more than $10,000.00 or imprisoned for not more than five years, or both.

SECTION 214 DECLARATION FORM

THIS SECTION TO BE COMPLETED BY APPLICANT/RESIDENT

DECLARATION

INSTRUCTIONS: Complete the Declaration below by reviewing all three boxes and signing the ONE box that applies. A separate Declaration must be signed for each proposed member of the household.

hereby declare, under penalty of perjury, that:

1. I am a citizen or national of the United States of America.

2. I am a non-citizen with eligible immigration status, as described on reverse side.

REQUEST FOR AN EXTENSION

I hereby certify that I am a non-citizen with eligible immigration status, as noted in block 2 above, and as described on the reverse, but the evidence needed to support my claim is temporarily unavailable. I am therefore requesting additional time to obtain the necessary evidence. I further certify that diligent and prompt efforts will be undertaken to obtain this evidence.

Penalties for misusing this consent: Title 18, Section 1001 of the US Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the US Government. HUD, the Housing Authority and any owner (or any employee of HUD, the Housing Authority or the owner) may be subjected to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on the form HUD 9886 is restricted to the purpose cited on the form HUD 9886. Any person who knowingly or willfully 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, the Housing Authority or the owner responsible for the unauthorized disclosure or improper use.

THIS SECTION TO BE COMPLETED BY APPLICANT/RESIDENT

If you checked box 2 on the front side of this page, and are claiming to be a non-citizen with eligible immigration status, one of the following boxes must be checked:

If you checked one of the above boxes you must submit one of the following documents

VERIFICATION CONSENT

hereby consent to the following:

1. The use of the attached evidence to verify my eligible immigration status to enable me to receive financial assistance for housing

2. The release of such evidence of eligible immigration status by the project owner without responsibility for the further use or transmission of the evidence by the entity receiving it, to; (a) HUD, as required by HUD; and (b) the INS for the purposes of verification of the immigration status of the individual. NOTIFICATION: Evidence of eligible immigration status shall be released only to the INS for purposes of establishing eligibility for financial assistance and not for any other purpose. HUD is not responsible for the further use or transmission of the evidence or other information by the INS.

CONSENT TO VERIFICATION OF INCOME

I consent to allow HUD or OHA to request and obtain income information from the sources listed on this form for the purpose of verifying my eligibility and level of benefits under HUD’s assisted housing programs. I understand that Housing Authorities that receive income information under this consent form cannot use it to deny, reduce or terminate assistance without first independently verifying what the amount was, whether I actually had access to the funds and when the funds were received. In addition, I must be given an opportunity to contest those determinations.

Privacy Act Notice. Authority: 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 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 Housing Authority, including the 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 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.

Penalties for misusing this consent: HUD, the Housing Authority and any owner (or any employee of HUD, the Housing Authority or the owner) may be subjected to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.

Use of the information collected based on the form HUD 9886 is restricted to the purpose cited on the form HUD 9886. Any person who knowingly or willfully 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, the Housing Authority or the owner responsible for the unauthorized disclosure or improper use.

P.O. Box 585
100 Wingfield
Osceola, AR 72370

May 8, 2007

RE: VIOLENCE AGAINST WOMEN ACT

Dear Resident:

In an effort to reduce domestic abuse and to provide housing to victims of domestic abuse, Congress made changes to the Violence Against Women Act (VAWA). These changes affect all public housing residents and become effective January 5, 2006.

Osceola Housing Authority will require male and female residents to certify to the incidents in which they claim they were victims of domestic abuse. Osceola Housing Authority will not disclose the certification information provided by the victim except as law permits.

In general, Osceola Housing Authority may not terminate the lease of a resident who is a certified victim of an actual or threatened incident of domestic abuse as defined by VAWA. Also, in general, Osceola Housing Authority may not terminate the lease of a certified victim for criminal activity that is directly related to domestic abuse.

However, Osceola Housing Authority may terminate the perpetrator’s lease. Also, Osceola Housing Authority may terminate the lease of a victim, if there is an actual and immediate threat of harm to others, or for other lease violations not based on domestic abuse.

If you think that you are a victim of actual or threatened domestic abuse, or that you are facing lease violations for an actual or threatened domestic abuse incident, please contact your Property Manager for more information on your rights under VAWA.

Sincerely,

Robert Collins
Executive Director, PHM

COMMUNITY SERVICE AND SELF SUFFICIENCY POLICY

A. Background

The Quality housing and Work Responsibility Act of 1998 requires that all non-exempt (see definitions) public housing adult residents (18 or older) contribute eight (8) hours per month of community service (volunteer work) or participate in eight (8) hours of training, counseling, classes or other activities that help an individual toward self sufficiency and economic independence. This is a requirement of the Public Housing Lease.

B. Definitions

Community Service – volunteer work which includes, but is not limited to

  • Work at a local institution including, but not limited to: school, child care center, hospital, hospice, recreation center, senior center, adult day care center, homeless shelter, indigent feeding program, cooperative food bank, etc.;
  • Work with a non-profit organization that serves PHA residents or their children such as: Boy Scouts, Girl Scouts, Boys or Girls clubs, 4-H program, PAL, Garden Center, Community clean-up programs, beautification programs, other youth or senior organization;
  • Work at the Authority to help improve physical conditions
  • Work at the Authority to help with children’s programs
  • Work at the Authority to help with senior programs
  • Helping neighborhood groups with special projects
  • Working through resident organizations to help other residents with problems, serving as an officer in a Resident organization, serving on the Resident Advisory Board; and
  • Caring for the children of other residents so they may volunteer

NOTE: Political activity is excluded

Self-Sufficiency Activities – activities that include, but are not limited to:

  • Job readiness programs
  • Job training programs
  • GED classes
  • Substance abuse or mental health counseling
  • English proficiency or literacy (reading) classes
  • Apprenticeships
  • Budgeting and credit counseling
  • Any kind of class that helps a person toward economic independence; and
  • Full time status at any school, college or vocational school

Exempt Adult – an adult member of the family who

  • Is 62 years of age or older
  • Has a disability that prevents him/her from being gainfully employed
  • Is the caretaker of a disabled person
  • Is working at least 20 hours per week; or
  • Is participating in a welfare-to-work program

C. Requirements of the Program

  1. The eight (8) hours per month may be either volunteer work or self-sufficiency program activity, or a combination of the two
  2. At least eight (8) hours of activity must be performed each month; an individual may not skip a month and then double up the following month, unless special circumstances warrant special consideration. The Authority will make the determination of whether to allow or disallow a deviation from the schedule.
  3. Activities must be performed within the community and not outside the jurisdictional area of the Authority
  4. Family obligations
    • At lease execution or re-examination after February 1, 2000, all adult members (18 or older) of a public housing resident family must
      • i. Provide documentation that they are exempt from Community Service requirement if they qualify for an exemption, and
      • ii. Sign a certification that they have received and read this policy and understand that if they are not exempt, failure to comply with the Community Service requirement will result in non-renewal of their lease
    • At each annual re-examination, non-exempt family members must present a completed documentation form (to be provided by the Authority) of activities performed over the previous twelve (12) months. This form will include places for signatures of supervisors, instructors, or counselors certifying to the number of hours contributed
    • If a family member is found to be noncompliant at the re-examination, he/she and the Head of Household will sign an agreement with the Authority to make up the deficient hours over the next twelve (12) month period
  5. Change in exempt status
    • If, during the twelve (12) month period, a non-exempt person becomes exempt, it is his/her responsibility to report this to the Authority and provide documentation of such.
    • If, during the twelve (12) month period, an exempt person becomes non-exempt, it is his/her responsibility to report this to the Authority. The Authority will provide the person with the Recording/Certification documentation form and a list of agencies in the community that provide volunteer and/or training opportunities

U.S. Department of Housing and Urban Development
Office of Public and Indian Housing

DEBTS OWED TO PUBLIC HOUSING AGENCIES AND TERMINATIONS

Paperwork Reduction Notice: The information collection requirements contained in this notice have been approved by the Office of Management and Budget (OMB )under the Paperwork Reduction Act of 1995 (44 U.S.C.3520) and assigned OMB control number 2577-0266. In accordance with the Paperwork Reduction Act, HUD may not conduct or sponsor, and a person is not required to respond to a collection of information unless the collection displays a current valid OMB control number.

NOTICE TOAPPLICANTS AND PARTICIPANTS OF THE FOLLOWING HUD RENTALASSISTANCE PROGRAMS

  • Public Housing (24CFR960)
  • Section 8 Housing Choice Voucher, including the Disaster Housing Assistance Program (24CFR982) Section 8 Moderate Rehabilitation (24CFR882)
  • Project-Based Voucher (24CFR983)

The U.S. Department of Housing and Urban Development maintains a national repository of debts owed to Public Housing Agencies (PHAs) or Section 8 landlords and a diverse information of former participants who have voluntarily or involuntarily terminated participation in one of the above-listed HUD rental assistance programs. This information is maintained within HUD’s Enterprise Income Verification (EIV) system, which issued by Public Housing Agencies (PHAs) and their management agents to verify employment and income information of program participants, as well as, to reduce administrative and rental assistance payment errors. The EIV system is designed to assist PHAs and HUD in ensuring that families are eligible to participate in HUD rental assistance programs and determining the correct amount of rental assistance a family is eligible for. All PHAs are required to use this system in accordance with HUD regulations at 24CFR 5.233.

HUD requires PHAs, which administers the above-listed rental housing programs, to report certain information at the conclusion of your participation in a HUD rental assistance program. This notice provides you with information on what information the PHA is required to provide HUD, who will have access to this information, how this information is used and your rights. PHAs are required to provide this notice to all applicants and program participants and you are required to acknowledge receipt of his notice by signing page 2. Each adult household member must sign this form.

What information about you and your tenancy does HUD collect from the PHA?

The following information is collected about each member of your household (family composition): full name, date of birth, and Social Security Number.

The following adverse information is collected once your participation in the housing program has ended, whether you voluntarily or involuntarily move out of an assisted unit:

  1. Amount of any balance you owe the PHA or Section 8 landlord (upto$500,000) and explanation for balance owed (i.e. unpaid rent, retroactive rent (due to unreported income and/ or change in family composition) or other charges such as damages, utility charges, etc.); and
  2. Whether or not you have entered into a repayment agreement for the amount that you owe; and
  3. Whether or not you have defaulted on a repayment agreement; and
  4. Whether or not the PHA has obtained a judgment against you; and
  5. Whether or not you have filed for bankruptcy; and
  6. The negative reason(s) for your end of participation or any negative status (i.e. abandoned unit, fraud, lease violations, criminal activity, etc.) as of the end of participation date.

Who will have access to the information collected?

This information will be available to HUD employees, PHA employees, and contractors of HUD and PHAs.

How will this information be used?

PHAs will have access to this information during the time of application for rental assistance and reexamination of family income and composition for existing participants. PHAs will be able to access this information to determine a family’s suitability for initial or continued rental assistance, and avoid providing limited Federal housing assistance to families who have previously been unable to comply with HUD program requirements. If the reported information is accurate, your current rental assistance may be terminated and your future request for HUD rental assistance may be denied for a period of up to ten years from the date you moved out of an assisted unit or were terminated from a HUD rental assistance program.

How long is the debt owed and termination information maintained in EIV?

Debt owed and termination information will be maintained in EIV for a period of up to ten (10) years from the end of participation date.

What are my rights?

In accordance with the Federal Privacy Act of 1974, as amended (5USC552a and HUD regulations pertaining to its implementation of the Federal Privacy Act of 1974(24CFR Part16), you have the following rights:

  1. To have access to your records maintained by HUD
  2. To have an administrative review of HUD’s initial denial of your request to have access to your records maintained by HUD
  3. To have incorrect information in your record corrected upon written request
  4. To file an appeal request of an initial adverse determination on correction or amendment to record request within 30 calendar days after the issuance of the written denial
  5. To have your record disclosed to a third party upon receipt of your written and signed request

What do I do if I dispute the debtor termination information reported about me?

You should contact the PHA, who has reported this information about you, in writing, if you disagree with the reported information. The PHA’s name, address, and telephone numbers are listed on the Debts Owed and Termination Report. You have a right to request and obtain a copy of this report from the PHA. Inform the PHA why you dispute the information and provide any documentation that supports your dispute. Disputes must be made within three years from the end of participation date. Otherwise the debt and termination information is presumed correct. Only the PHA who reported the adverse information about you can delete or correct your record.

Your filing of bankruptcy will not result in the removal of debt owed or termination information from HUD’s EIV system. However, if you have included this debt in your bankruptcy filing and/or this debt has been discharged by the bankruptcy court, your record will be updated to include the bankruptcy indicator, when you provide the PHA with documentation of your bankruptcy status.

The PHA will notify you in writing of its action regarding your dispute within 30 days of receiving your written dispute. If the PHA determines that the disputed information is incorrect, the PHA will update or delete the record. If the PHA determines that the disputed information is correct, the PHA will provide an explanation as to why the information is correct.

This Notice was provided by the below-listed PHA:
Osceola Housing Authority
100 Wingfield Street
Osceola, AR 72370

I hereby acknowledge that the PHA provided me with the Debts Owed to PHAs & Termination Notice:

CONSENT TO BACKGROUND CHECK

hereby authorize the Osceola Housing Authority to obtain any and all information necessary to determine my eligibility under the Public Housing Assistance Program. I understand that such information will be kept confidential and will be used only for housing screening purposes.

I also authorize the Osceola Housing Authority to obtain from the local police department, sheriff’s department, tenant/consumer credit and criminal reporting agencies and the Federal Bureau of Investigation, any and/or all criminal records that they may have on file in my name. Furthermore, I release the local police department, sheriff’s department, tenant/consumer credit and criminal reporting agencies and the Federal Bureau of Investigation and its employees thereof from any liability arising from the release of this information.

Privacy Act Notice. Authority: 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 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 Housing Authority, including the 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 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.

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