Blank Housing Authority Of Mckinney Texas PDF Template

MCKINNEY HOUSING AUTHORITY

1200 N. Tennessee St. McKinney, Texas 75069 * Office (972) 542-5641 Fax: (972) 562-8387

APPLICATION for PUBLIC/ PHA-OWNED HOUSING

This is not a Section 8 application and cannot be used for the Housing Voucher program.

Instructions: Please read Carefully. Incomplete applications will not be processed

This application is valid for all public housing properties operated by the McKinney Housing Authority

hereinafter referred to as "PHA".

To be qualified for admission to public housing an applicant must:

a.Be a family as defined in PHA’s Admission and Continued Occupancy policy;

b.Document citizenship or eligible immigration status or pay a higher rent;

c.Have an Annual Income at the time of admission that does not exceed the income limits established by HUD that are posted in PHA office.

d.Provide documentation of Social Security numbers for all family members;

e.Meet or exceed the Applicant Selection Criteria;

f.Pay any money owed to PHA or any other housing authority;

g.Not have had a lease terminated by a PHA in the past 12 months;

h.Be able and willing to comply with the PHA lease;

i.Not have any family members engaged in any criminal activity that threatens the life, health, safety, or right to peaceful enjoyment of the premises by other residents, and not have any family members engaged in any drug-related criminal activity;

j.Not have any family members subject to a lifetime sex offender registration in any state.

Complete applications will be entered on the waiting list in the order received. The waiting list will then be processed in order according to unit type and size (and admission preferences if applicable).

Each applicant who meets the above qualifications will receive one unit of the size and type needed. If the applicant accepts the offer, the applicant will be offered a lease. If the applicant refuses the offer without good cause, the application will be withdrawn from the waiting list and the applicant will not be permitted to reapply for 12 months.

Applicants with disabilities will be given assistance, if requested, with the completion of the application at PHA’s office at the address above.

PHA will conduct a criminal record check on all adult applicants or those for whom adult records are available.

McKinney Housing Authority is an Equal Housing Provider

April 16, 2012- June 28, 2012

APPLICATION for PUBLIC/ PHA-OWNED HOUSING

Date of Application:

Time of Application:

App #

1.Name of head of household:

2.Name of adult co-head of household:

3.Current address, Street, Apt. # Current City, State and Zip

Current Area Code, Home & Work Phone #s

Family Information

6.List all persons who will live in the unit, including foster children, live-in aides (if needed for the care of a family member). No one except those listed on this form may live in the unit.

April 16, 2012- June 28, 2012

19.Does your household have any medical expenses (include insurance, Medicare deduction, doctor bills, dentist bills, hospital bills, clinic costs, medicine, therapy, supplies, medical transportation, etc.)? Yes No If yes, please describe the type of expense (not your medical condition) and the unreimbursed amount you spend per month on each medical expenses:

Type of expense:

20.Do you have any expenses on behalf of a household member with disabilities so an adult in the family can work?Yes No If yes, describe the nature of the expense and the monthly amount:

Name, address & phone # of someone who can verify the expense:

21. Do you have childcare expenses for children under age 13 so an adult in the family can work, go to school or attend job training? Yes No If yes, Name, address and phone # of childcare provider:

Monthly unreimbursed child care cost: $

22.Is any member of the household age 18 or older (other than family head and spouse) a full time student or person with a disability? Yes No If yes, Name of the family member and name and address of someone who can verify this information: Name of family member:

Name, address & phone # of someone who can verify this information:

24.Do you want an apartment at an all elderly building? Yes No (Head or spouse over 62)

25.Do you want to have a pet in your apartment?Yes No

PHA will be contacting all former landlords for the period three years from the date of application

I/we certify that the statements on this application are true to the best of my/our knowledge and belief and understand that they will be verified. I/we authorize the release of information to the Housing Authority by my/our employer(s), the Texas Health and Human Services Commission, the Social Security Administration, and/or other business or government agencies. I/we understand that any false statement made on this application will cause me/us to be disqualified for admission.

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 statement or entry in any matter within the jurisdiction of a department or an agency of the United States shall be fined not more than $10,000 or shall be imprisoned for not more than five years or both.

April 16, 2012- June 28, 2012