Application for Rent-Geared-to-Income Assistance Form 1 (Part 1)

Transcription

1 Applicatin fr Rent-Geared-t-Incme Assistance: Applicatin fr Rent-Geared-t-Incme Assistance Frm 1 (Part 1) Instructins 1. Please print, and fill ut all sectins f the applicatin frm. Yu will find infrmatin at the beginning f each sectin that explains what is needed. 2. Please have all husehld members 16 years f age and ver: read and sign the Cnsent frm n the next page read and sign the Declaratin n page 9 f this applicatin. 3. Yu may be asked fr prf f any infrmatin yu give in yur applicatin. 4. After yu have cmpleted the Husing Applicatin frm, return it t the Scial Services Department Husing Divisin at: Husing Access Centre c/ 82 Erie Street, 2 nd Flr, Stratfrd ON N5A 2M4 Phne: Tll free: Fax: If yu need any assistance r have any questins abut cmpleting the applicatin, please cntact the Husing Access Centre. 6. If this infrmatin is required in an accessible frmat, please cntact ext 245. Tell us immediately if yu mve r if yur telephne number changes. If we cannt cntact yu, yur name may be remved frm the waiting list, and we may be unable t ffer yu husing. Fr mre infrmatin abut scial husing, g t tear ff and keep this page fr yur recrds.

2 Applicatin fr Rent-Geared-t-Incme Assistance: Applicatin Checklist: Please use this page t ensure that yur applicatin is cmplete when yu submit it t this ffice. Parts f Basic Applicatin fr Rent-Geared-t-Incme: Office Use Signed Cnsent t Disclsure f Infrmatin and Dcuments (Page 3) Cntact Infrmatin (Page 4) Husehld Infrmatin Attachments (Page 5): Scial Insurance, Birth Certificate r Citizen cards fr everyne t verify Canadian Citizenship. Otherwise, Landed Immigrant Papers r Refugee Status Papers. Dependent Custdy - Cmpletin f Declaratin f Child Supprt & Custdy- Frm 102 and legal curt dcument/agreement Verificatin f Pregnancy if applicable Asset Infrmatin (Page 6) Incme Infrmatin (Page 7) Yu must verify all incme that applies t yur entire husehld: Ontari Wrks/ODSP A cpy f yur mst recent cheque stub, drug r dental card OAS/GIS, GAINS, CPP, Other Pensins/Allwances, etc. A cpy f yur mst recent cheque stub(s) r bank depsit shwing the amunt Emplyment A cpy f yur last 8 week s wrth f pay stubs. Emplyment Insurance/WSIB A cpy f yur mst recent cheque stub(s) r a cmputer printut shwing weekly amunts. Child/Spusal Supprt Received/Payments A cpy f yur mst recent receipt(s) Incme Tax Ntice f Assessment fr each applicant ver the age f 16 A cpy prvided t yu by Canada Revenue Agency. If yu have misplaced yur riginal dcument(s), yu can btain a cpy f this infrmatin by calling Canada Revenue Agency at Declaratin signed (Page 9) Building Chices (Page 12-14) Frm 1 (Part 2) Landlrd Reference (Page 15) Frm 1 (Part 3) Cntinued n next page 2

3 Applicatin fr Rent-Geared-t-Incme Assistance: Additinal Frms attached if necessary: Request fr Hmelessness Status Frm 101 Declaratin f Child Supprt & Custdy Frm 102 Applicatin fr Special Pririty Status Frm 103 Declaratin f Intent t Sell Prperty Frm 104 Request fr an Additinal Bedrm Medical Frm 105 Request fr Accessible Accmmdatin Transfer Frm 106 Medical Verificatin Frm 108 Office Use Only Date Received: Received by: Applicant 1: Applicant 2: 3

4 Applicatin fr Rent-Geared-t-Incme Assistance: Cnsent t Disclsure f Infrmatin and Dcuments 1. I cnsent t the release f infrmatin t an authrized representative f the City f Stratfrd Scial Services Department fr the purpse f determining past, initial r cntinuing eligibility fr rent-geared-t-incme (RGI) assistance and/r special needs husing including my placement n any applicable waiting lists 2. Withut restricting the generality f the cnsent in sectin 1, I specifically cnsent t the release f infrmatin relating t any assets held in any financial institutin by r n behalf f me, my spuse r same-sex partner, and any dependents in my husehld I further cnsent t an authrized representative f the Cnslidated Service Manager fr Perth Cunty (the City f Stratfrd r any f its agents under cntract) disclsing t any party persnal infrmatin abut me, my spuse r same-sex partner, and any dependents included in my husehld fr the purpse f determining initial r cntinuing eligibility fr RGI assistance and/r special needs husing including my placement n any applicable waiting lists. I further cnsent t the exchange f infrmatin with any agency, Ministry r department f the City f Stratfrd, the Gvernment f Ontari, the Gvernment f Canada, the gvernment f any ther prvince r territry, r any ther party fr the purpse f determining past, initial r cntinuing eligibility fr assistance under the Husing Services Act, 2011, the Ontari Wrks Act, 1997, the Ontari Disability Supprt Prgram Act, 1997, r the Day Nurseries Act, and/r special needs husing including my placement n any applicable waiting lists. Name f applicant Signature Date Name f spuse Signature Date Names f dependents (16 years and lder) Signature Date 4

5 Cntact Infrmatin Applicatin fr Rent-Geared-t-Incme Assistance: Please prvide yur name and current cntact infrmatin. Tell us immediately if yu mve r if yur telephne number changes. If we cannt cntact yu, yur name may be remved frm the waiting list and we may be unable t ffer yu husing. Applicant 1 - Last Name First Name Date f Birth (day/mnth/year) Gender Male Apt/Unit Number Street Number Street Name Female Scial Insurance Number Twn/City Prvince Pstal Cde Hme Phne Number addresses: Wrk Phne Number Cell Phne Number Alternate Persn t Cntact: Phne number (where we can leave a message): Applicant 2 - Last Name First Name Date f Birth (day/mnth/year) Gender Male Apt/Unit Number Street Number Street Name Female Scial Insurance Number Twn/City Prvince Pstal Cde Hme Phne Number addresses: Wrk Phne Number Cell Phne Number Alternate Persn t Cntact: Phne number (where we can leave a message): 5

6 Applicatin fr Rent-Geared-t-Incme Assistance: Present Accmmdatin Are yu currently hmeless? Yes N If, Yes please cmplete and attach a Request fr Hmelessness Status Frm 101 Own/C-Own Rent Temprary Staying with N Permanent Relative r Friend Address Hw much d yu currently pay per mnth fr rent? D yu pay subsidized rent /rent-geared-t-incme (RGI) at this address? Yes N Have yu r any applicants listed n page 5 been tenants f subsidized accmmdatin at any time? If yes, please state where and when: Yes N D yu we any rental arrears t any Landlrd? Yes N Husehld Infrmatin Please prvide infrmatin abut all adults and children wh will live with yu ther than Applicant 1 r Applicant 2 listed n page 4. Last Name First Name Relatinship Date f Birth Day/Mnth/Y ear Male/ Female Scial Insurance Number D all f the peple listed currently live with yu full-time? Yes N If n, please give the name f the persn, the date they will start living with yu, and the reasn they are nt living with yu nw: Please attach a Declaratin f Child Supprt & Custdy - Frm 102, fr all custdy arrangements Is any member f yur husehld expecting a baby? Yes N If yes, Expected due date: If yes, please attach a Dctr s nte as verificatin: Yes N 6

7 Status in Canada Applicatin fr Rent-Geared-t-Incme Assistance: Were all the peple in yur husehld brn in Canada? Yes N Please prvide infrmatin fr all peple brn utside f Canada. Attach Verificatin (Phtcpy i.e Birth Certificate, Recrd f Landing, Canadian Immigratin Dcuments, etc.) Name Date mved t Canada Current status in Canada Is there a spnsrship agreement in place? Date spnsrship agreement ends Prf attached Yes N Yes N Applicatin fr Special Pririty Status Cmplete this sectin nly if yu are applying fr Special Pririty n the waiting list because smene that yu live with, r have lived with in the last 3 mnths, is abusing yu. Yu will als need t cmplete the Special Pririty Applicatin Package (Frm 103) which can be requested frm the Husing Access Centre. Asset Infrmatin Assets are valuable things that yu wn. There are sme assets that give yu incme and there are thers that d nt. All types f assets wned by yu and all ther peple wh will be living with yu must be declared. Here are sme examples f bth kinds f assets: Bank accunts, Cash, Term Depsits Registered Retirement Savings Plans Registered Educatin Plans (RESP) Guaranteed Investment Certificates (RRSP) Cllectins r valuables (GIC) Stcks / Shares, Mutual Funds, Savings Bnds A license which gives yu incme Real estate (taxi license) Business Assets Life Insurance (cash surrender value) Persn wh wns the asset Details f Asset (type, accunt number, name f financial institutin) Value / Accunt Balance ($) Des any husehld member n this applicatin wn prperty (e.g. huse, cttage, farm, land, mbile hme, trailer, etc.)? Yes N If Yes, please prvide the fllwing infrmatin as well as cmplete the Declaratin f Intent t Sell Prperty (Frm 104): Type f Prperty Lcatin Assessed value ($) Mrtgage wing($) 7

8 Incme Infrmatin Applicatin fr Rent-Geared-t-Incme Assistance: List ALL grss mnthly incme yu and the peple wh will be living with yu receive frm all surces. This can include, but is nt limited t, incme surces such as: Old Age Security / Guaranteed Incme Emplyment (full time, part time, Ontari Wrks (OW) Supplement / Guaranteed Annual Incme casual) Ontari Disability Supprt Plan Supplement Emplyment Insurance (EI) (ODSP) (OAS / GIS / GAINS) Wrkplace Safety Insurance Bard Canada Pensin Plan (CPP) Retirement Incme Fund (RIF) draws / (WSIB) payments Investment Incme Child supprt payments (e.g. interest / dividends) Life Incme Fund (LIF) payments Alimny r spusal supprt Other pensins (e.g. cmpany, private, payments freign, military) Name f persn receiving incme Type f Incme Grss mnthly incme ($) (befre deductins) Self-emplyment / Business Infrmatin Are yu self-emplyed r d yu wn yur wn business? Yes N If yes, please prvide the fllwing infrmatin: Business Name: Address: Annual Incme: Estimated Value f Business Assets: 8

9 NOTE: Applicatin fr Rent-Geared-t-Incme Assistance: T be cnsidered eligible fr a rent subsidy, applicants must have pursued all surces f incme available t them. This includes basic financial assistance under the Ontari Wrks Act, 1997, supprt under the under the Divrce Act (Canada), the Family Law Act r the Reciprcal Enfrcement f Supprt Orders Act, benefits under the Emplyment Insurance Act (Canada), Gvernment f Canada r Gvernment f Ontari pensins fr persns aged 65 r lder, and supprt r maintenance due under the Immigratin Act (Canada) Basic Rent Geared-t-Incme Eligibility Rules: 1 At least ne member f yur husehld is 16 years ld r lder. 2 Each member f yur husehld is a Canadian citizen, permanent resident f Canada r a refugee claimant. 3 N deprtatin rder has been made r has becme effective fr any members f yur husehld. 4 N member f yur husehld wes arrears f rent r wes mney fr damages t scial husing. 5 N member f yur husehld has had a cnvictin fr misrepresentatin f incme related t scial husing within the past tw years. 6 Yu must be able t live independently; r independently with supprt services. 7 Yu must have a psitive reference frm a previus landlrd. Occupancy Standards Yu can indicate what size f unit yu want t live in. Hwever, yur chice must fall within a range f unit sizes that is determined by the ccupancy standards that apply t yur husehld size. The standards are: there can be n less than ne persn per bedrm applicants can chse t have tw children f the same sex share a bedrm cuples (married, cmmn-law, same-sex partners) are allcated ne bedrm single adults are each allcated ne bedrm a single adult may chse a bachelr-style (n bedrms) unit if there are n ther husehld members if there is a dcumented medical need, a baby/child is expected, r there are dcumented child custdy requirements, an extra bedrm may be prvided. (Frm 105) If yu d nt indicate any size preference fr a unit, we will assume yu will nly accept the largest sized unit fr which yu qualify. Example: The smallest size unit fr which a husehld cnsisting f tw parents with three children (all f the same sex) is eligible is a three-bedrm unit. The largest size unit this husehld wuld be eligible fr is a fur-bedrm unit. 9

10 Declaratin Applicatin fr Rent-Geared-t-Incme Assistance: 1. I declare that all infrmatin given fr this applicatin is true t the best f my knwledge and that I have nt withheld r left ut any required infrmatin. 2. I declare that n member f my husehld is currently under a remval rder t leave Canada. 3. I agree t infrm a C-rdinated Access Wrker fr the City f Stratfrd, r his r her designate, f any changes in my incme, assets, and cntact infrmatin r husehld cmpsitin. 4. I understand that the infrmatin given fr this applicatin may be used fr the purpse f making decisins r verifying eligibility fr assistance under the Husing Services Act, 2011, the Ontari Disability Supprt Prgram Act, 1997, the Ontari Wrks Act, 1997, r the Day Nurseries Act. 5. I understand that if smething n this frm is incrrect r nt true, I may be ineligible fr rent-geared-tincme assistance and may be prhibited frm re-applying fr a minimum perid f tw years. Name (please print) Signature Date Applicant Spuse Dependents (16 years f age and lder) This infrmatin is cllected under the legal authrity f the Husing Services Act, 2011 fr the purpse f administering the scial husing prgrams prescribed in this Act and its assciated Regulatins. Questins abut this cllectin shuld be frwarded t the Directr f Scial Services, City f Stratfrd at 82 Erie Street, Stratfrd ON, N5A 2M4 (519) x 252 r