Programs to assist the Homeless

Homeless Assistance Program Screener
Q#	Question	Response
3	Is the applicant homeless- at imminent risk of homelessness- or in unstable/unsafe housing as defined by HUD?	Yes	No
5	Does at least one qualifying population category apply to the household?	Yes	No
6	Is the applicant a U.S. citizen- national- or non-citizen with eligible immigration status?	Yes	No
7	Will the applicant provide documentation of citizenship or eligible immigration status for all household members claiming assistance?	Yes	No
8	Are all (or the relevant) household members ineligible non-citizens with no qualifying immigration status?	Yes	No
9	Can the applicant provide a valid SSN or ITIN (or documentation of exemption) for the required household members?	Yes	No
10	Is the applicant at least 18 years of age- an emancipated minor- or the head of household?	Yes	No
11	Is the household's gross income at or below the program's applicable AMI/income limit?	Yes	No
12	Does the household income exceed the program's income limit?	Yes	No
13	Can the applicant document and disclose all sources of household income?	Yes	No
14	Can the applicant document and disclose all household assets?	Yes	No
15	Will the applicant agree to periodic income/eligibility (and student-status) recertification?	Yes	No
16	Does the applicant have unreported or undisclosed income sources?	Yes	No
17	Can the applicant document all household members and provide proof of relationship (birth certificates- IDs- custody documents)?	Yes	No
18	Are all household members who will occupy the unit listed on the application?	Yes	No
19	Are there undisclosed individuals living in the household who are not listed on the application?	Yes	No
20	Is any household member subject to a lifetime sex-offender registration requirement?	Yes	No
21	Has any household member been convicted of manufacturing/producing methamphetamine on assisted-housing premises?	Yes	No
22	Will the applicant consent to a criminal background check?	Yes	No
23	Has the applicant been evicted from assisted housing for drug-related criminal activity within the lookback period?	Yes	No
24	Is any household member currently engaged in illegal drug use (threatening other residents)?	Yes	No
25	Does the applicant owe an unpaid debt to a PHA- HUD program - or prior housing provider?	Yes	No
26	Has any household member committed fraud, bribery or other corrupt acts in connection with a federal housing/assistance program?	Yes	No
27	Is the applicant willing to participate in coordinated entry and vulnerability assessment?	Yes	No
28	Does the applicant need and is willing to engage in case management and supportive services?	Yes	No
29	Will the applicant actively search for and occupy an eligible unit within the program's timeframe?	Yes	No
30	Will the unit pass and will the applicant allow the required housing-quality inspections (HQS/NSPIRE)?	Yes	No
31	Will the rent be reasonable and within the program's payment standard?	Yes	No
32	Will the applicant sign a qualifying lease (and HAP contract where applicable)?	Yes	No
33	Will the assisted unit/home be the applicant's primary residence?	Yes	No
34	Does the applicant intend to sublet, transfer or use the unit for non-residential or commercial purposes?	Yes	No
35	Will the applicant pay the required tenant share of rent and any required security/utility deposits?	Yes	No
36	Will the applicant comply with the lease terms, house rules, family obligations and program requirements (including residential-only use)?	Yes	No
37	Will the applicant promptly report changes in household income, composition- or status?	Yes	No
38	Does the applicant understand their rights under the Violence Against Women Act (VAWA)?	Yes	No
39	Does the applicant understand their fair-housing rights and protected-class status?	Yes	No
40	Do full-time student household members meet a qualifying student exception?	Yes	No
41	Is the household composed entirely of full-time students who do NOT meet any qualifying exception?	Yes	No
43	Is the applicant receiving duplicative federal/state rental assistance for the same housing?	Yes	No
44	Will the applicant certify (under penalty of perjury where applicable) that all information provided is true- complete- and accurate?	Yes	No