1
Was the applicant referred by a CoC - partner agency, victim-service provider or approved provider?
Yes
No
2
Is the applicant applying without the required qualifying referral?
Yes
No
3
Is the applicant homeless- at imminent risk of homelessness- or in unstable/unsafe housing as defined by HUD?
Yes
No
4
Is the applicant fleeing or attempting to flee domestic/dating violence- sexual assault- stalking- or trafficking?
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
42
Does the application comply with the program's jurisdiction- allocation- and portability requirements?
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
45
Will the applicant consent to third-party verification and release of information for all submitted eligibility data?
Yes
No
46
Has the applicant provided false, misleading, or incomplete information on this or a prior application?
Yes
No
47
Can the applicant provide valid government-issued photo identification (or accepted ID documents)?
Yes
No
48
Is the property located within an eligible rural area/census tract ?
Yes
No
49
Can the applicant provide verifiable employment/income history?
Yes
No
50
Does the applicant have stable, sufficient income to meet mortgage obligations?
Yes
No
51
Does the applicant meet the minimum credit-score requirement (or alternative credit guidelines)?
Yes
No
52
Is the applicant's debt-to-income (DTI ) ratio within program limits?
Yes
No
53
Can the applicant provide recent federal tax returns (or IRS verification of non-filing)?
Yes
No
54
Can the applicant provide recent bank statements for all accounts?
Yes
No
55
Can the applicant provide recent pay stubs?
Yes
No
56
Will the applicant complete a HUD-approved homebuyer education/financial-literacy course?
Yes
No
57
Will the applicant occupy the home within the required timeframe after closing?
Yes
No
58
Will the applicant maintain and occupy the property in compliance with program/affordability requirements?
Yes
No
59
Does the property meet (or will it meet after rehab) minimum habitability and safety standards?
Yes
No
60
Is the applicant in active bankruptcy proceedings (or recent disqualifying bankruptcy)?
Yes
No
61
Has the applicant had a foreclosure, deed-in-lieu or short sale within the lookback (or active proceedings)?
Yes
No
62
Is the applicant currently delinquent on any federal debt (taxes- student loans- child support)?
Yes
No
63
Does the applicant own other residential property suitable for occupancy?
Yes
No
64
Has the applicant been convicted of a disqualifying felony (e.g. fraud, financial or other) within the lookback period?
Yes
No
65
Is the applicant debarred, suspended or excluded from receiving federal funds/benefits?
Yes
No
66
Has the applicant reached the maximum allowable amount/duration of assistance?
Yes
No
67
Does the applicant intend to use the property as a rental- vacation home- or investment property?
Yes
No
68
Does the applicant have unresolved judgments, liens or garnishments exceeding the program threshold?
Yes
No
69
Is the applicant currently incarcerated (with no qualifying release date)?
Yes
No
70
Is the applicant a current resident of or located within the jurisdiction or service area administering the program?
Yes
No
71
Does the applicant (or a household member) have a documented qualifying disability/condition with verification?
Yes
No
72
Has the applicant completed or is willing to complete the required application packet?
Yes
No
73
Has the applicant been terminated from a housing/assistance program for cause within the lookback period?
Yes
No
74
Does the applicant have an active felony warrant- probation violation- or is fleeing prosecution?
Yes
No
75
Is the applicant unwilling to engage in required services, case management,- lease terms or program rules?
Yes
No
76
Is the applicant already permanently/stably housed without need for assistance?
Yes
No
77
Has the applicant refused to provide required documentation or sign required forms?
Yes
No
78
Is the applicant a non-resident (outside the service area) with no intent to relocate?
Yes
No
79
Did the applicant (or their family member) perform qualifying U.S. military service?
Yes
No
80
Was the applicant discharged under conditions other than dishonorable?
Yes
No
81
Is the applicant eligible for VA healthcare services?
Yes
No
82
Is the applicant willing to undergo VA clinical assessment and case management?
Yes
No
83
Can the applicant provide a DD-214 or equivalent proof of military service?
Yes
No
84
Was the applicant's only service non-qualifying (e.g.- training-only Reserve/Guard without federal activation)?
Yes
No
85
Was the applicant discharged dishonorably from military service?
Yes
No
86
Is the applicant ineligible for VA healthcare benefits?
Yes
No
87
Is the disability of long-continued and indefinite duration (12+ months)?
Yes
No
88
Does the disability substantially impede the applicant's ability to live independently or perform daily activities?
Yes
No
89
Would more suitable housing improve the applicant's ability to live independently?
Yes
No
90
Is the applicant willing to sign the required HUD consent, release-of-information and certification forms (e.g.- 9886/9887)?
Yes
No
91
Is the applicant capable of living independently with or without supportive services?
Yes
No
92
Is the head of household, co-head or spouse the person with the qualifying disability?
Yes
No
93
Does any household member's pattern of alcohol abuse threaten other residents?
Yes
No
94
Is the applicant seeking disability housing without a qualifying disabled head of household?
Yes
No
95
Is the applicant unable or unwilling to live independently or meet essential lease obligations even with reasonable accommodation?
Yes
No
96
Does the applicant pose a direct threat to the health and safety of other residents or property?
Yes
No
97
Is the assistance sought for a property that is not the applicant's primary residence?
Yes
No
98
Is the applicant a full-time student dependent of income-ineligible parents who does not meet a student exception?
Yes
No
99
Is the applicant the named tenant/lessee residing in the unit for which assistance is sought?
Yes
No
100
Is the rental unit owned by an immediate family member- or is the applicant related to/part of the owner's household?
Yes
No
101
Has a household member qualified for unemployment benefits or been unemployed within the lookback?
Yes
No
102
Has the household experienced a COVID-19-related financial hardship?
Yes
No
103
Can the applicant demonstrate a risk of homelessness or housing instability?
Yes
No
104
Does the applicant owe unpaid rent/utilities or have past-due- eviction- or shut-off notices?
Yes
No
105
Is the applicant currently living in unsafe or unhealthy housing conditions?
Yes
No
106
Has the applicant already received assistance (or a third-party payment) covering the same expenses for this time period?
Yes
No
107
Is the requested assistance for an eligible (current or prospective) rent expense?
Yes
No
108
Is the applicant requesting assistance for eligible utility, energy or internet costs?
Yes
No
109
Is the applicant requesting assistance for an ineligible expense (e.g.- telephone or cable TV)?
Yes
No
110
Is the unit an ineligible type (e.g.- hotel/motel/short-term rental)?
Yes
No
111
Can the applicant provide a lease, mortgage statement or other proof of rental obligation?
Yes
No
112
Is the landlord willing to participate and accept direct payment (with contact/payment info provided)?
Yes
No
113
Does the applicant agree that assistance will be used solely for eligible expenses?
Yes
No
114
Does the applicant understand that assistance is subject to the availability of funds and is not guaranteed?
Yes
No
115
Does the applicant qualify under a local or state-designated preference category?
Yes
No
116
Is the applicant willing to attend a mandatory program briefing if selected?
Yes
No
117
Has any household member been convicted of a violent crime against persons or property within the lookback period?
Yes
No
118
Has any household member engaged in drug-related criminal activity within the program's lookback period?
Yes
No
119
Does the applicant have an unresolved history of lease violations, evictions, property damage or housing-related debt?
Yes
No
120
Has any household member committed violence against another household member (VAWA perpetrator restriction )?
Yes
No
121
Is at least one household member 62 or older and a primary occupant of the unit?
Yes
No
122
Will the applicant consent to a credit and/or rental-history verification?
Yes
No
123
Can the applicant provide references from previous landlords?
Yes
No
124
Is the household composed solely of members under the required elderly age with no qualifying elderly member?
Yes
No
125
Does the applicant require a level of medical/nursing care that exceeds what the program can support?
Yes
No
126
Has the applicant disposed of assets for less than fair market value within the lookback period?
Yes
No
127
Does the applicant understand the program's rent-calculation and continued-occupancy rules?
Yes
No
128
Does the applicant receive other rental assistance that may be combined (affecting rent calculation; not eligibility)?
Yes
No
129
Has the applicant applied for- or is willing to apply for- all mainstream benefits they may be entitled to?
Yes
No
130
Does the applicant meet the chronic homelessness threshold (long-term or repeated episodes)?
Yes
No
131
Was the applicant recently discharged from an institution without stable housing?
Yes
No
132
Do the applicant's assets exceed the program's asset limit?
Yes
No
133
Does the applicant have a history of arson convictions that pose a risk to other residents?
Yes
No
134
Has the applicant been banned or barred from the housing agency's properties or from federally assisted housing?
Yes
No
135
Is the applicant under the program's required minimum age?
Yes
No
136
Does the applicant have stable income sufficient for housing stability without the program?
Yes
No
137
Did the applicant voluntarily terminate employment within the lookback without a valid recognized reason?
Yes
No
138
Does the applicant have an active substance-use disorder requiring immediate inpatient treatment?
Yes
No
139
Is the applicant a dependent of another household member already enrolled in the program?
Yes
No
140
Does the applicant have reliable transportation/access to program activities?
Yes
No
141
Is the applicant legally authorized to work/participate where required?
Yes
No
142
Is the applicant able to commit to the required program duration?
Yes
No
143
Are there active legal actions (e.g.- protective orders- civil actions) that would interfere with program participation?
Yes
No
144
Can the applicant provide third-party verification of their homeless history?
Yes
No
145
Can the applicant document prior residence (or absence thereof) for the required period?
Yes
No
146
Is the applicant residing in an institutional setting beyond program limits with no prior qualifying homeless episode?
Yes
No
147
Can the applicant provide proof of residency?
Yes
No
148
Does the applicant own the property for which rental assistance is being sought?
Yes
No
149
Will the household comply with the program's occupancy standards?
Yes
No
150
Is the applicant a first-time homebuyer?
Yes
No
151
Does the purchase price fall within the program's maximum purchase-price limits?
Yes
No
152
Is the applicant the unremarried surviving spouse of a qualifying veteran?
Yes
No
153
Does the applicant have or can obtain a valid Veterans Administration Certificate of Eligibility (COE)?
Yes
No
154
Does the applicant have an existing (VA or non-VA) mortgage on the property?
Yes
No
155
Is the applicant refinancing to obtain a lower rate or switch from Adjustable Rate Mortgage to fixed-rate?
Yes
No
156
Are the applicant's payments on the existing loan current (within allowed late tolerances)?
Yes
No
157
Is the applicant attempting to take cash out of the home's equity through this refinance?
Yes
No
158
Does the applicant meet VA/lender credit and income requirements?
Yes
No
159
Is the applicant a Native American veteran (or a veteran married to a Native American)?
Yes
No
160
Will the property be located on Federal Trust Land?
Yes
No
161
Does the applicant's tribal government have a Memorandum of Understanding (MOU) with the VA?
Yes
No
162
Is the applicant purchasing land that is NOT located on Federal Trust Land?
Yes
No
163
Does the applicant have a qualifying service-connected disability?
Yes
No
164
Does the applicant meet one of the specific severe-disability criteria required for the adaptive-housing grant?
Yes
No
165
Will the grant be used to build, buy or adapt a home to accommodate the applicant's disability?
Yes
No
166
Will the applicant hold title to the home being adapted or purchased?
Yes
No
167
Is the applicant's disability NOT service-connected?
Yes
No
168
Is the applicant currently eligible for an SAH or SHA grant?
Yes
No
169
Is the applicant temporarily living in a home owned by a family member?
Yes
No
170
Does the applicant own the home where the temporary adaptations are needed (disqualifying for Temporary Residence Adaptation (TRA))?
Yes
No
171
Did the applicant receive a Specially Adapted Housing (SAH) grant?
Yes
No
172
Is the applicant under age 70?
Yes
No
173
Is the applicant age 70 or older at the time of application?
Yes
No