Fillable Cumberland County Emergency Rental Assistance (CCERAP) Application Submittal

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Cumberland County Emergency Rental Assistance (CCERAP) Application Submittal

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Page 1 of 7
Cumberland County Emergency Rental Assistance (CCERAP) Application
Submittal Instructions and Checklist
The Cumberland County Emergency Rental Assistance Program is available for eligible households
financially impacted by COVID-19.
Eligible Households: Defined as a renter household in which at least one or more individuals meets
the following criteria:
o Qualifies for unemployment or has experienced a reduction in household income,
incurred significant costs, or experienced a financial hardship due to COVID-19;
o Demonstrates a risk of experiencing homelessness or housing instability; and
o Has a household income at or below 80% of the area median income level.
Additional Criteria:
All applicants must live in Cumberland County
All applicants must meet income eligibility criteria and must have a documented loss of income
due to COVID-19. Program recipients may not receive rental assistance from other sources to
cover the same expense. After 6 months of assistance, applicants will need to provide copies
of updated income documentation.
Renter households may apply for rent and/or utility assistance (arrears, current and future) for
up to 12 months in 3 month increments.
Renter households may seek assistance for any arrears beginning March 13, 2020.
Households may return for additional assistance if they continue to have a need.
Utilities are limited to electricity, gas, fuel oil, water and sewer and trash removal.
Priority is given to those applicants that are below 50% of the area median income or
unemployed for 90 days. The program limits eligibility to households with income that does not
exceed 80% of area median income.
All payments will be made directly to the landlord or utility company.
Household
Size
1
2
3
4
5
6
7
8
80% AMI
$47,550
$54,350
$61,150
$67,900
$73,350
$78,800
$84,200
$89,650
50% AMI
$29,750
$34,000
$38,250
$42,450
$45,850
$49,250
$52,650
$56,050
Instructions: You may submit this application along with all supporting documentation to:
Email- rentrelief@cchra.com
Mail- Rent Relief, CCHRA, 114 N Hanover St. Carlisle, PA 17013
Page 2 of 7
DropOff- CCHRA Drop Box in front at 114 N Hanover St. Carlisle, PA 17013
Remote Locations available to pick up applications visit www.cchra.com for details
Initial Application Checklist
If this is the first time you are applying for funds, please make sure to submit the following:
❑ Program Application with all questions complete and signed by tenant and landlord
❑ Documentation of COVID-19 Impact: If you experienced a loss of income due to COVID-19, submit
a notice or email from your employer documenting job loss, furlough, closure, reduction in hours, or
other documentation that supports your loss of income due to COVID-19. If you are unable to pay
your rent or utilities due to an unexpected medical cost, submit your medical bill.
❑ Photo ID
❑ Rent Ledger
❑ Signed Lease
❑ Landlord W-9 Form
❑ Copy of Broker License if Property Management is applying on behalf of owner
❑ Income Documentation: Documentation of any household income from before you experienced a
loss of income due to COVID. (Paystubs, W-2s, tax filings, bank statements demonstrating regular
income, attestation from an employer)
▪ If you are self-employed, submit the Self-Employment Certification Form.
▪ Unemployed: provide documentation regarding unemployment compensation. (UC Claim
Confirmation Letter, bank statement showing unemployment benefits)
❑ If you are seeking utility assistance, submit the utility bill. Please note you may be asked to submit
additional documentation.
Return Application Checklist
If you have already submitted the initial application and are returning for additional
assistance, please submit the following:
❑ Self-Certification for Continued Assistance.
❑ If you are seeking utility assistance, submit the utility bill or proof of arrears.
Page 3 of 7
Tenant/Landlord Application
TENANT:
First Name: ___________________________ MI:____ Last Name: ________________________
Address: ______________________________________________
City:___________________________
State:_______ Zip Code:_____________ Home Phone #: _________________________________
Cell#:___________________________Email:___________________________________________
Do you wish to receive automated updates? ☐Yes☐No
Number/Email to receive automated updates:
______________________________________________
Gender: ☐Male ☐Female
Race: (You can select more than one):
☐American India or Alaska Native ☐Asian ☐Black or African American
☐Native Hawaiian or Other Pacific Islander ☐White
Ethnicity: ☐Hispanic/Latino ☐Non Hispanic/Latino
Veteran: ☐Yes ☐No
Number of bedrooms in unit listed above: _____
Please list all household members below:
Household Member
Relationship
Date of Birth
Income PRE
COVID
Income Post
COVID
1.
2.
3.
4.
5.
6.
Page 4 of 7
Landlord Name: _________________________________________________________
Address: __________________________________________________ City: _________________
State: __________ Zip Code: _________________ Phone: ___________________________
E-mail: __________________________________________________
Please check the type(s) of assistance you are requesting help with (Request for 3 months at a
time, limit 12 months total):
☐Rental Assistance
Months:______________
Amount:______________
☐Rental Arrears
Months:______________
Amount:______________
☐Utility Assistance
☐Gas/Oil ☐Electric ☐Water
Months:______________ Months:______________ Months:______________
Amount:______________ Amount:______________ Amount:______________
☐Sewer ☐Trash
Months:______________ Months:______________
Amount:______________ Amount:______________
☐Utility Arrears
☐Gas/Oil ☐Electric ☐Water
Months:______________ Months:______________ Months:______________
Amount:______________ Amount:______________ Amount:______________
☐Sewer ☐Trash
Months:______________ Months:______________
Amount:______________ Amount:______________
Page 5 of 7
Please indicate what circumstance apply by checking the applicable box below:
☐Qualifies for unemployment
☐Experienced a reduction in household income. Please Explain:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
☐Incurred significant costs Please Explain:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
☐Experienced a financial hardship due to COVID-19. Please Explain:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
☐Demonstrates a risk of experiencing homelessness or housing instability. Please
Explain:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Required Documentation: Attach a notice or email from your employer documenting job loss,
furlough, closure, reduction in hours, or other documentation that supports your loss of
income due to COVID-19. If you are unable to pay your rent or utilities due to an unexpected
medical cost, attach the medical bill.
Do you receive any permanent or temporary rental assistance such as a Housing Choice
Voucher (Section 8) or other rental assistance?
☐Yes
☐No
Please list any emergency rental assistance that you have applied for and the outcome of that
application (whether you received assistance).
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Page 6 of 7
LANDLORD
Landlord/Owner Name: _________________________________________________________
Address: __________________________________________________City: _________________
State: __________ Zip Code: _________________ Phone: ___________________________
E-mail: __________________________________________________
Management Company (if applicable): _____________________________________________
Address: ___________________________________________________City: _________________
State: __________ Zip Code: _________________ Phone: ___________________________
E-mail: __________________________________________________
Remit Payment to: ☐Landlord/Owner ☐Management Company (Provide copy of broker license)
Number of Bedrooms in Rental Unit Listed Above: ______
Monthly Rent Amount: $_____________________ Date Next Payment Due: ____________
Amount of Last Payment Received: $___________ Date of Last Payment: ______________
Lease Start Date: ___________________________ Lease End Date: ___________________
Is the tenant in arrears? ☐Yes ☐No If yes, how much does the tenant owe? $_______
Are you currently receiving any other form of rental assistance for this household?
☐Yes ☐No
If yes, how much have you received? $_______________ per _____________
The undersigned certifies that: (Please initial each statement that is true and accurate)
________ To the best of his or her knowledge the apartment referenced above contains no health or
safety violations that threatens the health or safety of the tenant and is habitable.
________The undersigned certifies that they have not received rent payments, from the tenant or any
other program, that covers the unpaid rent listed above.
________ The undersigned agrees that they will not evict the tenant, or ask the tenant to leave for the
duration of this assistance. The undersigned agrees that if the tenant is facing eviction, the
undersigned will only accept payment arrears if the eviction will be avoided.
Page 7 of 7
________ The undersigned certifies that all taxes are up to date on the above listed rented property.
________The undersigned confirms that the above information is true and accurate to the best of his
or her knowledge and that providing false representations herein constitutes an act of fraud.
I certify that the information presented in this application is true and accurate to the best of my
knowledge. I certify that I have not already been provided rental or utility assistance for the funds
requested in this application. The undersigned further understand(s) that providing false
representations herein constitutes an act of fraud. As a person or entity receiving ERAP assistance, I
agree to repay assistance that is determined to be duplicative. By signing below, this constitutes an
agreement with Cumberland County Housing Authority
_____________________________________________________
Signature of Applicant / Head of Household Date
______________________________________________________
Signature of Landlord Date
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Cumberland County Emergency Rental Assistance (CCERAP) Application Submittal

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Completed 19 May 2021

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