# Documentation REQUIRED to Apply: > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/tribal%3Acatawba%3A804536e5866ffe8c ## Record - **Collection:** Tribal code - **Document type:** Tribal code ## Text IDC Housing Assistance Application Documentation REQUIRED to Apply: All Adults Over 18 in the Household: • Tribal ID, if applicable • Driver’s license or state issued ID • Social Security card • If employed: 4-6 pay stubs or letter from your employer stating your pay rate and an average amount of hours you work every week, on company letterhead or notarized • If unemployed: unemployment benefit letter (even if you don't qualify for unemployment benefits) and Affidavit of Unemployment • Social Security or Supplemental Security Income: benefit letter • Most recent Federal tax return, or Affidavit for Non-filing tax return • TANF, if applicable • Per capita payments/Tribal General Assistance, if applicable • Print out of Checking Account or Affidavit of No Bank Account • Print out of Saving Account or Affidavit of No Bank Account • Copy of additional saving account, such as 401k or IRA, if applicable • Marriage license or notarized statement of what constitutes you as a family (unmarried couples), if applicable All Children in the Household: • Tribal ID, if applicable • Social Security card • Birth Certificate • Proof of custody, if applicable • Copy of child support orders or signed and notarized Child Support Affidavit Exhibit 3 Page 1 ISWA Housing Development Corporation Housing Assistance Application Date ____/____/____ 1) HOUSING PROGRAMS: Check the program(s) you are applying for. Check this box if you are interested in applying for a yearly leased rental dwelling unit. Rental Housing Program Check this box if you are interested in Emergency Housing. Emergency Housing 2) APPLICANT INFORMATION: Applicant’s Name (Last) Present Street Address (First) (Middle) No. of Years (Street Address) Own Rent (City) (State) (Zip Code) Contact Information (Phone Number) Previous Street Address (Email Address) No. of Years (Street Address) Own Rent (City) Marital Status Number of Dependents Are you unemployed? Married Separated (Zip Code) Unmarried (including single, divorced, widowed) Ages of Dependents If yes, please explain why you are unemployed. Name of Employer (Business Phone No.) (State) Yes Address of Employer (Applicant’s Position/Title) (Type of Business) No. of years on job No Are you selfemployed? Yes No Yrs. In this line of work Employer’s fax # and/or email address: Are you or anyone in the household related to any ISWA employee’s? If so, list their name and your relation: Are you a full-time student? If yes, what school do you attend? Yes No Yes No If you are applying for Emergency Housing, do you have proof of being a burnout victim, victim of domestic violence, or homeless? If no, you will not be eligible for emergency housing. Co-Applicant’s Name (if applicable) Present Street Address (Last) (First) Yes No N/A (Middle) No. of Years (Street Address) Own Rent (City) (State) Previous Street Address (Zip Code) No. of Years (Street Address) Own Rent (City) (State) (Zip Code) Contact Information (Phone Number) Marital Status Number of Dependents Are you unemployed? Married Separated (Email Address) Unmarried (including single, divorced, widowed) Ages of Dependents If yes, please explain why you are unemployed. Name of Employer (Business Phone No.) Yes Address of Employer (Co-Applicant’s Position/Title) (Type of Business) No. of years on job No Are you selfemployed? Yes No Yrs. in this line of work Employer’s fax # and/or email address: Are you a full-time student? If yes, what school do you attend? Are you or anyone in the household related to any ISWA employee’s? If so, list their name and your relation: If you are applying for Emergency Housing, do you have proof of being a burnout victim, victim of domestic violence, or homeless? If no, you will not be eligible for emergency housing. 3) 2) 3) 4) 5) 6) 7) 8) 9) 10) No Yes No N/A HOUSEHOLD COMPOSITION: List the head of household first. Then list each member who will be residing in the home. Give the relationship of each family member to the head of household. Full Name 1) Yes (Head of Household) Relationship Age DOB Social Security Number Does anyone live with you who are not listed on the previous page? Yes No Does anyone plan to live with you in the future who are not listed on the previous page? Yes No Please explain if you answer “yes” to either question above. __________________________________________________________________________________________ __________________________________________________________________________________________ 4) INCOME: SOURCE How much annual income is your household receiving? Applicant Co-Applicant Salary Overtime Pay Commissions Fees Tips Bonuses Interest and/or Dividends Net Income from Business Net Rental Income Social Security, Pensions, Retirement Funds, Etc. (Received Periodically) Unemployment Benefits Workers Compensation, Etc. Child Support Alimony Public Assistance Other 5) ASSETS TYPE Checking Account(s) Savings Account(s) Credit Union Account(s) Life Insurance Stocks Other Other Household Members 18 & Older TOTAL TOTALS BANK NAME ACCOUNT NUMBER CASH VALUE INCOME FROM ASSETS Have you disposed of any assets in the last 24 months? Yes No If yes, please list any assets disposed of: __________________________________________________________ 6) HOME OWNERSHIP STATUS: Check the one that applies to you. I currently own my own home free and clear. I currently am buying my home and have a mortgage to pay off. I currently lease with an option to buy the home I reside in. I currently rent the home I reside in. I have a land assignment. Other (please explain) 7) Type of Residence: Check the one that applies to you. My current residence is a single-family home. My current residence is a duplex. My current residence is an apartment. My current residence is a mobile home. Other (please explain) _________________________________________ _________________________________________ _________________________________________ 8) Are your property taxes paid and up to date (if applicable)? Yes No 9) Which agency do you have Homeowner’s Insurance with (if applicable)? 10) LIABILITIES: List outstanding obligations (your debts) including auto loans, credit cards, charge accounts, Credit union loans, personal loans, medical expenses, real estate loans except for the home you live in and any other loans. TYPE CREDITOR’S NAME MONTHLY UNPAID BALANCE DUE DATE PAYMENT __________________________ Do you have any outstanding unpaid judgments? Yes No In the last 7 years, have you declared bankruptcy? Yes No Are you a party in a lawsuit? Yes No If yes, to any of the above, please explain: _____________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 11) MONTHLY HOUSING EXPENSE: Mortgage (Monthly) $ Property Insurance (Yearly) $ Property Taxes (Yearly) $ Rent if not buying home (Monthly) $ Utility Costs (Monthly) $ Child Care (Monthly) $ Other $ Describe any special circumstances relative to your housing or its financing: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ I/We certify that all the statements on this ISWA Development Corporation Housing Assistance Application are true and correct to the best of my/our knowledge. I/We understand that funds are limited and that ISWA Development Corporation cannot guarantee that financial assistance will always be available. I/We understand that completion of the Homebuyer’s Educational Program offered by the ISWA Development Corporation is required when participating in Housing Assistance Programs before the disbursement of any funds and is not a guarantee that financial assistance will be provided. Privacy Act Notice: This information is to be used by the ISWA Development Corporation in determining whether you qualify for assistance under its programs. It will not be disclosed outside the agency except as required and permitted by law. You do not have to provide this information, but if you do not, your application for approval of assistance may be rejected. 12) Applicant: ________________________________________ _________________________ 13) Co-Applicant: ________________________________________ _________________________ Signature Signature Date Date ~~~~~~~~~~~~~~~~~~~~~FOR OFFICE USE ONLY~~~~~~~~~~~~~~~~~~~~ Received By: Client #: Reviewed By: Date Received: Approved By: # of People in Household/# of Bedrooms: Comments: Verified Income: Min. 30% 80% No. in Family Minimum Allowable Income 30% Median Income 1 2 3 4 5 6 7 8 $16,830 $19,210 $21,633 $24,013 $27,600 $31,612 $35,624 $39,636 $19,800 $22,600 $25,450 $28,250 $32,470 $37,190 $41,910 $46,630 *income guidelines updated 07/01/2022 Maximum Allowable Income 80% Median Income $52,750 $60,300 $67,850 $75,350 $81,400 $87,450 $93,450 $99,500 100% Median Income $66,000 $75,400 $84,800 $94,200 $101,800 $109,300 $116,900 $124,400 AUTHORITY TO VERIFY INFORMATION This is your authority to verify my accounts, employment, outstanding debts, including any present or previous mortgages, to order a consumer credit report, criminal background checks and to make any other inquires pertaining to my qualifications for assistance from ISWA Development Corporation. Copies of this letter may be made for Distribution to any party with which I have a financial or credit relationship and that party may treat such copy as an original. PRIVACY ACT NOTICE: This information is to be used by ISWA Development Corporation in determining whether you qualify for assistance under its programs. It will not be disclosed outside the agency except as required and permitted by law. This documentation will remain in effect for one year from the date signed. You do not have to provide this information, but if you do not your application for approval of assistance may be rejected. Any household member over the age of 18 needs to sign below: ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ (Applicant’s Printed Name) (Applicant’s Signature) (Co-Applicant’s Printed Name) (Co-Applicant’s Signature) (Co-Applicant’s Printed Name) (Co-Applicant’s Signature) (Co-Applicant’s Printed Name) (Co-Applicant’s Signature) ________________________________________ Today’s date (Date of Birth) (Social Security Number) (Date of Birth) (Social Security Number) (Date of Birth) (Social Security Number) (Date of Birth) (Social Security Number) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/tribal%3Acatawba%3A804536e5866ffe8c. Public record. Not legal advice.