Low Rent Housing: The NPTHA manages Low Rent housing units in the Lapwai and Kamiah areas. Only (2023)

NPTHA Programs

Low Rent Programs

Low Rent Housing: The NPTHA manages Low Rent housing units in the Lapwai and Kamiah areas. Only

qualified low-income families are eligible for assistance. Applicants are placed on a waiting list with preference

given to Nez Perce families. The Low Rent program is a month-to-month lease and the rent is based on 22% of

adjusted gross income.

Low-Income Housing Tax Credit (LIHTC) Rentals: The NPTHA manages LIHTC units in the Lapwai area. Only

qualified low-income families are eligible for assistance. Although preference is provided to Nez Perce families,

various income restrictions apply. The LIHTC program accepts Section 8 vouchers and requires all tenants to

apply for Section 8 vouchers. Rents are calculated annually based on 22% of adjusted gross income.

Homeownership

Starter Home Program (SH): This program is a five-year lease with option to purchase and only applies to

available homeownership units the NPTHA built before 1998. Eligible applicants will earn credits during the

lease phase to buy down the purchase price. Only Nez Perce families who can complete the mortgage process

within five years are eligible.

Option to Purchase Program (OPP): This program is a three-year lease with option to purchase available for our

Sundown Heights homeownership units. Eligible applicants will earn mortgage payment credits during the

lease phase and receive buy-down assistance. Only Nez Perce families who can complete the mortgage process

within three years are eligible.

Financial Assistance

Individual Development Account (IDA): This is a savings program designed to encourage low-income Nez Perce

Families to save for 1) down payment to purchase home or 2) home repairs/improvements. The NPTHA will

provide a $2 match for every $1 saved toward the purchase of a home or a $1 for $1 match for home repairs/

improvements.

Mortgage Finance Assistance (MFA): Down payment and closing costs assistance is available for eligible low

and moderate income families who are purchasing a home through a private lender. MFA is not applicable

when buy-down assistance is provided by other NPTHA programs.

Home Repair Programs

Senior Rehab Program: This program provides assistance to low-income senior citizens who own their own

home. The grant amount is a maximum of $4,500 to complete essential repairs. The NPTHA will assist in

compiling estimates and arranging completion of repairs.

Education Classes

Education Classes:: The NPTHA provides the following Education Classes:

*Homebuyer Education: Overview of the program benefits and step by step process for those interested in

purchasing a home. Also, a requirement of Section 184 Guaranteed Loan program.

*Money Basics: Learn to manage your personal finances, understanding credit, etc.

*Renter's Rights & Responsibilities: A complete review for current tenants and future tenants.

*Maintenance Class: Learn various do-it-yourself maintenance tasks.

*Homeowners Maintenance Class: A guide to inspecting, and completing home repairs and improvements.

*Post Purchase Class: Facts and issues that come up after you’ve purchased your home.

All housing assistance provided by the NPTHA is subject to federal income guidelines. Moderate income

families may be eligible for various programs, however, are not able to receive the same benefits as lowincome families. All applicants are required to attend housing counseling programs. Various eligibility requirements apply to each program, please talk to a housing counselor for more information.

Application Instructions

Attached is the application for Housing Assistance. Please return the

completed application to the NPTHA office with the following items:

Copies of Tribal enrollment cards for all enrolled household members;

Copies of social security cards for all household members;

Copies of most recent paycheck stubs and/or other proof of income;

IDA & Mortgage Finance Assistance applicant do not need to

complete sections 4 or 5.

You will receive notice within two weeks regarding the status of your

application. Once you are on the waiting list, you can check your status at

our front office. The waiting list is prioritized by preference points and

application date thereafter.

All housing assistance provided by the NPTHA is subject to federal and

state income guidelines. Moderate income families may be eligible for

various programs; however, are not able to receive the same benefits as

low-income families.

If you need assistance in completing this application, please contact the

NPTHA Office in either Lapwai or Kamiah.

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Nez Perce Tribal Housing Authority

P. O. Box 188

Lapwai, ID 83540

(208) 843-2229 fax: (208) 843-2973

PART I: Housing Assistance Application

SECTION 1: Applicant Information

ASSISTANCE DESIRED

Applicant Name:______________________________________ Co-Applicant Name:___________________________________

Home Phone: ______________ Work Phone: _____________ Home Phone: ______________ Work Phone: _____________

Mailing Address: _________________________________________________________________________________________

Indicate the type of housing assistance you are applying for:

Low Rent

Tax Credit Rental

Purchase SDH Lot

IDA

Starter Home

MFA

Desired Location

Orofino

Lapwai

Kamiah

Do you presently Own a Home?

Yes

No

Are you presently a NPTHA participant?

Yes

No

Purchase SDH Home

Other: ________________

Other:___________________

If yes, please provide address:

If you are presentaly a NPTHA participant, please explain:

Please indicate your housing goals:

What is your family’s current housing situation?

OWN

RENT

Does any household member owe any amount to the NPTHA?

Have you completed our Homebuyer Education Class?

Have you completed our Money Basics Class?

LIVE WITH FAMILY

Yes

Yes

Yes

No

No

No

MH

SH

Other

Verified: _______________________

Date Completed: _________________

Date Completed: _________________

HOUSEHOLD

List all household members that are applying to live in this home with you and provide Social Security cards and Tribal ID.

Name

Relationship

Enrollment

M/F

Tribal Affiliation

TO APPLICANT

Number

First

Middle Initial

Last

Applicant

2 of 2

Social Security

Number

DOB

SECTION 2: Income and Asset Information

Applicant Name:___________________________________

Co-Applicant Name:___________________________________

CURRENT EMPLOYMENT INFORMATION

Length:

Current Employer/Address

Yrs.___Mo.___

Full-time

Position/Title

Part-time

Net Mo. Income Gross Monthly Income

Current Employer/Address

Position/Title

Gross Monthly Income

Length:

Yrs.___Mo.___

Full-time

Part-time

Net Mo. Income

IF EMPLOYED WITH CURRENT EMPLOYER LESS THAN 2 YRS, COMPLETE THE FOLLOWING SECTOIN:

Previous Employer/Address

Length:

Yrs.___Mo.___

Annual Income

Address

Previous Employer/Address

Address

Length:

Yrs.___Mo.___

Annual Income

ALL HOUSEHOLD INCOME

List all household members that are applying to live in this home with you and provide Social Security cards and Tribal ID.

Household Member

Source of Income

Amount

Frequency

INCOME QUESTIONAIRE

Do YOU or ANYONE in your household receive OR expect to receive income from:

(Report all dollar amounts above)

YES

NO

1. Employment wages or salaries? (Include overtime, tips, bonuses, commissions and payments received in

cash)

2. Self-employment? (Include overtime, tips, bonuses, commissions and payments received in cash)

3. Regular pay as a member of the Armed Forces/Military

4. Unemployment benefits or workman’s compensation?

5. Public Assistance, General Relief or Temporary Assistance for Needy Families (TANF)?

6. (a) Child support or Alimony?

(We must count court-ordered support whether or not it is received unless legal action has been taken to

remedy. We must also count support that is not court-ordered rather received directly from payer. Payments

received in a lump sum will also be counted.)

(b) How is the support received? (Check all that apply.)

Child Support Enforcement Agency

Court of Law

Directly from Individual

Other

3 of 3

Name of Agency: _____________________

Name of Court: _______________________

Name of Person: ______________________

Explain: _____________________________

YES

NO

(c) If support/alimony is court-ordered but not actually received, are you taking legal action to

remedy?

Explain: ____________________________________________________________________

(d) Have you received repayment(s) of past due child support? (If so, obtain third party documentation

of amounts, source, and dates.)

7. Social Security, SSI or any other payments from the Social Security Administration?

8. Regular payments from a Veteran’s benefit, pension, retirement benefit or annuities?

9. Regular payments from a severance package?

10. Regular payments from any type of settlement? (For example, insurance settlements)

11. Payments from any per capita related to land claims settlements, dividends?

12. Educational grunts, scholarships, or other student benefits?

13. Regular gifts or payments form anyone outside of the household?

(This includes anyone supplementing your income or paying any of your bills)

14. Regular payments from lottery winnings or inheritances?

15. Regular payments from rental property, trust, or other types of real estate transactions?

16. Any other income sources or types not listed?

17. Do you or any other household members expect any changes to your income in the next 12

months?

Explain: ____________________________________________________________________

ASSET INFORMATION

Include all assets held and the income derived from the asset. INCLUDE ALL ASSETS HELD BY ALL HOUSEHOLD

MEMBERS INCLUDING MINORS.

Do YOU or ANYONE in hour household have:

YES

NO

18. Checking or savings account?

Household Member

4 of 4

Financial Institution

Amount

19. CD’s, money market accounts or treasury bills?

Household Member

Financial Institution

Amount

20. Stocks, bonds or securities?

Household Member

Amount

Company or Broker

YES

NO

21. Trust Funds?

Household Member

Financial Institution

Amount

22. Pensions, IRAs, Keogh or other retirement accounts?

Household Member

Financial Institution

Amount

23. Whole life insurance policy?

Household Member

Amount

Financial Institution

24. Real estate, rental property, land contracts/ contract for deeds or other real estate

holdings?

(This includes your personal residence, mobile homes, vacant land, farms, vacation homes or commercial

property.)

Household Member

Address of Property

Amount

25. Personal property held as an investment?

(This including paintings, coin or stamp collections, artwork, collector or show cars, and antiques. This does

not include your personal belongings such as your car, furniture or clothing.)

Household Member

Item

Amount

26. Have you or any other household members disposed of or given away any asset(s) for

LESS than fair market value within the past 2 years?

Household Member

Amount

Explain: _____________________________________________________________

SECTION 3: General Questionnaire

HOUSING REFERENCES

List housing references for the past 3 years. (If additional space is required, use the back of this application.)

Landlord’s Name/Address

Your Address

Name:

Address:

Phone:

Own/Rent

Own

(

)

From:

Address:

Own

(

)

From:

Address:

5 of 5

To:

Rent

Name:

Phone:

To:

Rent

Name:

Phone:

Dates

From:

Own

(

)

Rent

To:

VEHICLE IDENTIFICATION

List Vehicle information for all vehicles that are owned or operated by any household member.

Tag/License Plate#

State Issued

Vehicle #1

Make/Model/Year

Vehicle #2

EMERGENCY CONTACT

List emergency contact

Name:

Address:

Phone:

(

)

Relationship:

Years Known:

SECTION 4: Background Information

Background Information

YES

NO

1. Do you expect any additions to the household within the next twelve months?

Name & Relationship: _________________________________________________________

Explain: ____________________________________________________________________

2. Is there anyone living with you now who won’t be living with you at this property?

Name & Relationship: _________________________________________________________

Explain: ____________________________________________________________________

3. Do you have full custody of your child(ren)? (If no, obtain proof of amount of time child(ren) will be living in

the unit)

Explain: ____________________________________________________________________

4. Are there any absent household members who under normal conditions would live with you?

(For example, a spouse away in the military.)

Explain: ____________________________________________________________________

5. Does your household have or anticipate having any pets other than those used as service

animals?

Explain: ____________________________________________________________________

6. Have you or anyone else named on this application filed for bankruptcy?

Explain: ____________________________________________________________________

7. Do you owe any money to a utility company?

Explain: ____________________________________________________________________

8. Have you or anyone else named on this application been convicted of a felony?

Explain: ____________________________________________________________________

9. Have you or anyone else named on this application been convicted for dealing or

manufacturing illegal drugs?

Explain: ____________________________________________________________________

10. Have you or anyone else named on this application been convicted of property damage?

Explain: ____________________________________________________________________

11. Have you or anyone else named on this application been evicted from a rental unit of any

type, including a home, apartment, mobile home, etc.?

Explain: ____________________________________________________________________

6 of 6

SECTION 5: Rental Program Questions

APPLICATION STATUS

The following questions pertain to specific eligibility requirements of the Tax Credit Program, please answer if you are

applying for any rental program.

YES

NO

1. Do you or any other ADULT household members claim zero income?

Household member: _________________________________________________________

Explain: ____________________________________________________________________

2. Are you or any other household members (INCLUDING MINORS) currently a full-time student

or expect to be one in the next 12 months?

Household member(s): ________________________________________________________

_______________________________________________________

_______________________________________________________

3. Will you or any ADULT household member require a live-in care attendant to live

independently?

Name of attendant: _________________________________________________________

Relationship (if any): __________________________________________________________

4. Will your household be receiving Section 8 rental assistance at time of move-in?

Name of Agency: ____________________________________________________________

Contact Person: _____________________________________________________________

5. Will your household be eligible or have you applied to receive Section 8 rental assistance?

(YOU MUST COMPLETE THE APPLICATION BEFORE BEING ELIGIBLE FOR NPTHA SUBSIDY.)

Name of Agency: ____________________________________________________________

Date of Application: __________________________________________________________

SECTION 6: IDA and MFA Questions

Financial Assistance Questionnaire

1. What type of home are you purchasing or interested in purchasing?

New manufactured

New Home already built

Existing home

Used manufactured

Build a new home

Existing home with improvements

(not eligible for IDA.)

2. Is the home you are interested in purchasing located within the Nez Perce Reservation boundaries (1855 Treaty)?

Yes

No

3. Will the home you purchase be your primary residence (at least 9 months per year)?

Yes

No

4. Do you have a plan for completing your purchase?

Explain: ____________________________________________________________

Estimated cost of home $: _________________________________ Estimated purchase date: _________________

Lender: _________________________________ Have you prequalified for a loan:__________________________

5. Which costs are you requesting from Mortgage Finance Assistance:

Down Payment

Inspection costs

Appraisal costs

Attorney costs

6. Which costs are you saving for:

Down Payment

goal amount$: _______

Inspection costs

goal amount$: _______

Appraisal costs

goal amount$: _______

Application fees

goal amount$: _______

Closing fees

goal amount$: _______

Improvement costs

goal amount$: _______

w/ purchase of home

7 of 7

SECTION 7: Signatures

Housing Counseling Agreement

It is a proven fact that Housing Counseling and Homebuyer Education classes prevent problems for renters and homebuyers. In order to

obtain housing assistance from the NPTHA, pre and post counseling is required by NPTHA policy. The pre-counseling will include at least

4 to 12 hours of educational instruction offered in group sessions, depending on the program assistance requested. Additional one-on-one

counseling can be required based on the needs of the family as determined by the NPTHA and the type of program assistance desired.

Post counseling may also be required on a month to month basis.

Classes will be conducted by NPTHA Housing Counselors in the Homeownership Opportunity Center. All Housing counseling

requirements apply to the head or heads of household; consequently, both heads of household or the equivalent must complete the

required classes and housing counseling sessions. Scheduling of individual sessions will be arranged to the greatest extent practical so

that your work obligations are not interrupted.

Please indicate by your signature below that you understand that your participation in the Housing Counseling Program is a requirement

for acceptance to the program and for continued occupancy. By your signature below, you also agree to contact a NPTHA Housing

Counselor to arrange for your participation classes.

Applicant Signature

Date

Co-Applicant Signature

Date

Signature Clause

I understand that the NPTHA is relying on this information to verify my household’s eligibility for NPTHA housing assistance programs. I

certify that all information and answers to the questions contained in this application are true and complete to the best of my knowledge. I

consent to release the necessary information to determine my eligibility including minors who will reside in the home. I understand that

providing false information or making false statements is considered grounds for denial of my application. I also understand that such

action may result in criminal penalties.

I authorize my consent to have the NPTHA verify the information contained in this application for purposes of providing my eligibility for

occupancy and/or any other housing assistance provided by the NPTHA. I will provide all necessary information including source(s) of

income, names, addresses, phone numbers, account number where applicable and any other information required for expediting the

application process. I hereby authorize and instruct the NPTHA to obtain and review my credit report for any prequalifying purposes. I

further understand that the NPTHA can at any time require a criminal background check on any of the applicants and occupants residing

in or applying to reside in the home. It is understood that assistance may be denied or discontinued as a result of allegations or conviction

of a crime that is a violation of the NPTHA policies.

My signature below also authorizes the release of account information from and to other financial institutions that I have supplied to the

NPTHA in connection with such evaluation. In other words, I understand that the processing of this application will require providing my

information to an agency as well as an agency providing personal information to the NPTHA. I understand that acceptance for occupancy

is contingent on all occupants meeting NPTHA’s resident selection criteria and the applicable Program requirements and policies as they

now exist or as they may hereafter by be revised OR ADDED by the NPTHA.

Applicant Signature

Date

Co-Applicant Signature

Date

All additional ADULT household members must sign below indicating consent for the release of information

Signatures:

Other Family Member over age 18

Date

Other Family Member over age 18

Date

Other Family Member over age 18

Date

Other Family Member over age 18

Date

Other Family Member over age 18

Date

Housing Counselor Signature

Date

For Office Use Only

Total Household Income: Monthly: $

Income Classification:

Very-Low Income

annual$

Percentage of AMI:

Program Eligible:

8 of 8

Pre-qualification summary

Make/Model/Year$

Low Income

Moderate Income

Above Income

Bedroom Size Elibible

LR

LIHTC

SH

OPP

Lot

IDA

MFA

Authorization for the Release of Information/

Privacy Act Notice

to the U.S. Department of Housing and Urban Development (HUD)

and the Housing Agency/Authority (HA)

PHA requesting release of information; (Cross out space if none)

(Full address, name of contact person, and date)

IHA requesting release of information: (Cross out space if none)

(Full address, name of contact person, and date)

Authority: Section 904 of the Stewart B. McKinney Homeless

Assistance Amendments Act of 1988, as amended by Section 903

of the Housing and Community Development Act of 1992 and

Section 3003 of the Omnibus Budget Reconciliation Act of 1993.

This law is found at 42 U.S.C. 3544.

This law requires that you sign a consent form authorizing: (1)

HUD and the Housing Agency/Authority (HA) to request verification of salary and wages from current or previous employers; (2)

HUD and the HA to request wage and unemployment compensation claim information from the state agency responsible for

keeping that information; (3) HUD to request certain tax return

information from the U.S. Social Security Administration and the

U.S. Internal Revenue Service. The law also requires independent

verification of income information. Therefore, HUD or the HA

may request information from financial institutions to verify your

eligibility and level of benefits.

Purpose: In signing this consent form, you are authorizing HUD

and the above-named HA to request income information from the

sources listed on the form. HUD and the HA need this information

to verify your household’s income, in order to ensure that you are

eligible for assisted housing benefits and that these benefits are set

at the correct level. HUD and the HA may participate in computer

matching programs with these sources in order to verify your

eligibility and level of benefits.

Uses of Information to be Obtained: HUD is required to protect

the income information it obtains in accordance with the Privacy

Act of 1974, 5 U.S.C. 552a. HUD may disclose information

(other than tax return information) for certain routine uses, such as

to other government agencies for law enforcement purposes, to

Federal agencies for employment suitability purposes and to HAs

for the purpose of determining housing assistance. The HA is also

required to protect the income information it obtains in accordance

with any applicable State privacy law. HUD and HA employees

may be subject to penalties for unauthorized disclosures or improper uses of the income information that is obtained based on the

consent form. Private owners may not request or receive

information authorized by this form.

Who Must Sign the Consent Form: Each member of your

household who is 18 years of age or older must sign the consent

form. Additional signatures must be obtained from new adult

members joining the household or whenever members of the

household become 18 years of age.

Original is retained by the requesting organization.

U.S. Department of Housing

and Urban Development

Office of Public and Indian Housing

OMB Control Number 2577-0295

Expiration Date 1/31/2025

Persons who apply for or receive assistance under the following

programs are required to sign this consent form:

PHA-owned rental public housing

Turnkey III Homeownership Opportunities

Mutual Help Homeownership Opportunity

Section 23 and 19(c) leased housing

Section 23 Housing Assistance Payments

HA-owned rental Indian housing

Section 8 Rental Certificate

Section 8 Rental Voucher

Section 8 Moderate Rehabilitation

Failure to Sign Consent Form: Your failure to sign the consent

form may result in the denial of eligibility or termination of

assisted housing benefits, or both. Denial of eligibility or termination of benefits is subject to the HA’s grievance procedures and

Section 8 informal hearing procedures.

Sources of Information To Be Obtained

State Wage Information Collection Agencies. (This consent is

limited to wages and unemployment compensation I have received during period(s) within the last 5 years when I have

received assisted housing benefits.)

U.S. Social Security Administration (HUD only) (This consent is

limited to the wage and self employment information and payments of retirement income as referenced at Section 6103(l)(7)(A)

of the Internal Revenue Code.)

U.S. Internal Revenue Service (HUD only) (This consent is

limited to unearned income [i.e., interest and dividends].)

Information may also be obtained directly from: (a) current and

former employers concerning salary and wages and (b) financial

institutions concerning unearned income (i.e., interest and dividends). I understand that income information obtained from these

sources will be used to verify information that I provide in

determining eligibility for assisted housing programs and the level

of benefits. Therefore, this consent form only authorizes release

directly from employers and financial institutions of information

regarding any period(s) within the last 5 years when I have

received assisted housing benefits.

ref. Handbooks 7420.7, 7420.8, & 7465.1

form HUD-9886 (7/94)

Consent: I consent to allow HUD or the HA to request and obtain income information from the sources listed on this form for

the purpose of verifying my eligibility and level of benefits under HUD’s assisted housing programs. I understand that HAs that

receive income information under this consent form cannot use it to deny, reduce or terminate assistance without first

independently verifying what the amount was, whether I actually had access to the funds and when the funds were received. In

addition, I must be given an opportunity to contest those determinations.

This consent form expires 15 months after signed.

Signatures:

_____________________________________________

______________

Head of Household

Date

___________________________________________

Social Security Number (if any) of Head of Household

__________________________________________________

Other Family Member over age 18

________________

Date

__________________________________________________

Spouse

_______________

Date

__________________________________________________

Other Family Member over age 18

________________

Date

__________________________________________________

Other Family Member over age 18

_______________

Date

__________________________________________________

Other Family Member over age 18

________________

Date

__________________________________________________

Other Family Member over age 18

_______________

Date

__________________________________________________

Other Family Member over age 18

________________

Date

Privacy Act Notice. Authority: The Department of Housing and Urban Development (HUD) is authorized to collect this information

by the U.S. Housing Act of 1937 (42 U.S.C. 1437 et. seq.), Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), and by the Fair

Housing Act (42 U.S.C. 3601-19). The Housing and Community Development Act of 1987 (42 U.S.C. 3543) requires applicants and

participants to submit the Social Security Number of each household member who is six years old or older. Purpose: Your income and

other information are being collected by HUD to determine your eligibility, the appropriate bedroom size, and the amount your family

will pay toward rent and utilities. Other Uses: HUD uses your family income and other information to assist in managing and monitoring

HUD-assisted housing programs, to protect the Government’s financial interest, and to verify the accuracy of the information you provide.

This information may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory

investigators and prosecutors. However, the information will not be otherwise disclosed or released outside of HUD, except as permitted

or required by law. Penalty: You must provide all of the information requested by the HA, including all Social Security Numbers you,

and all other household members age six years and older, have and use. Giving the Social Security Numbers of all household members

six years of age and older is mandatory, and not providing the Social Security Numbers will affect your eligibility. Failure to provide

any of the requested information may result in a delay or rejection of your eligibility approval.

Penalties for Misusing this Consent:

HUD, the HA and any owner (or any employee of HUD, the HA or the owner) may be subject to penalties for unauthorized disclosures or improper uses of

information collected based on the consent form.

Use of the information collected based on the form HUD 9886 is restricted to the purposes cited on the form HUD 9886. Any person who knowingly or willfully

requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more

than $5,000.

Any applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, against

the officer or employee of HUD, the HA or the owner responsible for the unauthorized disclosure or improper use.

Original is retained by the requesting organization.

ref. Handbooks 7420.7, 7420.8, & 7465.1

form HUD-9886 (7/94)

Nez Perce Tribal Housing Authority

P.O. Box 188

Lapwai, ID 83540

Phone: 208.843.2229 Fax: 208.843.2973

Employment Income Verification

Employers Name:

Phone #:

Address:

Fax #:

The Applicant/Tenant named below has applied for occupancy in one of our homes or is a current tenant. Due to the requirements of

our various funding sources, we must verify all income and assets for this person and their household to determine eligibility. Please

complete the following information and return it as soon as possible to the NPTHA Office via mail or fax.

NPTHA Representative: ________________________________________________

Applicant/Tenant Release Statement

Applicant/Tenant Name: ____________________________________________ Social Security #:_____________________

I hereby authorize the release of the following information to determine my eligibility for occupancy in a unit managed by the Nez Perce

Tribal Housing Authority. Please complete this form in full and return to the NPTHA at your earliest convenience.

Signature: _______________________________________________________ Date: ______________________________

This Section to be Completed by Employer

Please do not leave any sections blank; enter zero “0” or N/A

Employee Name: ___________________________________

Presently Employed: [ ] Yes [ ] No

Job Title_______________________________

Employment Start Date:________ Last Date of Employment (if applicable):_________

Current Wage/Salary: $______ (check one):

[ ] Hourly [ ] Weekly [ ] Bi-Weekly [ ] Monthly [ ] Semi-Monthly [ ] Yearly [ ] Other

Average # of Regular Hours Per Week: _____

Year-to-Date Earnings: $______ from (mm/dd/yy) _____through (mm/dd/yy) _____

Overtime Rate:

$______ per hour

Average # of overtime hours per week: ______

Shift Differential: $______ per hour

Average of differential hours per week: ______

Commissions, Bonuses, Tips, Other: $______ (check one):

[ ] Hourly [ ] Weekly [ ] Bi-Weekly [ ] Monthly [ ] Semi-Monthly [ ] Yearly [ ] Other

List any anticipated change in the employee’s rate of pay within the next 12 months: ________ Effective Date: ________________

If the employee work is seasonal or sporadic, please indicate the layoff period(s): _______________________________________

Additional Remarks:

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Employer’s Printed Name:____________________ Employer’s Signature:____________________ Date ________________

Your assistance in completing this form accurately and timely is greatly appreciated!

Nez Perce Tribal Housing Authority

P.O. Box 188

Lapwai, ID 83540

Phone: 208.843.2229 Fax: 208.843.2973

Employment Income Verification

Employers Name:

Phone #:

Address:

Fax #:

The Applicant/Tenant named below has applied for occupancy in one of our homes or is a current tenant. Due to the requirements of

our various funding sources, we must verify all income and assets for this person and their household to determine eligibility. Please

complete the following information and return it as soon as possible to the NPTHA Office via mail or fax.

NPTHA Representative: ________________________________________________

Applicant/Tenant Release Statement

Applicant/Tenant Name: ____________________________________________ Social Security #:_____________________

I hereby authorize the release of the following information to determine my eligibility for occupancy in a unit managed by the Nez Perce

Tribal Housing Authority. Please complete this form in full and return to the NPTHA at your earliest convenience.

Signature: _______________________________________________________ Date: ______________________________

This Section to be Completed by Employer

Please do not leave any sections blank; enter zero “0” or N/A

Employee Name: ___________________________________

Presently Employed: [ ] Yes [ ] No

Job Title_______________________________

Employment Start Date:________ Last Date of Employment (if applicable):_________

Current Wage/Salary: $______ (check one):

[ ] Hourly [ ] Weekly [ ] Bi-Weekly [ ] Monthly [ ] Semi-Monthly [ ] Yearly [ ] Other

Average # of Regular Hours Per Week: _____

Year-to-Date Earnings: $______ from (mm/dd/yy) _____through (mm/dd/yy) _____

Overtime Rate:

$______ per hour

Average # of overtime hours per week: ______

Shift Differential: $______ per hour

Average of differential hours per week: ______

Commissions, Bonuses, Tips, Other: $______ (check one):

[ ] Hourly [ ] Weekly [ ] Bi-Weekly [ ] Monthly [ ] Semi-Monthly [ ] Yearly [ ] Other

List any anticipated change in the employee’s rate of pay within the next 12 months: ________ Effective Date: ________________

If the employee work is seasonal or sporadic, please indicate the layoff period(s): _______________________________________

Additional Remarks:

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Employer’s Printed Name:____________________ Employer’s Signature:____________________ Date ________________

Your assistance in completing this form accurately and timely is greatly appreciated!

General Income Verification

Source’s Mailing Address:

Requestor:

Phone #:

(

)

Fax #:

(

)

Date:

The applicant named above has applied for housing assistance to be provided through the Nez Perce Tribal Housing Authority Program.

We must verify all income and asset sources of this person and their household to determine eligibility. Please complete the following

information and return as soon as possible to the NPTHA Office.

Your assistance in completing this form accurately and timely is greatly appreciated!

Applicant/Tenant Release Statement:

Applicant/Tenant Name:

Date:

I hereby authorize the release of the following information in order to determine my eligibility for the Nez Perce Tribal Housing Program.

Please complete this form in full and return it to the NPTHA at your earliest convenience.

Signature:

Social Security #:

Check the type(s) of income received, the GROSS amount CURRENTLY receiving, and date began receiving benefit:

Income Type

Amount

Earned Wages

$

General Assistance

$

Unemployment

$

Veteran’s Benefit, Retirement Pay or Annuity

$

Disability/SSI

$

TANF

$

Income from Real Estate/Lease

$

Child Support, Alimony, Etc.

$

Per Capita

$

Income from Real Estate/Lease:

$

Other:

$

Frequency

(Please list type)

Are there any expected changes in the next 12 months?

Signature of Source:

Date Completed Form:

NPTCP Use Only:

Comments:

Phone #:

Date First Started

General Income Verification

Source’s Mailing Address:

Requestor:

Phone #:

(

)

Fax #:

(

)

Date:

The applicant named above has applied for housing assistance to be provided through the Nez Perce Tribal Housing Authority Program.

We must verify all income and asset sources of this person and their household to determine eligibility. Please complete the following

information and return as soon as possible to the NPTHA Office.

Your assistance in completing this form accurately and timely is greatly appreciated!

Applicant/Tenant Release Statement:

Applicant/Tenant Name:

Date:

I hereby authorize the release of the following information in order to determine my eligibility for the Nez Perce Tribal Housing Program.

Please complete this form in full and return it to the NPTHA at your earliest convenience.

Signature:

Social Security #:

Check the type(s) of income received, the GROSS amount CURRENTLY receiving, and date began receiving benefit:

Income Type

Amount

Earned Wages

$

General Assistance

$

Unemployment

$

Veteran’s Benefit, Retirement Pay or Annuity

$

Disability/SSI

$

TANF

$

Income from Real Estate/Lease

$

Child Support, Alimony, Etc.

$

Per Capita

$

Income from Real Estate/Lease:

$

Other:

$

Frequency

(Please list type)

Are there any expected changes in the next 12 months?

Signature of Source:

Date Completed Form:

NPTCP Use Only:

Comments:

Phone #:

Date First Started

Landlord Reference Check

Name of Applicant:

Home Community Applying For:

Reference Performance Method:

Telephone

Person-to-Person

Written

Own

Rental

Other

)

Fax #:

Name of Person Performing Reference:

Address of Previous Residence:

Type of Residence

Landlord’s Name:

Phone #:

(

Type of Landlord:

Dates of Residency:

Management Co.

(

)

Real Estate Co.

From:

Private Owner

To:

Amount of Monthly Rent:

# of Occupants:

# of Late Payments:

# of Returned Checks:

# of Disturbance Complaints:

# of Times Police Called:

YES

NO

1.

Did the resident or his family/guests damage the home or the property?

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2.

Did the resident pay for the damages?

3.

Does this person maintain good housekeeping practices?

4.

Did the resident violate the lease agreement in any way?

5.

Did the resident violate any of your house rules in any way?

6.

Was/is there any drug or other illegal activity connected with this resident?

7.

Did the resident give the proper notice for vacating the unit?

8.

Was this person evicted?

9.

Would you rent to this individual again?

10.

Do you currently have any legal proceeding/litigation pending with this resident?

11.

Did the resident have any pets?

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Applicant/Tenant Release Statement & Signature:

I Hereby Authorize the release of the above information to determine my eligibility for the Housing Credit Program. Please complete this

form in full and return it to the NPTHA at your earliest convenience.

Signature: __________________________________

Signature:

Date:

Title:

Office Use Only:

Received:

SSN# _____________________________

Comments: