ARE YOUR HOUSING COSTS TOO HIGH



New York State Emergency Rental Assistance Program

for Underwood Estates

The NYS Emergency Rental Assistance Program is a way to help with emergency

rental costs while you recover from the flood. It may help you afford a better place

to live, or, if you like where you are living now, it may help you pay your rent

and security deposit.

YOU WILL QUALIFY IF:

You were a resident of Underwood Estates Mobile Home Park and were displaced by

flooding. The level of your assistance will be based current housing expenses and

reasonableness of cost.

HOW THE PROGRAM WORKS:

1. Application: Complete this Preliminary Application.

2. Verification: Provide information as necessary, including identification of household members, current housing expenses, and proof of residency at time of natural disaster (such as driver license, college identification, Social Security Card, utility bills, and other forms of verification).

3. Rent Certification: Have the landowner that is providing you with temporary housing complete and sign the Verification of Rent Certification. You will also sign the certification to confirm your acceptance of the housing arrangement.

4. Review: Your application and rent certification will be reviewed to determine the level of assistance. Staff may inspect the dwelling for occupancy and acceptability.

5. Payments: Funds may pay a portion of, or all of, your rent to your landlord each month, for up to three months, in addition to a security deposit. Housing payments will be issued to the landlord as quickly as possible each month.

A. Applicant

Name: ___________________________________________________

Current Mailing Address: ____________________________________

Town, State, Zip: ___________________________________________

Telephone: _______________________________________________

Present Landlord: __________________________________________

Address: _________________________________________________

Landlord's Telephone: ______________________________________

B. Residence at Underwood Estates Mobile Home Park

Address:

Lot Rent Amount $

Do you own home?

If so, how much is your month loan amount? $

Were you renting home?

If so, how much was your monthly rent? $

List ALL Family Members (including you as head):

| | | | |Race: | |

|Name |Sex |Relationship to you|Ethnicity: |W-White |Gross Annual Income |

|(First, MI, Last) | | | |B-Black | |

| | | |Hispanic or |N-Native American |(Optional) |

| | | |Non-Hispanic |P-Pacific Islander | |

| | | | |A-Asian | |

| | | |(Optional) |(Optional) | |

| | | | | | |

|1. | |HEAD | | | |

| | | | | | |

|2. | | | | | |

| | | | | | |

|3. | | | | | |

| | | | | | |

|4. | | | | | |

| | | | | | |

|5. | | | | | |

| | | | | | |

|6. | | | | | |

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CLINTON COUNTY HOUSING

24 MARGARET, SUITE 7

PLATTSBURGH, NY 12901

PH:518.825.0800

FAX: 518.563.2824

TDD # (800) 421-1220 (For the hearing impaired)

FOR OFFICE USE ONLY:

APPLICATION

C. Housing Information

Has any other agency ever helped you pay your rent?

If so, list the name, address, and phone number of the

agency:

___________________________________________

___________________________________________

D. Contact Information

Please list the name and phone number of two people we may call to

help us locate you.

_______________________________________________________

Name Phone

_______________________________________________________

Name Phone

You MUST include and income information for EACH member of the family.

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