Catholic Charities Hawaii
Rent Assistance and Mediation Program (RAMP) This program is different from previous COVID19 assistance programs that Catholic Charities Hawaii (CCH) has administered before. Please read application packet to its entirety. If you have already received RRHAP assistance you have to re-apply for RAMP funding. This is a different funding source from RRHAP so the applications will not carry over.Program Eligibility:Full-time resident of the State of HawaiiHas unpaid rent and a valid tenancy agreement for primary residence in the State of Hawaii. Primary residence has to be a 6 months’ valid tenancy agreement or longer. Month to month rental agreements are eligible if initial tenancy agreement was for 6 months and longer.18 years of age or olderDemonstrates a loss of income directly resulting from the COVID-19 pandemicCurrent household income does not exceed 100% AMI (as defined by HUD 2020 Income Limits)No asset limitsThis program cannot pay for rent that has been paid by tenant or another entity. This program cannot make payments for applicants receiving subsidized assistance where applicant pays a percentage of income for rent and the balance is subsidized by government, such as but not limited to: Section 8, Public Housing, etc. Maximum Assistance Per Applicant: Monthly rent payments of up to $1,500.00 or mediation services of up to $500.00 per household, statewide, will be made directly to the landlord or mediation agency. Rent payments can be made in lump sum amounts for a maximum of two months. Payment for mediation services will be up to $500.00 per household. To submit your completed application:Applications will only be accepted within the timeframe below. Please note that the timeframe for an online application versus a hard copy or electronic version are different. Any applications outside of the timeframes posted below will not be considered and discarded. Online Application will be open between January 11, 2021 to January 13, 2021 between 8:00am to 5:00pm. Please do not start your online application at 4:30pm as it may time outIf applying online, please ensure you have good internet and apply through a desktop computer or laptop as mobile devices may time outStandard mail in applications, fax applications, or email applications, must be post marked or sent between January 11, 2021 – January 18, 2021If you choose to mail in your application, please mail to: 1822 Keeaomuku Street Honolulu, HI 96822 Attn: COVID19 Help – RAMP. Keep in mind that there have been significant mail delays this year. NOTE: Please DO NOT send in any document with this initial application! CCH or a partner agency will review your application and contact you if it meets the program qualifications. At that time, we will request the needed documentation.To Request an Application Form:Requests for an application can be mailed, faxed, and emailed upon request between January 6, 2021 to January 13, 2021. Application requests outside of this timeframe will not be consideredCall/email/mail/fax the Oahu Catholic Charities Hawaii office to request an applicationCall: (808) 521-4357Please listen carefully and choose the COVID19 prompt (#1)Please leave a clear message stating: your name, mailing address, and phone number. Please repeat your phone number twiceEmail: COVID19help@Mail: 1822 Keeaumoku Street Honolulu, HI 96822 - Attn: COVID19 Help – RAMPFax: (808) 527-4439 - Attn: COVID19 Help - RAMPYou may also visit our website directly at: , to download an electronic copy or wait for the Online Application link to activate on January 11, 2021 to January 13, 2021 between 8:00am to 5:00pm.Important – When completing the application:Please let your landlord know that you are applying for rental assistance and have their contact information readily available, especially if you are applying online: Name, mailing address, email address, phone number.Please ensure that you double check your email (@ symbol is present, no spaces, spelling, etc.) as this will be the main mode of notification and communicationActively check and monitor the email address you have provided (especially your spam/junk folder) and actively check your voicemailPlease ensure that the voicemail on the phone number you list is set up and not fullApplication processing:We estimate that funds will cover approximately 2,000 applications and demand great enough to reach capacity in a weekWe will be processing applications on a priority basis to help very low income households:Household income is at 50% AMI or below We will be providing accommodations to give applicants equal access to assistance Translation of application in certain languages and interpreter services for households with Limited English Proficiency (LEP)Mailing of the application to households that have technology challenges between January 6, 2021 to January 13, 2021. All applications must be post marked or sent (email or fax) between January 11, 2021 – January 18, 2021. Any applications submitted outside of this timeframe will not be considered and discarded. Email: COVID19help@ Please tell us which ISLAND you live on the SUBJECT linePhone, Mail or Fax: Oahu OfficeCatholic Charities Hawai‘i Clarence T.C. Ching Campus1822 Ke‘eaumoku StreetHonolulu, HI 96822Oahu Help Line: (808) 521-4357Oahu Fax: (808) 527-4439 Attention: COVID19 Help - RAMPHilo OfficeCatholic Charities Hawai‘i62 Kinoole Street Hilo, HI 96720HI Island Help Line: (808) 961-7050 HI Island Fax: (808) 961-7039Attention: COVID19 Help – RAMPMaui OfficeCatholic Charities Hawai‘i2050 Main Street, Suite 3AWailuku, HI 96793Maui County Help Line: (808) 873-4673Maui County Fax: (808) 872-6219Attention: COVID19 Help - RAMPKauai OfficeCatholic Charities Hawai‘i4373 Rice Street, Suite 1Lihue, HI 96766 Kauai Help Line: (808) 241-4673Kauai Fax: (808) 632-6919 Attention: COVID19 Help - RAMPCatholic Charities Hawaii (CCH) Rent Assistance and Mediation Program (RAMP) ApplicationDo you need an interpreter? FORMCHECKBOX No FORMCHECKBOX YesIf YES, language? FORMTEXT ?????Are you applying for your household? FORMCHECKBOX No FORMCHECKBOX Yes (if Yes, skip to #1)Are you applying on someone’s behalf and consent has been confirmed? FORMCHECKBOX No FORMCHECKBOX YesConsent was provided on this date and via: FORMTEXT ????? FORMCHECKBOX Verbally FORMCHECKBOX EmailOther: FORMTEXT ?????Partner Agency you are from: FORMTEXT ?????Other entity: FORMTEXT ?????APPLICANT Last NameFirst NameMI FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????SSN (last 4 digits)*EmailPhone Number FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PROPERTYProperty AddressCityZip FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Which Island do you live on? FORMTEXT ?????HOUSEHOLD COMPOSITION – ADULTS only (Please list household members in the order as they appear on the Lease/Rental Agreement. If you have adult household members not on your lease, please list them as well.)Member NumberLast NameFirst NameMIRelationship to ApplicantDate of Birth (MM/DD/YY)SS# (Last 4 Digits)*1 FORMTEXT ?????2? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????6? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8? FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????* For ADULTS only. Last 4 of Social Security Number. If No SSN, use the last 4 digits from Valid Government IDAdditional Adult Household Members (If more space is needed, please attach a separate sheet): FORMTEXT ?????How many minor children (17 years old and younger) are in the household? FORMTEXT ?????FINANCIAL ASSISTANCEHave you applied or are planning to apply to other financial assistance programs for rent? FORMCHECKBOX No FORMCHECKBOX YesIf YES, from where (list dates + all agencies): FORMTEXT ?????COVID-19 RELATEDThis is a COVID-19 related financial assistance program. How has COVID-19 affected you so you could not pay rent? Please explain: FORMTEXT ?????You must be able to provide documentation to support your situation. Examples: Employer layoff/furlough letter, notification of business closure, etc. Do you have documentation? FORMCHECKBOX No FORMCHECKBOX YesIf YES, what document will you be providing?: FORMTEXT ?????HOUSEHOLD INCOME - INCOME LIMIT CHART (100% AMI)Household size12345678910Honolulu (Oahu)$88,200$100,800$113,400$125,900$136,000$146,100$156,200$166,200$176,300$186,400Hawai‘i Island$58,400$66,700$75,000$83,300$90,000$96,700$103,300$110,000$116,700$123,300Maui County$71,800$82,000$92,300$102,500$110,700$118,900$127,100$135,300$143,500$151,700Kaua‘iCounty$68,000$77,700$87,400$97,100$104,900$112,700$120,500$128,200$136,000$143,800This program can only assist households who are at or below the 100% AMI gross income limit for their county (please see chart above). To figure out if your household meets this requirement, please ask for: Unemployment/PUA benefits statementIf this benefit is still pending, the income is $0.00If working, two (2) of the most current employment pay stubs You will have to look at the GROSS pay and not the “take home” payAny other income: social security, disability, welfare/TANF, etc.Food stamps are not to be included in your Household Gross Income calculationIf you are having difficulties obtaining income documents, please notify a CCH office or partner agency.INCOME QUALIFICATION (Provide income information for ALL ADULT household members even if they do not have income)Household Member NumberTotalGross Annual IncomeIncome Affected by COVID-19 (Y/N)Types of Income 1 FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????2 FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????3 FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????4 FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????5 FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????6 FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????7 FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ?????8 FORMTEXT ?????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT =Mem1Income+Mem2Income+Mem3Income+Mem4Income+Mem5Income+Mem6Income+Mem7Income+Mem8Income+Mem9Income+Mem10Income 00.00← Total Current Household gross annual income~Please note that the above income documents will have to be provided by you at a later time~OPTIONAL CCH DEMOGRAPHIC DATA for ADULTS onlyHousehold Member NumberGender*Race**1 FORMDROPDOWN FORMDROPDOWN * Gender: M, F, Other/Prefer not to say2 FORMDROPDOWN FORMDROPDOWN 3 FORMDROPDOWN FORMDROPDOWN ** Race: 1 - Asian2 - Black/African American3 - Native Hawaiian/Pacific Islander 4 - White/Caucasian5 - Native American/Alaska Native6 - Other/Prefer not to say4 FORMDROPDOWN FORMDROPDOWN 5 FORMDROPDOWN FORMDROPDOWN 6 FORMDROPDOWN FORMDROPDOWN 7 FORMDROPDOWN FORMDROPDOWN 8 FORMDROPDOWN FORMDROPDOWN TYPE OF ASSISTANCE REQUESTEDWhat is the base rent you pay every month? _ FORMTEXT ?????__ (Do NOT include tax, late fees, parking, utilities, etc.)Maximum rent assistance per household per month is $1,500.00 statewide, or the amount owed per month, whichever is less. You can request a maximum of two (2) months which is $3,000.00 maximum total. ~IMPORTANT: This program cannot pay for rent that has already been paid by you or another entity. If rent has been paid and a program check has been processed, that check will be voided and should be sent back to CCH. If the check has been deposited by your landlord for rent that has already been paid, a refund for the amount of the already paid rent will have to be paid back to CCH. Example:If your monthly rent is $1,000.00, you will list $1,000.00 below per month for a maximum of two (2) months (total of $2,000.00). If your monthly rent is $2,500.00, you will list $1,500.00 below per month for a maximum of two (2) months (total of $3,000.00).MonthRent Amount RequestedJanuary 2021 FORMTEXT ?????February 2021 FORMTEXT ?????March 2021 FORMTEXT ?????April 2021 FORMTEXT ?????Total Amount(s) FORMTEXT ?????When requested, you will have to provide your:Valid and Current Tenancy Agreement(this includes: month to month if initial tenancy agreement was for six months and more)LANDLORD/PROPERTY MANAGER INFORMATION Please let your Landlord/Property Manager know that they will be contacted by CCH or a partner agency for the purpose of this program. They must complete a Vendor Verification Form which asks to confirm your situation and their W9 information. **This form must be completed to process your application packet.Landlord/Property Manager Name: FORMTEXT ?????Mailing Address: FORMTEXT ?????City, Zip Code FORMTEXT ?????Phone Number: FORMTEXT ?????Email Address: FORMTEXT ?????10. Other RESOURCESAre you interested in Mediation resources? FORMCHECKBOX No FORMCHECKBOX Yes11. Mental Health/Counseling RESOURCESIt seems that you are going through a stressful situation right now. Did you want to explore counseling resources? If Yes, please call (808) 527-4470 = CCH Counseling Center (Oahu, Maui County, Kauai). For Hawaii County, please call (808) 961-7000.CERTIFICATIONBy submitting your application and documents to Catholic Charities Hawaii and partners, "I/We certify that the information given on this form is true and accurate to the best of my/our knowledge. I have included all household members. I am/We are aware that there are penalties for willfully and knowingly giving false information on an application for Federal or State funds. Penalties for falsifying information may include immediate repayment of all Federal or State funds received and/or prosecution under the law. I understand that the documentation packet must be submitted in a timely manner. I understand that the information on this form is subject to verification. And I authorize my landlord/property manager to release requested information on Vendor Verification Form to Catholic Charities Hawaii or partner agency."STATEMENT OF CONSENTInformation collected in this application will be shared with the Hawaii Housing Finance and Development Corporation and partner agencies working with Catholic Charities Hawaii.I have read the Statement of Consent and by submitting my application and documents, I agree to share the items listed above._ FORMTEXT ?????______________ ___ FORMTEXT ?????____________________ _ FORMTEXT ?????__Print NameSignature (signed or typed)Date ................
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