In the process of securing housing assistance or a spot on a waiting list for subsidized housing, individuals and families often encounter various forms of paperwork and forms, one of which includes the MF-NREDC-102 form. This particular pre-application form serves as the initial step for those hoping to be placed on a site-based waiting list lottery for units at Community Parkway Housing, featuring 520 units with 2 and 3 bedrooms. Specifically designed for the Richmond, CA area, the form requires applicants to provide comprehensive information, including personal identification, household composition, and preference indicators that might affect their placement on the waiting list. With a strict application deadline highlighted, the form underscores the importance of timely and complete submissions, warning that incomplete or duplicate applications will be outright rejected. Additionally, the form details the requirement for applicants to furnish evidence and documentation upon selection for assistance, emphasizing the thorough vetting process. Preferences cater to families, individuals with disabilities, those displaced by natural disasters or government actions, and residents or employees of the City of Richmond. The applicant certification section at the end of the form acts as a legal affirmation of the veracity of the provided information, hinting at the legal implications of misrepresentation.
| Question | Answer |
|---|---|
| Form Name | Form Mf Nredc 102 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | Parkway_Housing Waitlist_Pre Application 520 526 south 28th st richmond form |
Website:www.chdcnr.com
PLEASEANSWERALLQUESTIONS. INCOMPLETEandDUPLICATEAPPLICATIONSWILLBEREJECTED.
Part1:Application/WaitingListIdentification
This
CommunityParkway Housing 520 NSP Units 2 and 3 Bedrooms Only
APPLICATION DEADLINE SEPTEMBER 7, 2012 AT 5:00 PM
Part2: ApplicantIdentification
Pleasenotethatapplicantswill berequiredtoprovideevidenceand documentation when selectedforassistance.
1. NameofApplicant/HeadofHousehold:
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DateofBirth: |
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AgeonDateof Application: |
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SocialSecurityNumber: |
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- ______ |
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Address: |
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(Street) |
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(apt.) |
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(City)(State)(Zip)
Pleaseprovideareliablemailingaddresswhereyoucanbereached. Sameasabove?( ) Yes ( ) No
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MailingAddress: |
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(Street orP.O.Box) |
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(apt.) |
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(City) |
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TelephoneNumber: ( |
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AlternateTelephoneNo.: ( |
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7.EmailAddress:
8.Ifyouwishtoprovideanadditionalcontactpersonororganization;pleaseindicatenameandcontact
information:
9.Whatisyourrace(applicantHeadofHousehold)?Pleaseindicateone ormoreasappropriate: (optional section)
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( )AmericanIndian/AlaskanNative |
( )Asian ( )NativeHawaiian/OtherPacificIslander |
10. WhatisyourEthnicity? ( )Hispanic |
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Revised 8/1/2012 |
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Part3:PreferenceInformation(Pleaseanswereachquestionasindicated;additionalinformationorverificationmayberequired.)
11. |
Aretheretwo(2)ormorepeopleinyourapplicantfamily? |
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)NO |
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Is anyothermemberofyourhouseholda personwithadisability? |
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)NO |
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Hasyourfamilybeendisplacedduetonaturaldisasterorgovernmentaction? |
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) YES |
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)NO |
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HasyourfamilybeenterminatedfromtheSection8HousingChoiceVoucherProgram and/or Section 8 Subsidized Housing?( ) |
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YES ( )NO |
IfYes,which one? |
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Areyoua residentof theCityof Richmond oremployedintheCityof Richmond? |
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)NO |
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17. How did you hear about us? _________________________________________________________________
Part4: HouseholdInformation
Listallpeoplewhowouldbe inyourhouseholdunderthispre- application,includingyourself.Providetherequiredinformationforallmembers. Pleaseprintclearly.
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TANF,SSI,etc.) |
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below)* |
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HeadofHousehold |
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TotalAnnual Gross FamilyIncomefromallSources:
*RelationshipKey:(indicateappropriatewordorletter):HeadofHousehold=H;
Part5: ApplicantCertification
Icertifythatallthe informationgivenaboveistrueandcomplete. Iunderstandthat,pursuantto Section1001of TitleXVIIIof theUnitedStateCode,anymisrepresentationorwillfully falsestatementsmadetoaDepartmentorAgencyof theUnitedStates Governmentisgroundsfordenialorterminationof assistanceandpunishableby fineand/or imprisonment.
ApplicantSignature:Date:
Revised 8/1/2012 |
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