Finding the right affordable housing option can be an intricate process, especially for those applying through Federal affordable housing programs like the Low-Income Housing Tax Credit (LIHTC) program. The Ingerman Application for Housing forms an essential initial step in assessing an applicant's eligibility for such housing opportunities. This comprehensive form meticulously gathers a wide array of information, spanning from basic identification details to more nuanced data regarding household composition, rental history, and financial stature. Applicants are prompted to disclose information not only about themselves but also about every individual who might reside in the household, including those temporarily away. This includes addressing potential changes in household size, rental history, including previous evictions or criminal convictions, and detailed income sources from employment, self-employment, alimony, or child support, among others. Applicants are also asked about student status, expected changes in household income, and possession of any accounts or assets, ensuring a thorough scrutiny is done to uphold the integrity of the program's eligibility criteria. It is paramount for applicants to approach this form with honesty and precision, as providing false information could lead to the loss of housing eligibility. By encapsulating critical elements needed to assess applicants' qualifications for housing assistance, the application serves as a crucial tool in the LIHTC's efforts to facilitate access to affordable housing.
| Question | Answer |
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| Form Name | Ingerman Application Form |
| Form Length | 7 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 45 sec |
| Other names | application housing lihtc printable, ingerman affordable housing toms river nj, application housing lihtc form, ingerman properties |
Date & Time Stamp
Property: __________________
Unit #: ___________________
Set Aside: _________________
APPLICATION FOR HOUSING - LIHTC
NOTE TO APPLICANT: In order for us to determine your eligibility or continued eligibility, you must provide all information included in this application. This information is considered confidential and will only be used as necessary in determining your eligibility for a Federal affordable housing program.
PROVIDING FALSE INFORMATION MAY RESULT IN LOSS OF YOUR HOUSING
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Applicant Name: |
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Home Telephone Number: |
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Address: |
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Apt. Number: |
Cell Phone Number: |
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Email Address: |
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What size apartment are you applying for? |
Studio 1 – 2 – 3 – 4 – 5 (circle one) |
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HOUSEHOLD COMPOSITION
Please read each question carefully, answer each question completely and be prepared to verify items checked “yes”.
List yourself and anyone who will live with you within the next 12 months. Be sure to include members temporarily away from home, including (but not limited to): dependents away at school, military persons stationed away from home that have a spouse or dependent in the home.
Please list household members starting with Head of household on line 1, then in order of oldest to youngest.
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Student Status: |
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Relationship |
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(Includes Elementary |
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Last Name, First Name |
to Head of |
Birth Date |
Age |
Social Security Number |
through Higher Education) |
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Household |
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Full |
Part |
N/A |
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Time |
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Head |
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1) Do you anticipate any changes in the size of your household within the next 12 months? |
YES |
NO |
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(Examples: a future spouse, a minor entering the home through adoption, children returning from foster care, etc.) |
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If yes, please describe any changes here: ___________________________________________________________________ |
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2) Will anyone under age 18 listed above live in the unit less than 50% of the next 12 months? N/A |
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NO |
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If yes, please explain here: ______________________________________________________________________________ |
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Does any member in your household have a disability and require a |
YES |
NO |
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Is any adult member of your household separated, but not divorced? |
YES |
NO |
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Does your household receive, or is it applying to receive, Section 8 rental or voucher assistance? |
YES |
NO |
Page 1 of 7 (Effective 11/1/12)
Please read each question carefully, answer each question completely and be prepared to verify items checked yes.
RENTAL HISTORY
The questions regarding household rental history apply to all members of your household, including minors and those temporarily absent from the home.
YES NO
Have you or anyone else named on this application filed for bankruptcy?
Please explain: ______________________________________________________________________________
Have you or anyone else named on the application been convicted of a drug related or other crime?
Please explain: ______________________________________________________________________________
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Have you or anyone else named on the application been subject to the lifetime registration requirement under a state |
sex offender registration program? |
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Please explain: _______________________________________________________________________________ |
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Have you or anyone else named on the application been evicted from a rental unit of any type including an apartment, |
home, mobile home or trailer? |
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Please explain: ________________________________________________________________________________ |
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Are there any special needs or accommodations the household will require such as, grab bars or a unit for mobility impaired or |
hearing/vision impaired? |
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Please explain: ________________________________________________________________________________ |
Head of Household Current Address:
Your Address |
Landlord’s Name/Address/Phone |
Own / Rent |
Dates |
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(if applicable) |
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From:______________ |
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To: |
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Head of Household Previous Address: |
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Your Address |
Landlord’s Name/Address/Phone |
Own / Rent |
Dates |
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From:_____________ |
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To: |
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Other Adult Current Address: |
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Landlord’s Name/Address/Phone |
Own / Rent |
Dates |
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From:_____________ |
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Other Adult Current Address: |
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Landlord’s Name/Address/Phone |
Own / Rent |
Dates |
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From:_____________ |
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Page 2 of 7 (Effective 11/1/12)
STUDENT ELIGIBILITY QUESTIONS
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6) |
Are ALL members of your household |
YES |
NO |
7) |
Will ALL members of your household be |
YES |
NO |
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(Example: a student who goes to school |
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Will ALL members of your household be |
YES |
NO |
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Is ANY ADULT member of your household a part or full time student in an institute of higher education? |
YES |
NO |
If yes, who is enrolled? ______________________________Which school are they enrolled in? ______________________
How do they pay for their education? ___________________What is the cost of tuition per semester? $_________________
10) Does ANY ADULT member of your household intend to become a student within the next 12 months? YES NO If yes, who will be enrolling in school? ___________________________ Name of School _____________________________
If yes, will they be enrolling as a
ALIMONY / CHILD SUPPORT INFORMATION
11) Does any member of your household have a COURT ORDER to receive Child Support or Alimony payments, even if no child
support or alimony is being received? (Case ID # or #’s)_______________________ |
YES NO |
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IF “NO”, SKIP TO QUESTION 12 |
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a.) |
Name of person with court order: ______________________ Payment Amount: $____________ per ____________ |
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Name of person(s) paying support / alimony: _________________________________________________________ |
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Are the FULL |
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NO |
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If “NO”, are you making efforts to collect the amounts due? |
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NO |
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If “YES”, please explain the efforts you’re making here: _____________________________________________________
12) Does any member of your household receive Child Support or Alimony payments that are NOT COURT ORDERED?
(This includes help from children’s father or mother for clothes, groceries, etc.) |
YES NO |
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IF “NO”, SKIP TO NEXT SECTION |
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Payment Amount: $__________________________________ per ___________________ |
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Name of person(s) paying support / alimony: |
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_________________________________Phone: __________________ for child: ___________________________ |
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_________________________________Phone: __________________ for child: ___________________________ |
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Page 3 of 7 (Effective 11/1/12)
Please read each question carefully, answer each question completely and be prepared to verify items checked yes.
INCOME INFORMATION
The questions regarding household income apply to all members of your household, including minors and those temporarily absent from the home.
YES |
NO |
TYPE OF INCOME |
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13) Is any member of the household employed? |
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Job 1) Who is employed? _________________________________________________________ |
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What company? _________________________________ Phone:__________________________ |
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__________________________________________________________________ |
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Job 2) Who is employed? _________________________________________________________ |
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What company? _________________________________ Phone:__________________________ |
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Check if there are any additional jobs in the household |
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(attach a separate sheet with contact information) |
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14) Are any household members |
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Who is |
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What type of work does this person do? _______________________________________________ |
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15) Are any adult members of your household unemployed? |
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Which adult members are unemployed? _______________________________________________ |
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16) Does any household member receive pay from the military? |
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Who is paid by the military? ________________________________________________________ |
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Which branch of the military? ______________________________________________________ |
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Contact Person: __________________________________Phone: __________________________ |
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17) Does any household member receive any payments from the Social Security |
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Administration? Which type: SS SSI SSDI Other |
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Who receives payments from the Social Security Office? _________________________________ |
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18) Does any household member receive severance pay or worker’s compensation? |
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Who is receiving severance pay or worker’s compensation? _______________________________ |
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What company pays them? _________________________________________________________ |
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Contact Person: ________________________________ Phone: ___________________________ |
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19) Is any household member unemployed and receiving payments from an Unemployment |
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Agency? |
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Who is receiving unemployment benefits? _____________________________________________ |
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What State: ________________ Contact Person: ______________________ Phone: __________ |
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20) Does any household member receive Public Assistance payments such as TANF or AFDC? |
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(Please do not include Food Stamp benefits here.) |
Who is receiving TANF or AFDC benefits? ___________________________________________
Caseworker: _____________________________________ Phone: _________________________
INCOME
AMOUNT
AMT $__________
PER__________
AMT $__________
PER__________
AMT $__________
PER __________
AMT $__________
PER__________
AMT $__________
PER__________
AMT $__________
PER__________
AMT $__________
PER__________
AMT $__________
PER__________
Page 4 of 7 (Effective 11/1/12)
INCOME INFORMATION CONTINUED
The questions regarding household income apply to all members of your household, including minors and those temporarily absent from the home.
YES NO
TYPE OF INCOME
21)Does any household member receive periodic payments from a pension, annuity or retirement benefit account?
Please check one: Pension Annuity Other Retirement
Who receives these benefits? ______________________________________________________
What company pays this person? ___________________________________________________
Contact Person: __________________________________ Phone: ________________________
INCOME
AMOUNT
AMT $__________
PER __________
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22) Does anyone outside of your household provide you with cash or contributions to help |
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pay expenses that a household would normally pay, such as rent, utility payments or |
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groceries? |
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What is the name of the person that pays you? ________________________________________ |
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What is their address? ___________________________________________________________ |
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Phone number? ________________________________________________________________ |
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23) Is there any other source of income we haven’t already asked about above that you |
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receive? |
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Please Describe: _______________________________________________________________ |
AMT $__________
PER__________
24)Does your household expect any changes in their income within the next 12 months?
Please Describe: _______________________________________________________________
25)Does your household receive
Which household member is in a
Which household member are the payments made to? __________________________________
What company pays this person? __________________________________________________
Contact Person: ___________________________________ Phone: ______________________
26) Do any adult members of your household have zero income?
Which adult members have zero income? _________________________________________________________________
Please read each question carefully, answer each question completely and be prepared to verify items checked yes.
ACCOUNT / ASSET INFORMATION
The questions regarding household accounts / assets apply to all members of your household, including minors and those temporarily absent from the home.
YES |
NO |
ACCOUNT INFORMATION |
27) Does any household member have a Checking, Savings, CD or Money Market account?
Bank 1) Bank Name: ___________________________ Name(s) on Account: _____________________________________
Account Type: Checking Savings CD Money Market
Bank 2) Bank Name: ___________________________ Name(s) on Account: _____________________________________
Account Type: Checking |
Savings |
CD |
Money Market |
Check if there are additional accounts of the above types belonging to the household.
(attach a separate sheet with the bank name, account type and name(s) on the account)
Page 5 of 7 (Effective 11/1/12)
Please read each question carefully, answer each question completely and be prepared to verify items checked yes.
ACCOUNT / ASSET INFORMATION
The questions regarding household accounts / assets apply to all members of your household, including minors and those temporarily absent from the home.
YES |
NO |
ACCOUNT INFORMATION |
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28) Does any household member have Stocks, Bonds, Mutual Funds, Capital Investments or a Whole Life Insurance |
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Policy (life insurance that you can make withdrawals from even if there isn’t a death. We do not count TERM insurance)? |
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Institution Name: __________________________________ Name(s) on Account: __________________________________ |
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Contact Phone: _______________________ Account Type: Stocks Bonds Mutual Funds Whole Life Insurance |
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29) Does any household member have an IRA, Keogh, 401K, Annuity or similar retirement account? |
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Institution Name: __________________________________ Name(s) on Account: __________________________________ |
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Contact Phone: _________________________Account Type: IRA Keogh 401K Other: _____________________ |
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30) Does any household member have a Pension account that will pay upon retirement or termination of employment |
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(NOT including IRA, Keogh, 401K or Annuity accounts)? |
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Institution Name: __________________________________ Name(s) on Account: __________________________________ |
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Contact/Phone: ________________________________________________________ Account Type: ___________________ |
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31) Does any household member own any Real Estate? (Include Rental Property, Primary Residence, Vacation Property, |
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Property Owner(s): _________________________________ Type of Property: ____________________________________ |
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What is the name of the bank or institution with financial interest in this property? (Mortgage Holder, Contract Owner, etc.) |
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Contact: __________________________________________________ Phone: ____________________________________ |
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32) Does any household member have personal property that they hold for investment purposes that they plan to sell |
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at a later date for profit? (Examples include: coin or stamp collections, antique cars, jewelry, etc.) |
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Property Type:_______________________________________________ Estimated Cash Value: $_____________________ |
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33) Does any household member have a Trust Account? |
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Institution Name: __________________________________ Name(s) on Account: __________________________________ |
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Is this account a Revocable or |
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34) Does any household member have any Treasury Bills or Government Savings Bonds? |
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Which household member: ______________________________________________________________________________ |
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Series: _______________ Face Value: $_______________ Serial Number: _______________ Issue Date: _______________ |
35) Does any household member have cash on hand or safe deposit boxes?
Which household member? ____________________________________ What amount is kept on hand? $_______________
36)Does any household member have any accounts or assets that were not described above? (Please DO NOT include personal use vehicles, furniture, clothing, etc.)
What type of account or asset is this? _____________________________________________________________________
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What is the estimated value of this asset if you were to sell it today? $____________________ |
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37) In the past two years, has any household member given away any asset(s) for less than they were worth? |
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(Examples include property, transferring an asset account into someone else’s name, charitable contributions etc.) |
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What was the estimated value of this asset? $________________________ |
Page 6 of 7 (Effective 11/1/12)
RACE/ETHNICITY QUESTIONS
Race of Head of Household: I prefer not to answer |
White |
Black or African American |
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American Indian/Alaska Native |
Asian/Pacific Islander |
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Ethnicity of Head Household: |
Hispanic or Latino |
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What is your marital status? Married, Single, Divorced, Separated, Widowed (Circle)
HOUSEHOLD CERTIFICATION
I understand that the information provided on this questionnaire will be used to determine my eligibility for Section 42 compliant properties. Under penalties of perjury, I certify that the information provided is true and accurate to the best of my knowledge. I also understand that false or omitted information is considered fraud and punishable according to the law and may result in the loss of my housing at this property.
By signing this application, I also grant the owner the right to obtain all information needed to determine my eligibility in accordance with the owner’s Resident Selection Criteria. Resident Selection Criteria may include but is not limited to criminal history checks, credit screening, prior eviction filings, landlord references, ability to pay rent, etc.
I also understand that the information provided is considered confidential and will be used solely for the purpose of determining my eligibility or continued eligibility in the Section 42 housing program.
CERTIFICATION: All household members who are 18 years of age, or will be 18 years of age within the upcoming 12 month period must sign below.
____________________________________________________________ |
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Head of Household |
Date |
____________________________________________________________ |
__________________________________________ |
Other Adult Member |
Date |
____________________________________________________________ |
__________________________________________ |
Other Adult Member |
Date |
____________________________________________________________ |
___________________________________________ |
Other Adult Member |
Date |
MANAGEMENT SIGNATURE: |
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This application /questionnaire accepted by: |
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Apartment Management / Owner’s Agent |
Date |
NOTE: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the United States as to any matter within its jurisdiction.
IN KEEPING WITH THE FAIR HOUSING ACT, WE DO NOT DISCRIMINATE BASED ON FAMILIAL STATUS, RACE, SEX, DISABILITY, COLOR, RELIGION OR NATIONAL ORIGIN.
Ingerman may charge an application fee as a condition of accepting your application. All application fees are nonrefundable. Additional security deposit may be charged before
Page 7 of 7 (Effective 11/1/12)