Shelter Verification Form PDF Details

The Shelter Verification Form, designated as I.M.310, serves a crucial role in formalizing the living arrangements between landlords and tenants, particularly in contexts requiring agency oversight such as temporary assistance programs. This extensive form, which must be completed solely by the landlord, demands detailed information encompassing several key areas: firstly, it elucidates the shelter's specifics, including its type (e.g., apartment, house, trailer), the number of bedrooms, any notable rent increases, or violations. It delves into the household composition, listing all residents along with their relationships to the tenant and the dates they moved in, effectively mapping the dwelling's occupancy. Next, it addresses the rent and associated shelter expenses—querying if the rent is current, the amount due, and if any part of the rent is allocated toward utilities or other household necessities. Additionally, it probes into whether the rent is subsidized, requiring details of any external contributions toward rent or utilities. Finally, the form closes with a section for landlord/owner information, insisting on transparency regarding ownership and management rights, alongside requiring the landlord's signature to affirm the veracity of the information provided. This form not only helps agencies and stakeholders understand the living situation of tenants seeking assistance but also ensures there's a formal record that can be referred to in disputes or clarifications regarding tenancy agreements.

QuestionAnswer
Form NameShelter Verification Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesshelter verification form michigan, shelter verification from, shelter verification form pdf, i m 310 shelter verification form

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I.M.310

SHELTER VERIFICATION FORM - To Be Completed by Landlord Only

 

 

 

 

 

Please check one:

 

Grey Area for Agency

 

 

 

 

1.

SHELTER DESCRIPTION

 

 

 

 

 

□ New Move

 

Use Only

 

 

Tenant Name: ________________________________________________________

 

 

 

 

 

 

 

□ Add Individual

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address: Street: ____________________________________

 

Apt ________

 

 

□ Rent Increase

 

Violations on

 

 

 

 

 

 

 

 

City_________________________ County___________ ZIP: _____________

 

 

Property ?

 

 

 

□ Other:

 

Yes

No

 

 

Dwelling Type: SHA Public Housing

Facility and # of Bedrooms: ____

 

 

 

 

 

 

 

 

 

 

Apartment

House

Trailer

Hotel/Motel Room

Other: ________________

 

If yes, check one:

 

 

 

 

 

Room & Board (meals included) Commercial Rooming House – Are meals included? Y N

 

Stop Rent

 

 

 

 

 

Room in private home (no meals) - Is any part of rent used by landlord for heat/utilities? Y N

 

Unfit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

PERSONS RESIDING AT ABOVE ADDRESS/HOUSEHOLD COMPOSITION

 

“Reference Icon”

 

Date Tenant Moved In or Will Move In: ______________

 

 

 

 

 

 

 

 

checked for Street

 

 

 

 

 

 

 

 

 

 

Name(s) of Persons(s) Responsible for Paying Rent: _______________________________________

 

listing ?

 

 

 

 

 

 

 

Name(s) of Any Other Person(s) Paying Rent: ____________________________________________

 

Yes

No

 

 

 

List All Persons Living at this Address:

Total Number of Persons: _________

 

 

 

 

 

 

 

 

 

 

Names:

 

 

 

Relationship to Tenant:

 

Date Moved In:

 

Tenant of

 

 

 

 

 

 

 

___________________________________

____________________

 

_______________

 

 

Record Verified

 

 

 

 

 

___________________________________

____________________

 

_______________

 

 

Name::

 

 

 

 

 

 

 

 

 

___________________________________

____________________

 

_______________

 

 

_________________

 

 

 

 

 

___________________________________

____________________

 

_______________

 

 

_________________

 

___________________________________

____________________

 

_______________

 

 

 

 

 

 

 

 

Use back side if more space is needed to list household members.

 

 

 

 

WMS Clearance

 

 

 

 

 

 

 

 

Is the landlord related to anyone listed above? Yes No Relationship: ______________________

 

checked For all NTA

 

 

 

Does the landlord live in the same apartment/rental unit as the tenant?

Yes

No

 

HH members.

 

 

 

Was a Cash Security Deposit paid by the tenant? Yes

No If Yes, Amount Paid: ____________

 

Contribution

 

 

 

Are you requesting a DSS Security Deposit Agreement?

Yes

No For more information see

 

Statement needed?

 

 

 

Renting to a TA Client at : http://www.ongov.net/dss/temporaryassistance.html

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

SHELTER EXPENSES

Is rent paid up-to-date? Yes No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fuel Type Verified

 

 

Amount of total monthly rent: $___________________

 

If no, for what month(s) does

 

 

__________________

 

 

Is Rent Subsidized? Yes No

 

 

 

the tenant owe? _________________

 

 

 

 

 

 

Subsidy Amt:

$_________________

 

 

Amount of rent owed: $ ___________

 

 

Fuel Vendor Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__________________

 

 

Tenant’s Share: $_________________

 

 

This is for informational purposes only. DSS does not

 

 

 

 

 

 

guarantee money owed for back rent.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Landlord requires tenant agree to rent voucher up to maximum grant

 

 

 

 

 

Customer of Service:

 

 

 

 

 

 

 

 

Check which of the following are included in the rent:

 

 

 

 

 

 

 

 

 

__________________

 

 

Heat

Air Conditioning

Stove

Refrigerator Water/Sewer Electricity

 

 

 

Cooking Fuel Garbage Collection Hot Water Furniture Other: ________________

 

Heat/Utility Acct. #:

 

 

 

__________________

 

 

If heat is not included in the rent, check the fuel type used and indicate the vendor: Oil

 

__________________

 

 

Natural Gas

Kerosene Wood Electricity Propane Coal Vendor: _______________

 

 

 

 

 

If non-heating utilities are not included in the rent, indicate the type of utilities and the vendor:

 

Owner verified through

 

 

 

 

Electricity: ________________ Cooking Gas: _______________ Water: ________________

 

ONGOV.net

 

Does the tenant pay you an amount, separate from the rent, for: heat? Y N Amount: $_________

 

Owner name:

 

 

__________________

 

 

Other non-heating utilities? Amount: $ _______ Water? Y N Amount: $ ___________

 

 

 

 

Does anyone from outside of the household pay all or any part of the rent, fuel or utilities? Y N

 

__________________

 

 

 

 

 

 

 

If yes, please explain: ________________________________________________

 

 

 

 

 

 

 

 

 

 

Does anyone perform any services for you for which he/she receives a lower rent? Y N

Collateral Contact

Date: ____________

Worker name:

__________________

______________________

Case # :

__________________

4.LANDLORD/OWNER

If anyone other than the Property Owner, you MUST supply a copy of the Management Agreement, LLC, Trust or other authorizing paperwork outlining who is authorized to sign and receive rents. The LL Statement will not be processed without this information.

Landlord Name (Please print): _______________________________ Day Phone #: ________________

Address: _________________________________________________________________________

Vendor ID: _______________________

Owner of Property (If different from above): _______________________________________________

Address: ________________________________________________ Day Phone #: ______________

Signature of Landlord:______________________________ Date: ___________________________

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How to fill out shelter verification letter step 1

2. Immediately after this selection of blanks is done, go to type in the applicable details in all these - Date Tenant Moved In or Will Move, WMS Clearance checked For all NTA, Fuel Vendor Name, Customer of Service, HeatUtility Acct, Owner verified through ONGOVnet, Use back side if more space is, Is the landlord related to anyone, Renting to a TA Client at, SHELTER EXPENSES, Is rent paid uptodate Yes No If, and Amount of total monthly rent Is.

Step no. 2 for submitting shelter verification letter

3. This next step is easy - fill out all of the empty fields in Collateral Contact Date Worker, Amount of total monthly rent Is, LANDLORDOWNER, If anyone other than the Property, Landlord Name Please print Day, Vendor ID, Owner of Property If different, Address Day Phone, and Signature of Landlord Date in order to finish the current step.

Stage number 3 of filling out shelter verification letter

Always be extremely attentive while completing Landlord Name Please print Day and Collateral Contact Date Worker, since this is the section in which many people make errors.

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