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  • NASHVILLE-DAVIDSON COUNTY COVID-19 APPLICATION FOR CDBG-CV RENT/ MORTGAGE ASSISTANCE

    This program is supported by Community Development Block Grant (CDBG) funds from the U.S. Department of Housing and Urban Development (HUD). Federal regulations require that we obtain information to document that assistance is being provided to lower-income households. This information is collected for statistical purposes only and is kept in strict confidence. The applicant should complete this form providing income information for all persons residing within their household, regardless of whether or not they are related.  Income verification is MANDATORY for program participation
  • Eligibility Requirements

    (Read carefully)
  • 1. Households residing in Nashville-Davidson County whose gross monthly income based on household size does not exceed the 80% Area Median Income (AMI) limits established for Nashville-Davidson County. For the purposes of eligibility to receive assistance, current household income as a result of the COVID-19 emergency situation, will be used. Income includes gross wages, income from assets, retirement, social security, disability, unemployment and any other resources or benefits received by household members age 18 and older.

    2. Households where the head or co-head of household (lease/mortgage holder) as of January 1, 2020 had full-time employment (minimum 32 hours a week – could be from multiple employers) who experienced a 25% loss of income directly related to COVID-19, and

    3. Households who have occupied their current housing since January 1, 2020 and were in good standing with their landlord or mortgage company as of February 29, 2020.

  • Ineligible Participants – General Criteria:

    (Read carefully)
  • 1. Applicants who were in default on their rent or mortgage payments before March 1, 2020.
    2. Applicants whose property is in foreclosure or listed for sale.
    3. Applicants that have been approved for a permanent (non-balloon) repayment plan from their lender.
    4. Applicants who reside in subsidized housing, i.e., public - affordable housing; receive rental assistance through a housing Choice voucher or reside in a unit that has a project-based voucher attached. These applicants will be referred to the Metropolitan Development and Housing Agency (MDHA) for assistance.
    5. Applicants who have or are already receiving rental/mortgage assistance through another agency/source for 100% of the funds needed to cover any shortage for the same period that assistance if being requested from the CDBG-CV Program.
    6. Applicants who are occupying units owned by an immediate family member. Immediate family includes (whether by blood, marriage or adoption) the spouse, parent (including a stepparent), child (including a stepchild), brother, sister (including a stepbrother or stepsister), grandparent, grandchild, and in-laws.

  • The Martha O'Bryan Center does not discriminate against any person in program or client services regardless of race, color, age, national origin, marital status, sex, disability, religion, or any other legally protected status.
  • Section 1: General Information

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  • Section 2: Demographic Information

    The information requested below is for statistical purposes only and has no bearing on the approval of your application for assistance. Please check the boxes that apply to the applicant(s). Optional
  • Section 3: Rental Assistance Housing Information

    I certify by completing this section that I am or anticipate being behind on my rent and experiencing a housing crisis and facing potential homelessness due to loss of income when COVID-19 restrictions were imposed by the Metro Nashville & the State of Tennessee.  
  • Section 4: Mortgage Assistance Housing Information

    I certify by completing this section that I am or anticipate being behind on my mortgage(s) and experiencing a housing crisis and facing potential homelessness due to loss of income when COVID-19 restrictions were imposed by the Metro Nashville & the State of Tennessee.
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  • Section 5 - Financial Hardship Questionnaire/ Screening Questions

  • Section 6: Income Self Certification

    INCOME is defined as the total annual gross income (before taxes) of all family and non-family members 18+years old living in the household.   All sources of income must be counted from all persons in the household based on the income anticipated to be received within the next 12 months.   







  • Section 7 - Asset Self-Certification

    ASSETS are defined as funds available/accessible to the applicant/co-applicant and includes money in savings, checking accounts, bonds, stocks, bonds, CDs, IRAs, 401k, surrender value of life insurance, equity in real estate (other than your primary residence), etc.  Please check/complete the category below that best describes the value of your assets.
  • Section 8 - Adults or Children Living In the Household

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  • Section 9 - Anticipated Annual Household Income Information

    PLEASE ENTER THE AMOUNT OF ANTICIPATD GROSS (BEFORE TAXES) ANNUAL INCOME for each household member 18 or older in the appropriate category in the table below: 
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  • Section 10 - Applicant (s) Signature/Certification

    By signing below, I/we certify that the information provided in this application is accurate and complete and that we are residents of Nashville-Davidson County.   I/we further acknowledge that eligibility for services funded through the CDBG-CV program is based upon having a qualifying annual family income level, and that the income level and/or status I have indicated in this self-certification is subject to further verification by the agency providing services, MDHA and/or HUD.   I/we acknowledge that meeting program eligibility requirements does not guarantee assistance will be provided.   I/we acknowledge and understand any false statements or false information made on this application will result in immediate denial of my/our application for this program.  I/we will provide documentation of all income sources upon request. I further understand that by signing, all information gathered about me and my household is personal and private and I authorize, Martha O’Bryan Center, to enter all household information into Charity Tracker.
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