Paperwork Reduction Notice: Public reporting burden for this collection of information is estimated to average 7 minutes per response. This includes the time for respondents to read the document and cerifty, and any recordkeeping burden. This information will be used in the processing of a tenancy. Reponse to this request for information is required to receive benefits. The agency may not collect this information, and you are not required to complete this form, unless it displays a currently vaild OMB control number. The OMB Number is 2577-0266 and expires 06/30/2026.
NOTICE TO APPLICANTS AND PARTICIPANTS OF THE FOLLOWING HUD RENTAL ASSISTANCE PROGRAMS:
- Public Housing (24 CFR 960)
- Section 8 Housing Choice Voucher, including the Disaster housing Assistance
- Program (24 CFR 982)
- Section 8 Moderate Rehabilitation (24 CFR 882)
- Project-Based Voucher (24 CFR 983)
The U.S. Department of Housing and Urban Development maintains a national repository of debts owed to Public Housing Agencies (PHAs) or Section 8 landlords and adverse information of former participants who have voluntarily or involuntarily terminated partiipation in one of the above-listed HUD rental assistance programs. This information is maintained within HUD's Enterprice Income Verificationn (EIV) system, which is used by Public Housing Agencies (PHAs) and their management agents to verify employment and income information of program participants, as well as, to reduce administrative and rental assistance payment errors. The EIV system is designed to assistPHAs and HUD in ensuring that family are eligible to participate in HUD rental assistance programs and determining the correct amount of rental assistance a family is eligible for. All PHAs are required to use this system in accordance with HUD regulations at 24 CFR 5.233.
HUD requires PHAs, which administers the above-listed rental housing programs, to report certain information at the conclusion of your participation in a HUD rental assistance program. This notice provides you with information on what information the PHA is required to provide to HUD, who will have access to this information, how this information is used, and your rights. PHAs are required to provide this notice to all applications and program particiapnts, and you are required to acknowledge receipt of this notice by signing page 2. Each adult household member must sign this form.
What information about you and your tenancy does HUD collect from the PHA?
The following information is collected about each member of your household (family composition): full name, date of birth, and Social Security Number
The following adverse information is collected once your participation in the housing program has ended, whether you voluntarily or involuntarily move out of an assisted unit:
- Amount of any balance you owe the PHA or Section 8 landlord (up tp $500,000) and explanation for balance owed (i.e., unpaid rent, retroactive rent (due to unreported income and/or change in family composition) or other charges such as damages, utility charges, etc.); and
- Whether or not you have entered into a repayment agreement for the amount that you owe the PHA; and
- Whether or not you have defaulted on a repayment agreement; and
- Whether or not the PHA has obtained a judgment against you; and
- Whether or not you have filed for bankruptcy; and
- The negative reason(s) for your end of participation or any negative status (i.e., abandoned unit, fraud, lease violations, criminal activity, etc.) as of the end of participation date.
08/2013 Form HUD-52675