BR3T Application for Assistance with Rent and/or Utilities for existing clients

This form is for households that meet all the following:

• Are existing BR3T clients with case numbers beginning with "HS".
• Currently live in a rental unit in Hays County and have a lease in their name
• Seeking Assistance with Rent and/or Utilities at their current rental unit in Hays County

To qualify for rent/utility assistance, you must have a rental unit in Hays County and be facing eviction.

To qualify for assistance, you must be able to show that you can pay your rent/utilities the month after BR3T's payment. You must supply 3 - 6 months of all household bank/monetary account statements.

Please provide documentation of all household income for the last 30 days, including:

• Award letter such as SNAP, WIC, TANF, SSI (if applicable)
• All household members paystubs
• Self employment income
• Retirement income
• Cash income
• Invesment income
• Social security
• Disability
• Unemployment compansation
• Alimony
• Child support

By submitting this Application), I/we, above named Applicant(s) hereby certify that:

1.        I authorize BR3T to solicit/verify information including employment and housing verification needed to provide housing stability services.

2.        I am an applicant of BR3T. I hereby give my permission to release and verify all information requested and understand that it will be kept in strict confidence to be used for program purposes only. I understand that photocopy of this release is as valid as the original and may be used to obtain employment information, rental information,  or verify other data.

3.        If I qualified for the program by evidencing my eligibility for unemployment benefits, I authorize BR3T and its partners to provide my information to the Texas Workforce Commission in order to verify my documentation.

4.         I will inform BR3T within ten calendar days if evicted from the Unit, if disconnected from Utility services, or if I no longer occupy the Unit as my principal residence within 6 months of start of lease.

5.         I understand and attest that if I qualified for this program by providing evidence that I qualify under another eligible program such as SNAP, LIHEAP or SSI (only allowed to be qualified for adults in the household) that my household size is comprised of 6 or fewer members and that my household income does not exceed the applicable limit.

6.       I acknowledge that all information collected, assembled, or maintained by BR3T pertaining to my application, except records made confidential by law or court order, are subject to the Texas Public Information Act (Chapter 552 of Texas Government Code) and BR3T must provide citizens, public agencies, and other interested parties with reasonable access to all records pertaining to this application subject to and in accordance with the Texas Public Information Act.

7.       I understand that I will be provided the opportunity to save a copy of this certification.

8.         The information I have provided is true, accurate, and complete, and if requested, I am able to provide documentation to prove my household’s loss of income or additional expenses. I understand that providing false, incomplete, or inaccurate information on application forms, may result in termination of participation in the Program, up to 5 years of imprisonment and for each occurrence a fine of up to $10,000.

When the application has successfully submitted after hitting the submit button below, you will be taken to a page with a big green checkmark. Be patient, it may take time to process and submit.

When the form has been submitted, you will receive a confirmation email to the email address you provided.