Consent and Release of Information
By Submitting this application, I certify that all my information provided in this application is true, accurate and complete, and I will provide additional documentation to support any representations.
I further acknowledge that falsification of any information or any material falsehoods or omissions in the application, including seeking duplicative benefits, is subject to state and federal penalties including fines and criminal prosecution. It could also result in denial of my application or in a government agency, its agents, or employees nullifying, my application and seeking to reclaim any financial assistance thats received.
I certify that I have not received assistance for the same period for the same unit(s). If it is determined that a duplication of assistance occurred I agree I will pay back the County within no more than 30 days.
I acknowledge that by submitting this application, I am in no way guaranteed financial assistance. I also understand that meeting the program’s eligibility and/or selection criteria does not guarantee that I will be selected for assistance.
I give consent/authorization for A-1 Community Housing, Alameda County Housing Development, Alameda County and its respective agents, employees, and assigns, to share, disclose, analyze, and discuss all documentation and information provided in this application in furtherance of offering me assistance, to prevent duplication of benefits, or to present aggregate data about the Unincorporated Alameda County Foreclosure Prevention Program for Small, Low-Income Property Owners.
I agree to participate in the evaluation of the Unincorporated Alameda County Foreclosure Prevention Program for Small, Low-Income Property Owners, which will help improve future service delivery and potentially expand resources for services. Your willingness to participate in any future evaluation process will not affect your eligibility or selection for this program in any way. Participation is not required.
I certify that the information submitted in this application is true and accurate. I acknowledge receipt of all information provided to me in the paragraphs above. I consent to the release of information as described above, and I understand that I have the right to revoke this consent in writing at any time.
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