Critical Home Repair Program Application

Before applying to Richmond Metropolitan Habitat for Humanity's (RMHFH's) Critical Home Repair Program, Please review the required documents list:

A. Photo Identification 
1. Copy of identification document for homeowner(s) (Ex. Virginia Driver's License or ID, or a passport)
B. Mortgage Verification Documentation (Select and provide the one that applies.)
1. Copy of current Mortgage Statement (You can request a copy from your lender.)
2. Copy of current Note for Current Mortgage (You can request a copy from your lender.)
3. Reverse Mortgage documentation (if applicable)
C. Verification of Income (Select ALL that apply. Provide ALL documents that apply for ALL
household members 18 or older.)
1. Personal statement explaining different income streams.
2. Paystubs: 1-month pay (monthly 1, biweekly 2, weekly 4)
3. Current Retirement and/or SSN Benefit Statement(s) Letter(s)
If you receive social security or retirement income, provide the 1099s for the last 2 years
4. Tax Returns, including W2s, 1099s, etc. (2 most recent years)
5. Other income documents (Ex, Self-employment, alimony, etc.)
*6. Certificate of Zero Income applies only if 18 or older and not receiving income (A link to the
A Certificate of Zero Income will be provided after the application is received.)
D. Verification of Assets (Select ALL that apply. Provide ALL documents that apply for ALL household members 18 or older.)
1. Past 6 months checking account statements, need ALL pages of individual & joint bank accounts
2. Past 6 months Savings account statements, need ALL pages of individual & joint bank accounts
3. Statements documenting the value of your assets (including the cash value of life insurance, a second
car for a household member, etc.)
E. Proof of Primary Residence (Provide both water and gas bills.)
1. Copy of most recent County or City water and gas bills (This does not include a Dominion Energy bill.)
F. Proof of Homeowners Insurance (Provide your UNEXPIRED homeowner's insurance.)
1. Copy of current Homeowners Insurance Declarations page
G. Real Estate Taxes
1. Copy of up-to-date Real Estate Taxes
H. Proof of Ownership
1. Copy of Death Certificate (This is ONLY needed for someone deceased and still listed as a property
owner.)
2. All property owners listed on the deed are living and able to sign documentation as needed.
3. Deed (Needed for properties in Chesterfield or Henrico)
I. Home Repair Images (optional, max 5)
1. I will upload a max of 5 images showing the most critical repairs needed. I understand that cosmetic
repairs are not critical.

Electronic Disclosure Authorization 

1. Scope of Communications to be Provided in Electronic Form: Your consent to receive electronic communications and transactions from Richmond Metropolitan Habitat for Humanity includes, but is not limited to:

• Notice of incomplete application and/or request for supporting documents. 
• Notice of program application being turned down. 

2. Communications in writing: All communications in either electronic or paper format from us to you will be considered "in writing." 

3. How to Update your Records: It is your responsibility to provide us with an accurate and complete email address and update us promptly of any changes in this information. You can update your email address and other contact information by contacing us at repairs@richmondhabitat.org. Please include your full name, old and new contact information for reference.  

4. Consent: By signing below, you agree that you have read understand, and agree to receive updates about the status of your application via email and that you have provided us with a current email address at which we may send electronic communications to you. You also agree that you are responsible for updating your safe senders list to include repairs@richmondhabitat.org to prevent delays in receiving communications. 

If you have any questions AFTER you review the qualifications and the required document list, please email repairs@richmondhabitat.org

I certify that the following address: 

{streetAddress}, {address293}, VA {address294} 

is my primary residence and that I have been a resident at this address at least twelve (12) months, prior to my application for assistance through Richmond Metropolitan Habitat for Humanity’s (RMHFH) Critical Home Repair Program.  

I understand I am not guaranteed to receive approval for repairs as funding is limited. However, if repairs are completed on my home, the most critical repairs will be prioritized first for completion. Cosmetic repairs will not be addressed. Depending on the funding used for repairs, additional qualifications may be applicable.

Payment will not be required for services. However, depending on the cost of repairs and the funding source to complete repairs, a Deed of Trust may be recorded. For example, a Deed of Trust may be recorded if the repairs exceed the established threshold in the following locations: City of Richmond-$15,000, Chesterfield County- $15,000, Henrico County- $12,500.

If it is determined my residence may, or will, be involved with the regulations concerning Lead Based Paint, I understand I will be informed of the process and outcome and how it may affect my ability to receive services under this program. I agree to sign all applicable forms related to lead testing, final reports, etc. and allow access to my home for testing.

If approved for repairs, I must demonstrate a Need for repairs, as well as, a Willingness to Partner with RMHFH. The Willingness to Partner is demonstrated by agreeing to and completing an Impact Statement within six (6) months of completion of repairs telling RMHFH about how the repairs impacted you.  

Sex Offender Registry: RMHFH screens all potential staff, board members, and applicants on the national sex offender registry, and by completing this application, I am submitting myself and all persons 18 or older, listed on this application, to such inquiry. 

My signature below grants permission to the designated agent to verify information contained in this application for assistance through Richmond Metropolitan Habitat for Humanity’s Critical Home Repair program. I understand the information in this application is strictly confidential. No information contained herein will be released to any other local, state, or federal agency for any purpose without my written consent, except as it may pertain to funding resources made available through this application. 

I certify that the information provided within this application is true, accurate, and correct to the best of my knowledge.

Complete the following if you are NOT a Homeowner but you are assisting the Homeowner in completing the application.

Richmond Metropolitan Habitat for Humanity, Inc.

2281 Dabney Road, Suite A

Richmond, Virginia 23230

PHONE (804) 232-7001 FAX (804) 232-7025

Applicants for Richmond Metropolitan's Habitat for Humanity Critical Home Repair program must provide information regarding their assets. Please declare your family's assets in the following categories and calculate a total value. Include all assets for all household members. Exclusions listed below.

Exclusions: The following items are not included as assets.

1. Necessary personal property, except as noted in number 8 of Inclusions, such as clothing, furniture, and vehicles specially equipped for persons with disabilities.

2. Interest in Indian trust lands.

3. Assets not effectively owned by the applicant. That is, when assets are held in an individual's name, but the assets and any income they earn accrue to the benefit of someone else who is not a member of the household and that other person is responsible for income taxes incurred on income generated by the asset.

4. Equity in cooperatives in which the family lives.

6. Assets not accessible to and that provide no income for the applicant.

7. Term life insurance policies (i.e. where there is no cash value

8. Assets that are part of an active business. "Business" does not include rental of properties that are held as an investment and not a main occupation.

For each section below, select the document you are uploading for each section. If a document is more than ONE page, it needs to be submitted as ONE PDF, not as individual images (ex: bank statements).

 

Remove your social security number from documents, if able.

Income documents MUST be submitted for anyone 18 or older who is receiving ANY form of income. 

**Those over 18 years old who do not receive income must sign a Certificate of Zero Income. Click here to access a copy of the Certificate of Zero Income.**