Rental Assistance Application

RENTAL ASSISTANCE APPLICATION

Please complete all information and upload all required documents before submitting.
TO SUBMIT A REQUEST FOR RENT ASSISTANCE YOU MUST UPLOAD THE FOLLOWING DOCUMENTS IN THE SPACES PROVIDED BELOW.
- EBLEN'S LANDLORD RENTAL INFORMATION FORM (DOWNLOAD FORM HERE) AND A 2024 W-9 FORM (DOWNLOAD HERE) GIVE BOTH FORMS TO YOUR LANDLORD TO COMPLETE AND RETURN TO YOU TO UPLOAD BELOW.
- COPY OF YOUR DRIVER'S LICENSE OR PHOTO ID
- LEASE AGREEMENT PAGES 1, 2 AND SIGNATURE PAGE(S)
- CURRENT RENTAL LEDGER (Record of Monthly Rent Payments)
- PROOF OF INCOME FOR THE PAST 30 DAYS (MOST RECENT PAY STUB, SSDI, ETC.)
FIRST NAME*
LAST NAME*
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMAIL
example@example.com
PHONE NUMBER*
Please enter a valid phone number.
ARE YOU A US VETERAN?*

YESNO
IF YOU ARE A VETERAN, IN WHICH BRANCH DID YOU SERVE?

AIR FORCEARMYCOAST GUARDMARINESNAVY
PLEASE EXPLAIN WHY YOU ARE REQUESTING RENT ASSISTANCE.*

PLEASE COMPLETE ONLY ONE SECTION BELOW.
- SECTION ONE IS TO BE COMPLETED IF YOU HAVE NOT RECEIVED AN INCOME IN THE LAST 30 DAYS.
- SECTION TWO IS TO BE COMPLETED IF YOU HAVE RECEIVED AN INCOME IN THE LAST 30 DAYS.
Self-Attestation for No Income in the Last 30 Days

SECTION ONE - COMPLETE IF YOU HAVE RECEIVED NO INCOME IN THE LAST 30 DAYS.
Iname certify that I have not been employed or self-employed (receiving earned income), completed any odd jobs, or had any other source of income (SSA/SSDI/SSI, child support, alimony, retirement income, etc.) in the last 30 days.

I attest that this statement about myself, to determine eligibility, is true and correct to the best of my knowledge.

Signature
IF YOU HAVE NO INCOME, PLEASE BE SURE YOU HAVE COMPLETED THE ATTESTATION OF NO INCOME PORTION OF THIS APPLICATION ABOVE.
Self-Attestation for Income in the Last 30 Days

SECTION TWO - COMPLETE IF YOU HAVE RECEIVED AN INCOME IN THE LAST 30 DAYS.
I have received this gross amount of income $ amountondate from business . Please provide documents to verify this information (pay stubs, etc.)
I attest that this statement about myself, to determine eligibility, is true and correct to the best of my knowledge.

Signature
PROOF OF INCOME FOR THE PAST 30 DAYS (PAYSTUBS, SSDI, ETC.)

Cancelof
Date*

MonthDayYear
Please enter today's date
Signature*

Powered by Jotform SignClear

ALL DOCUMENTS MUST BE UPLOADED HERE OR YOUR APPLICATION PROCESS WILL BE DELAYED.

**THE EBLEN LANDLORD INFORMATION FORM MUST BE DOWNLOADED HERE. AND THE W-9 FORM DOWNLOADED HERE. YOU ARE RESPONSIBLE TO GET IT BOTH OF THESE FORMS TO YOUR LANDLORD TO COMPLETE SO THAT YOU CAN UPLOAD IT BELOW.
EBLEN'S LANDLORD RENTAL INFORMATION FORM TO BE COMPLETED BY LANDLORD.*

Cancelof
W-9 FORM TO BE COMPLETED BY LANDLORD*

Cancelof
DRIVERS LICENSE OR OTHER PHOTO ID (UPLOAD SCAN, JPG OR PDF)*

Cancelof
LEASE AGREEMENT PAGES 1 AND 2 AND SIGNATURE PAGE*

Cancelof
RENTAL PAYMENT HISTORY (RECORD OF MONTHLY RENT PAYMENT)*

Cancelof
Once your application is submitted for processing, you will be contacted by email and/or a phone call to do a short interview.

Payments are made directly to the landlord/vendor on your behalf.
I authorize Eblen Charities to directly contact my landlord to verify rental amounts due, landlord addresses and other rent related information. Please sign below.*

Powered by Jotform SignClear

City of Asheville Home Recovery Program Rental Assistance Attestation
Thank you for applying for rental assistance. This tool screens for two items:
1. whether your rental home was damaged by the storm and
2. whether you or someone in your household has received rental assistance from FEMA or another source because of Tropcial Storm Helene.
Please complete this form to the best of your knowledge.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a number where we can reach you.
Email
1. Did your rental home suffer any damage from Tropical Storem Helene?*

YesNo
If yes, please specify the damage to the unit.
2. Has your ability to pay rent been affected by Tropical Storm Helene?*

YesNo
3. Did you or anyone in your household register with FEMA for assistance?*

YesNo
If yes, please indicate whether you were approved for any assistance and the type of assistance received.
4. Obligation to Update - If I or any of my household members receive FEMA Rental or other housing assistance related to Tropical Storm Helene in the period covered by this program, I agree to promptly report this change to Eblen Charities. Please initial to indicate your agreement.*
By signing below, I certify that all information provided in this questionnaire is accurate and complete to the best of my knowledge. I understand if I receive FEMA funding for rental assistance that I will notify the program of this change.*

Powered by Jotform SignClear
Date*

MonthDayYear
Please enter today's date.

The Housing Recovery Program: Rental Assistance Consent to Release
Purpose: By signing this form, the Primary Applicant permits Eblen Charities Rental Assistance Program to receive information about them from the Federal Emergency Management Agency (FEMA), Small Business Administration (SBA), insurance companies, and/or other relevant organizations. The Program uses this information to determine the Primary Applicant's eligibility (income qualifications, residence, other awards).

Instructions: The Primary Applicant Completes this form by providing their full legal name and the complete address of the rental property. The Primary Applicant must sign and date this Consent to Release Form for it to be valid.

I currently rent the property listed below and hereby consent to the release of my information, which has been collected by FEMA, SBA, insurance companies, the National Flood Insurance Program (NFIP), and/or other relevant organizations to Eblen Charities. Eblen Charities administers the Rental Assistance Program, and this information will be used to determine my eligibility and process the assistance amount for the Rental Assistance Program related to the rental property located at {address}.

I understand that I have an ongoing duty to inform the agency administering this program of any known or possible assistance received by any person who resides at the rental address for the qualifying event Tropical Storm Helene. This duty remains even after the assistance has been received.

I consent to the following information being disclosed to Eblen Charities:
- Information from third party entities including, but not limited to: inspection report(s), amount of assistance received, and future assistance to be received.
- Documentation of amounts paid to me or other owners or on my or their behalf by and insurance company for homeowner, flood or other insurance.
- Documentation of all financial assistance provided to me or others, received by me or other owners, or made available to me or other owners for storm recovery assistance and the purpose of that assistance (e.g., rental assistance, food and gas, home repairs).
- Tax and income records
- Additional information necessary as identified by Eblen Charities.
I consent that the above information may be disclosed to the above organization and others that may be identified by Eblen Charities. All the information contained in this Consent to Release form is true and complete to the best of my knowledge and belief.
Primary Applicant Name*
Primary Applicant Rental Property Address*
Primary Applicant Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Thank you for completing your application and uploading all neccessary documents:
1. Eblen Landlord Rent Information Form* Download above to give to your landlord to complete and you upload to this application
2. W-9 Form Download above to give to your landlord to complete and you upload to this appliction
3. Drivers's License or other photo ID
4. Proof of income in the last 30 days if you have income. If not complete the Statement of Attestation for No Income.
5. Lease Agreement pages 1 and 2 and signature page
6. Current Rent Ledger (Record of monthly rent payment)
Once your application is complete and submitted for processing, you will be contacted by email and/or a phone call to do a short interview.

Payments are made directly to the landlord/vendor on your behalf.
Should be Empty:

RENTAL ASSISTANCE APPLICATION

Self-Attestation for No Income in the Last 30 Days

Self-Attestation for Income in the Last 30 Days

City of Asheville Home Recovery Program Rental Assistance Attestation

The Housing Recovery Program: Rental Assistance Consent to Release