Rental Application Form

Riverbend Apartments
575 Dyer Avenue
Cranston, RI 02920
Phone: (401) 943-2234  | Fax: (401) 943-8680 | 711 Relay

Thank you for your interest in Riverbend Apartments.

Please be advised that to qualify to live at this location, applicants must meet certain eligibility requirements. Households must be within the Income Limit Guidelines.

Pre-Application Instructions:

1. Complete all sections of this application. Please make sure to read all instructions throughout this application.
2. Signatures are required by all household members who are 18 years or older.
3. Only family members who will be living in the apartment need to be listed in the Family Summary section
4. Copies of the following documents are required:

• Birth Certificate for all household members
• Social Security Card* for all household members
• Valid Photo Identification for all household members 18 years or older

*Each member of an applicant’s household except for those who do not claim to have eligible immigration status and persons 62 and older who were already receiving federal housing assistance somewhere else on January 31, 2025, must disclose such SSN before the household may be housed. However, they do not need to have or disclose their SSN in order to be placed on the waiting list. Furthermore, they may retain their place on the waiting list if all household members required to disclose a SSN cannot do so at the time a unit becomes available for them.

5. ALL household members are REQUIRED to complete the following forms.

• “Supplement to Application for Federally Assisted Housing- HUD-92006 - (Only household members who are 18 or older)
• “Race and Ethnic Data Reporting Form” – HUD-27061-H 
  Citizenship Declaration- The adult applicant must fill out the form for any household member under the age of 18.

Applications are reviewed with management by appointment only.

Incomplete applications and applications missing required documents will not be considered.

TOTAL INCOME:

A household’s income is the total anticipated amount of money received by ALL members of the household over the next 12 months based on their current income and any income earned from assets (starting from the date of application and projecting forward 12 months). This excludes income by live-in aides.

Income means money from ANY source including Wages (tips, bonus and commission, if applicable) Military Pay, Veterans Benefits, Disability Insurance Payments, SSA (received by all household members), SSI Federal (received by all household members), SSI State (received by all household members), Child Support, Alimony, Pension, Adoption Subsidy Payments, Education Grants, Stipends, Scholarships, Trade Union Benefits, Unemployment, Self- Employment Income, Public Assistance, Interest earned from Assets, Annuities, Workers Compensation, and Recurring Contributions such as: money someone gives you to pay your bills OR gives you as spending money OR the person uses to pay your bills directly.

Assets include checking and saving accounts, investments, stocks or bonds, mutual funds/trustaccounts, certificates of deposit, IRA accounts (for example, 401K, Roth Keogh or other retirement investments), whole life insurance policy, and real estate of all household members. If any household member currently owns property, the total amount of equity in the home shall be added to their total value of assets.

The Management Agent will not discriminate based on mobile voucher holder status. This question is asked for the sole purpose to: (1) determine an applicant household’s ability to pay rent for a unit that does not have project based rental subsidy; or (2) advise applicant households who are applying for a unit with project-based rental subsidy that if they move into such a unit that already has subsidy with the unit, they will be required by their voucher agency to give up their mobile voucher.

I/We certify that all information in this application is true to the best of my/our knowledge and I/we understand

• that false statements or information will lead to rejection of this Pre-Application or termination of tenancy after occupancy;
• that in consideration for being permitted to apply for this apartment, I, Applicant, do represent all information in this application to be true and that the owner/manager/employee/agent may rely on this information when investigating and accepting this Pre-Application;
• that the owner/manager/agent will rely on the information provided by the Applicant, once verified, to make a determination that Applicant is eligible and qualified for housing.
• that I, the Applicant, must notify the property, for which I have submitted a Pre-Application, of any change of address in writing and I understand that my Pre-Application may be cancelled if I fail to do so.

I/We understand I/We must pay a security deposit for an apartment upon occupancy. I/We understand that my eligibility for housing will be based on applicable income limits and by management’s Tenant Selection Plan. I/We certify that all information in this application is true to the best of my/our knowledge and I/We understand that false statements or information may be punishable by law and will lead to denial of this application.

All adult applicants, 18 or older, must sign application. By signing below, you authorize the management agent and its employees to run criminal background checks including the sex offender registry, credit reports, and to conduct landlord(s)/tenant history inquiries.

Applicant hereby releases, remises and forever discharges, from any action whatsoever, in law and equity, and all owners, managers and employees or agents, both of landlord and their credit checking agencies in connection with processing, investigating, or credit checking this application, and will hold harmless from any suit or reprisal whatsoever, except as otherwise limited by laws relating to the use of personal information, credit history or criminal background.

Please note that this is a Preliminary Application to be placed on the waitlist ONLY, and does not ensure occupancy. Additional information will be required at a later date to complete the processing of this application. Signed release forms will be required so that information may be obtained from sources such as, but not limited to Social Security Administration, Dept. of Social Welfare, Health Care Providers, Credit and Criminal Reporting Agencies. Because this development is financed by the Department of Housing and Urban Development, it is a Criminal Offense to make a Willfully False Statement or Misrepresentation on this rental application.

It is your responsibility to keep us informed in writing of any changes of your address, phone number as well as any income or household composition changes that may affect your eligibility.

PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures of improper use of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, for misusing the social security number as provided under the Social Security Act at 208 (a) (6), (7) and (8). Violation of these provisions are cited as violations of 42 U.S.C. 408 (a) (6), (7) and (8).

RIGHT TO REASONABLE ACCOMMODATION
The Agent for this property provides persons with disabilities the opportunity to request a reasonable accommodation in order to apply to and participate in such programs and activities. The Agent for this property will consider a reasonable accommodation, upon request, for qualified people with disabilities when an accommodation is necessary to ensure equal access to the development, its amenities, services and programs. Reasonable accommodations may include changes to the building, grounds, or an individual unit; changes to policies, practices, and procedures; and mitigating circumstances.

LIMITED ENGLISH PROFICIENCY
The Agent provides people whose primary language is not English and as a result have limited English proficiency, the opportunity to request free language assistance to apply to or participate in its programs and activities.

FAIR HOUSING/EQUAL OPPORTUNITY INFORMATION
The Agent for this property does not discriminate on the basis of race, color, religion, national origin, gender, disability, familial status, marital status, sexual orientation, genetic information, veteran/military status, receipt of public assistance, ancestry, age, gender identity or other basis prohibited by federal, state, or local law in the access or admission to its programs or employment or its programs, activities, functions or services.

ALL household members are REQUIRED to complete the Supplement to Application for Federally Assisted Housing

ALL household members are REQUIRED to complete the Race and Ethnic Data Reporting Form

ALL household members are REQUIRED to complete the Citizenship Declaration

Copies of the following documents are REQUIRED:

• Birth Certificate for all household members
• Social Security Card for all household members
• Valid Photo Identification for all household members 18 years or older