Republic Housing Authority

Classifications of pets are all breeds of birds, fish in aquariums, dogs, cats, anytime of rodents and turtles.

NO PETS are allowed by tenants under age of 62 years in the family apartments except for Hearing/Seeing Eye Dogs.

Republic Housing Authority WILL NOT APPROVE EXOTIC PETS SUCH AS SNAKES, MONKEYS SPIDERS GAME PETS. ETC.

 

Elderly Tenants are allowed one (1) small pet and must meet requirements set in the Pet Policy. 

 

A Non-refundable Pet Fee of $300.00 is required plus proof of current vaccination records and liability insurance, in effect, which will provide protection to a minimum $25,000.00

PIH (Public Indian Housing) smoke-free public housing rule was finalized on December 5, 2016, and became effective February 3, 2017. All Public Housing Authority must comply with the rule and implement smoke-free policies within 18 months of the effective date, no later than July 31, 2018. Medical Marijuana use is prohibited by Federal, and we are Federally funded. Republic Housing Authority administering public housing adopted a Smoke-Free Policy April 18, 2018, and Public Housing Authority is required to have the Smoke- Fee Policy fully enforced by June 30, 2018. The Housing Authority of the City of Republic, Missouri and hereafter referred to as RHA, prohibits the use of "prohibited tobacco products" and bans smoking in all living units, indoor common areas in public housing, and in Public Housing Authority administrative office buildings. The Smoke-Free policy also extends to all outdoor areas up to 25 feet from the housing and administrative office buildings. This Smoke-Free policy applies to all Resident's household members and guests.

The Violence against Women Act (VAWA) provides special protections for victims of domestic violence, dating violence, and stalking who are applying for or receiving assistance under the public housing program. For a more in-depth explanation please review RHA's Violence Against Women Act Policy which is available on our website under our policy page or upon request at Republic Housing Authority.

I hereby certify that I do not or will not maintain a separate subsidized rental unit in another location. I further certify that this will be my/our permanent residence. I understand I must pay a security deposit for the apartment. My eligibility for this housing will be based on rural development income limits and Republic Housing Authority's selection criteria. I certify that all information in this application is true to the best of my knowledge, and I understand that false statements or information is punishable by law and will lead to cancellation of this application or termination or tenancy after occupancy.

I do hereby authorize the staff/or representatives to contact any agencies, police departments, offices, groups or organizations to obtain and verify any information or materials which are deemed necessary to complete my application for the housing programs administrated by Republic Housing Authority. I also authorize verification of all the information listed on this application. 

The information solicited on this application is requested by the apartment owner in order to assure the Federal Government, acting through rural development that Federal Laws prohibiting discrimination against tenant applications on the basis on race, color, national origin, religion, sex, marital status, age and handicap are complied with. You are not required to furnish this information but are encouraged to do so. This information will not be used in evaluating your applications or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race/national origin/sex of the applicant of the basis of visual observation.

Once an applicant's name nears the top of the waiting list, they will be notified by mail or phone call to set up an appointment. 

Applicants must have up-to-date contact information and are required to report changes to Republic Housing Authority. 

If the phone call is not answered or letter is not deliverable, the pre-application will be noted as inactive. 

You must call the office once every six months to say you are still interested in remaining on the waiting list. Otherwise, your application will be pulled from the list and made inactive.

Content

I consent to allow HUD or the HA to request and obtain income information from the sources listed on this form for the purpose of verifying my eligibility and level of benefits under HUD's assisted housing programs. I understand that HA's that receive income information under this consent form cannot us it to deny, reduce or terminate assistance without first independently verifying what the amount was, whether I had access to the funds and when the funds were received. In addition, I must be given an opportunity to contest those determinations.

This form expires 15 months after signing.

Privacy Act Notice

Authority: The Department of Housing and Urban Development (HUD) is authorized to collect this information by the U.S. Housing Act of 1937 (42 U.S.C. 1437 et. seq.), Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), and by the Fair Housing Act (42 U.S.C. 3601-19). The Housing and Community Development Act of 1987 (42 U.S.C. 3543) requires applicants and participants to submit the Social Security Number of each household member who is six years old or older. Purpose: Your income and other information are being collected by HUD to determine your eligibility, the appropriate bedroom size, and the amount your family will pay toward rent and utilities. Other Uses: HUD uses your family income and other information to assist in managing and monitoring HUD-assisted housing programs, to protect the Government's financial interest, and to verify the accuracy of the information you provide. This information may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory investigators and prosecutors. However, the information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law. Penalty: You must provide all of the information requested by the HA, including all Social Security Numbers you, and all other household members age six years and older, have and use. Giving the Social Security Numbers of all household members six years of age and older is mandatory, and not providing the Social Security Numbers will affect your eligibility. Failure to provide any of the requested Information may result in a delay or rejection of your eligibility approval.   

 

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Penalties for Misusing this Consent:

HUD, the HA and any owner (or any employee of HUD, the HA or the owner may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form,

Use of the information collected based on the form HUD 9886 is restricted to the purposes cited on the form HUD 9886. Any person wits knowingly or willfully  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 against the officer or employee of HUD, the HA or the owner responsible for the unauthorized disclosure or improper use.

Original is retained by the requesting organization.

ref. Handbooks 7420.7, 7420.8, & 7455.1

form HUD- 9886 (07/14)                                                 

U.S. Department of Housing and Urban Development

Office of Public and Indian Housing

URBAN DEVELOPME

DEBTS OWED TO PUBLIC HOUSING AGENCIES AND TERMINATIONS

Paperwork Reduction Notice: Public reporting burden for this collection of information is estimated to average 7 minutes

per response. This includes the time for respondents to read the document and certify, and any recordkeeping burden. This Information will be used in the processing of a tenancy. Response to this request for information is required to receive benefits. The agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. The OMB Number is 2577-0266, and expires 04/30/2023-

NOTICE TO APPLICANTS AND PARTICIPANTS OF THE FOLLOWING HUD RENTAL ASSISTANCE PROGRAMS:

Public Housing (24 CFR 960)

Section 8 Housing Choice Voucher, including the Disaster Housing Assistance Program (24 CFR 982)

Section 8 Moderate Rehabilitation (24 CFR 882)

Project-Based Voucher (24 CFR 983)

The U.S. Department of Housing and Urban Development maintains a national repository of debts owed to Public Housing Agencies (PHAS) or Section 8 landlords and adverse information of former participants who have voluntarily or involuntarily terminated participation in one of the above-listed HUD rental assistance programs. This information is maintained within HUD's Enterprise Income Verification (EIV) system, which is used by Public Housing Agencies (PHAs) and their management agents to verify employment and income information of program participants, as well as, to reduce administrative and rental assistance payment errors. The EIV system is designed to assist PHAs and HUD in ensuring that families are eligible to participate in HUD rental assistance programs and determining the correct amount of rental assistance a family is eligible for. All PHAs are required to use this system in accordance with HUD regulations at 24 CFR 5.233.

HUD requires PHAS, which administers the above-listed rental housing programs, to report certain information at the conclusion of your participation in a HUD rental assistance program. This notice provides you with information on what information the PHA is required to provide HUD, who will have access to this information, how this information is used and your rights. PHAs are required to provide this notice to all applicants and program participants and you are required to acknowledge receipt of this notice by signing page 2. Each adult household member must sign this form.

What information about you and your tenancy does HUD collect from the PHA?

The following information is collected about each member of your household (family composition): full name, date of

birth, and Social Security Number.

The following adverse information is collected once your participation in the housing program has ended, whether you voluntarily or involuntarily move out of an assisted unit:

1. Amount of any balance you owe the PHA or Section 8 landlord (up to $500,000) and explanation for balance owed (le. unpaid rent, retroactive rent (due to unreported income and/or change in family composition) or other charges

such as damages, utility charges, etc.); and 2. Whether or not you have entered into a repayment agreement for the amount that you owe the PHA; and

3. Whether or not you have defaulted on a repayment agreement; and

4. Whether or not the PHA has obtained a judgment against you; and

5. Whether or not you have flied for bankruptcy; and

6. The negative reason(s) for your end of participation or any negative status (ie, abandoned unit, fraud, lease

violations, criminal activity, etc.) as of the end of participation date.

08/2013

 

OMB No. 2577-0266

Expires 04/30/2023

Authorization for the Release of Information/Privacy Act Notice to the U.S. Department of Housing and Urban Development (HUD) and the Housing Agency/Authority (HA)

Authority: Section 904 of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988, as amended by Section 903 of the Housing and Community Development Act of 1992 and Section 3003 of the Omnibus Budget Reconciliation Act of 1993 This law is found at 42 U.S.C. 3544.

This law requires that you sign a consent form authorizing: (1) HUD and the Housing Agency/Authority (HA) to request verification of salary and wages from current or previous employers: (2) HUD and the HA to request wage and unemployment compensation claim information from the state agency responsible for keeping that information: (3) HUD to request certain tax return information from the US. Social Security Administration and the US. Internal Revenue Service. The law also requires independent verification of income information. Therefore, HUD or the HA may request information from financial institutions to verify your eligibility and level of benefits.

Purpose: In signing this consent form, you are authorizing HUD and the above-named HA to request income information from the sources listed on the form. HUD and the HA need this information to verify your household's income, in order to ensure that you are eligible for assisted housing benefits and that these benefits are set at the correct level. HUD and the HA may participate in computer matching programs with these sources in order to verify your eligibility and level of benefits.

Uses of Information to be Obtained: HUD is required to protect the income information it obtains in accordance with the Privacy Act of 1974, 5 USC. 552. HUD may disclose information (other than tax return information) for certain routine uses, such as to other government agencies for law enforcement purposes, to Federal agencies for employment suitability purposes and to HAs for the purpose of determining housing assistance. The HA is also required to protect the income information it obtains in accordance with any applicable State privacy law. HUD and HA employees may be subject to penalties for unauthorized disclosures or improper uses of the income information that is obtained based on the consent form Private owners may not request or receive information authorized by this form.

Who Most Sigs the Consent Farm: Each member of your household who is 18 years of age or older must sign the consent form. Additional signatures must be obtained from new adult members joining the household or whenever members of the household become 18 years of age

Persons who apply for or receive assistance under the following programs are required to sign this consent form:

PHA-owned rental public housing

Turnkey III Homeownership Opportunities

Mutual Help Homeownership Opportunity

Section 23 and 19(c) leased housing

Section 23 Housing Assistance Payments

HA-owned rental Indian housing

Section & Rental Certificate

Section & Rental Voucher

Section Moderate Rehabilitation

Failure to Sign Consent Form: Your failure to sign the consent form may result in the denial of eligibility or termination of assisted housing benefits, or both. Denial of eligibility or termination of benefits is subject to the HA's grievance procedures and Section & informal hearing procedures.

Sources of Information To Be Obtained
State Ware Information Collection Agencies. (This consent is limited to wages and unemployment compensation I have received during period(s) within the last 5 years when I have received assisted housing benefits)

U.S. Social Security Administration (HLD only) (This consent is limited to the wage and self-employment information and payments of retirement income as referenced at Section 6103(17) of the Internal Revenue Code)
US. Internal Revenue Service (HUD only) (This consent is limited to unearned income [Le, interest and dividends))

Information may also be obtained directly from: (a) current and former employers concerning salary and wages and (b) financial institutions concerning unearned income (a, Interest and dividends) I understand that income information obtained from these sources will be used to verify information that I provide in determining eligibility for assisted housing programs and the level of benefits. Therefore, this consent form only authorizes release directly from employers and financial institution of information regarding ang periods) within the last 5 years when I have received assisted housing benefits 

Who will have access to the information collected?

This information will be available to HUD employees, PHA employees, and contractors of HUD and PHAS

How will this information be used?

PHAS will have access to this information during the time of application for rental assistance and reexamination of family income and composition for existing participants. PHAs will be able to access this information to determine a family's suitability for initial or continued rental assistance, and avoid providing limited Federal housing assistance to families who have previously been unable to comply with HUD program requirements. If the reported information is accurate, a PHA may terminate your current rental assistance and deny your future request for HUD rental assistance, subject to PHA policy.

How long is the debt owed and termination Information maintained in EIV?

Debt owed and termination information will be maintained in EIV for a period of up to ten (10) years from the end of participation date or such other period consistent with State Law.

What are my rights?

In accordance with the Federal Privacy Act of 1974, as amended (5 USC 552a) and HUD regulations pertaining to its implementation of the Federal Privacy Act of 1974 (24 CFR Part 16), you have the following rights:

1. To have access to your records maintained by HUD, subject to 24 CFR Part 16.

2. To have an administrative review of HUD's initial denial of your request to have access to your records maintained by HUD.

3. To have incorrect information in your record corrected upon written request.

4. To file an appeal request of an initial adverse determination on correction or amendment of record request within 30 calendar days after the issuance of the written denial.

5. To have your record disclosed to a third party upon receipt of your written and signed request.

What do I do if I dispute the debt or termination information reported about me?

If you disagree with the reported information, you should contact in writing the PHA who has reported this information about you. The PHA's name, address, and telephone numbers are listed on the Debts Owed and Termination Report. You have a right to request and obtain a copy of this report from the PHA. Inform the PHA why you dispute the information and provide any documentation that supports your dispute. HUD's record retention policies at 24 CFR. Part 908 and 24 CFR Part 982 provide that the PHA may destroy your records three years from the date your participation in the program ends. To ensure the availability of your records, disputes of the original debt or termination Information must be made within three years from the end of participation date; otherwise the debt and termination information will be presumed correct. Only the PHA who reported the adverse information about you can delete or correct your record. Your filing of bankruptcy will not result in the removal of debt owed or termination information from HUD's EIV system. However, if you have included this debt in your bankruptcy filing and/or this debt has been discharged by the bankruptcy court, your record will be updated to include the bankruptcy indicator, when you provide the PHA with documentation of your bankruptcy status.

The PHA will notify you in writing of its action regarding your dispute within 30 days of receiving your written dispute. If the PHA determines that the disputed information is incorrect, the PHA will update or delete the record. If the PHA will provide an explanation as to why the information os correct.