Kingz Haven Intake
Client Information
Client Name
*
First Name
Middle Name
Last Name
Client Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Client Email
*
example@example.com
Address History (Last 90 Days)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Voucher Type
*
CityFHEPS
Section 8
SOTA
FHEPS
SHARES
HASA
NONE
Other
Preferred Borough
*
Brooklyn
Queens
Manhattan
Bronx
Staten Island
Maximum Rent (if no voucher)
Maximum Rent (Voucher)
EX: 2BD $3.058 This is the maximum rent amount if all utilities are included in the lease.
Potential Household Share
The portion of your rent you would be responsible for each month. This amount includes any CA shelter allowance.
Number of Bedrooms (Preferred)
*
STUDIO,1,2,3,4
Voucher Expiration / Desire Move Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
VOUCHER HOLDERS ENTER VOUCHER EXPIRATION DATE
Source of Income
*
Employment
Self-Employed
Public Assistance
Pension / Retirement
Child Support
Savings / Assets
Other
Pets
*
Dog
Cat
No Pets
Service Animal / Emotional Support Animal
Other
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Caseworker Information
Case Manager
First Name
Last Name
Case Manager's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Case Manager's Email
example@example.com
Housing Specialist
First Name
Last Name
Housing Specialist's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Housing Specialist's Email
example@example.com
Organization
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Supporting Documents
Government ID(s)
*
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Goverment IDs, Passport, Social Security Card
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Income Documents
*
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Last 30-60 Days , Budget Letters, Award Letters
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Voucher Award Letter / Shopping Letter
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DSS - 7 or DSS - 7 b ( “ Shopping Letter”) DSS - 7a or DSS - 7c (“Household Share Letter”)
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Client Consent Documents (If applicable)
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Household Composition Documents (If applicable)
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Residency Letter from Shelter Facility. Case Manager / Housing Specialist can provide.
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How did you hear about Kingz Haven Housing Hub?
*
Please Select
Instagram
TikTok
Google Search
Kingz Vision Website
Referral from a Friend or Family Member
Referral from a Case Manager / Agency
Landlord or Property Owner
Flyer / Advertisement
Previous Client
Other
Who referred you? (Name & organization, if applicable)
KHHH HOS Routing
Staff note: When an intake is ready for housing review, proceed to KHHH | Housing Ready & Property Search Profile: https://form.jotform.com/262228123401040
KHHH Case/Client ID
*
Required for staff processing once assigned
Intake Review Status
*
Intake Received
Needs Documents
Ready for Housing Review
Closed/Not Eligible
Assigned Housing Specialist
First Name
Last Name
Review Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Internal Review Notes
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