KH | Intake | New Client Intake | v1.1
LIVE INTERIM INTAKE — Jotform is the controlled intake layer while HOS/KHHH remain pre-production. Current verified KH and official program guidance controls.
CURRENT KH INTAKE — Reviewed 2026-09-30. Interim Jotform workflow pending HOS/KHHH production approval.
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)
*
Browse Files
Drag and drop files here
Choose a file
Goverment IDs, Passport, Social Security Card
Cancel
of
Income Documents
*
Browse Files
Drag and drop files here
Choose a file
Last 30-60 Days , Budget Letters, Award Letters
Cancel
of
Voucher Award Letter / Shopping Letter
Browse Files
Drag and drop files here
Choose a file
DSS - 7 or DSS - 7 b ( “ Shopping Letter”) DSS - 7a or DSS - 7c (“Household Share Letter”)
Cancel
of
Client Consent Documents (If applicable)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Household Composition Documents (If applicable)
Browse Files
Drag and drop files here
Choose a file
Residency Letter from Shelter Facility. Case Manager / Housing Specialist can provide.
Cancel
of
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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, re-verify the program/payment standard, form revision, and destination from the current official source before any live housing packet submission.
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
Next Workflow Step
Privacy & Consent
Kingz Haven Privacy Policy
Acknowledgment
*
This acknowledgment is not a blanket release of confidential records, does not enroll you in SMS or marketing messages, and does not engage a real estate broker. Separate consent or authorization will be requested when required.
Security reminder: do not send passwords or banking credentials. Please use the secure upload fields for any requested sensitive documents.
Submitter Role
*
Client
Case Manager / Caseworker
Housing Specialist
Authorized Agency Staff
Other Authorized Representative
Other
Relationship / Authority to Submit for Client
*
Organization
*
Submitter Name
*
First Name
Last Name
Submitter Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submitter Email
*
example@example.com
DocuSign Workflow
E-Sign Required?
Yes
No
DocuSign Document Key
DocuSign Approval Status
DocuSign Envelope ID
DocuSign Signature Status
By submitting this intake, you confirm the information is true and that you are authorized to provide it. This form does not guarantee housing placement, brokerage, legal, or financial services, and information may be shared with authorized housing or agency partners only as needed for housing-support processing.
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