TENANT HOUSING VOUCHER & CASE MANAGER INTAKE FORM
Streamlining Move-In & Coordination for Subsidized Housing Programs
SECTION 1: APPLICANT / TENANT INFORMATION
Intake & Verification: Tenant submits this form along with their active Voucher and RTA/RFTA packet from their program agency.
Full Legal Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Desired Move-In Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Voucher Bedroom Count
*
Voucher Expiration Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SECTION 2: VOUCHER & PROGRAM DETAILS
Landlord Packet: Landlord completes ownership/W-9 details in the RTA packet and returns it to the case manager
Housing Program Type
*
Section 8 (Housing Choice)
HUD-VASH
Rapid Re-Housing (CoC/ESG)
HOME TBRA
Local/City Voucher
Other
Administering Housing Agency / Organization Name
*
Maximum Authorized Rent / Utility Standard (if known):
*
SECTION 3: HOUSING SELECTION & VOUCHER ENTITLEMENT
Inspection & Approval: Housing agency conducts an HQS safety inspection and verifies rent reasonableness for the unit.
Housing Structure Preference
*
Single-Family Home
Apartment
Townhouse / Duplex
Condominium
Authorized Unit Bedroom Selection
*
Studio
1 Bedroom
2 Bedroom
3 Bedroom
4+ Bedroom
SECTION 4: CASE MANAGER / HOUSING SPECIALIST INFORMATION
HAP Contract & Move-in: Hap contract and lease are executed; direct deposit setup is completed and lease starts.
Case Manager / Specialist Name
*
First Name
Last Name
Agency/Department Name
*
Office Address / Portal Link:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Direct Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
SECTION 5: DEPOSIT & FINANCIAL ASSISTANCE BREAKDOWN
Security Deposit Assistance Provided By Agency?
*
Yes
No
Pending / Application
Is a Request for Tenancy Approval (RTA) Packet Attached?
*
Yes
No
Issued / Need Link
Needs to be Issued
If yes, please upload
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SECTION 6: INFORMATION EXCHANGE AUTHORIZATION
Signature: I hereby authorize property management and my designated Housing Agency Case Manager / Housing Specialist named above to exchange required documents, rental verifications, lease agreements, inspection scheduling details, and financial subsidy information necessary to evaluate and complete my tenancy approval under the rental assistance program.
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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