Housing Authority of the County of Lake, Illinois

PARTICIPANT OBLIGATIONS IN THE LOW RENT PROGRAM

 

Income, Household Composition

 

            I understand that I am required to report to the Authority in writing all changes in income, assets, family composition, allowances or claimed income exclusions within 10 days of the effective date of those changes. This includes reporting all benefits or other sources of income received on behalf of minor children as well as income earned or otherwise received from all household members 18 years of age or older (including full time students). I understand that such information may or may not affect the terms of my lease according to Authority Policy.

 

            I also understand that if I choose to pay income-based rent, my rent will be 30 percent of my total household income after allowances and exclusions.  Further, I understand that the failure to report all changes in my household income, assets or composition as required may result in the termination of my lease.  Should I fail to report increases in household income in accordance with Authority policy, I understand that the Authority will seek payment in full for the amount of rent I should have been paying retroactive to the date the unreported increased household income became effective. Additionally, I recognize that it is my responsibility to provide notice of decreased household income, income adjustments or income exclusions in a timely manner and that my failure to do so will not result in a reduction of rent retroactive to the date such changes became effective.

 

COMMUNITY SERVICE

 

I certify that I am eligible for an exemption from the Community Service requirement for the following reason:

 

1. I am 62 years of age or older.
    
2. Blind or disabled and who certify that because of this disability she or he is unable to comply with the requirement or is the primary caretaker of such an individual; (Certification of Disability Form will serve as documentation).
   
   
3. I am working (Employment Verification form will serve as documentation).
    
4. I am participating in a Welfare to Work Program. (Must provide verification letter from agency).
   
   
5. I am receiving TANF and am participating in a required economic self-sufficiency program or work activity (Must provide verification from the funding agency that you are complying with job training or work requirements).
   
   
6. I am a full time student (Must provide verification letter from school attended).
   
   
7. I am not eligible to claim an exception as outlined above.

Every adult household member must sign below and include the appropriate community service exemption number. Supporting documentation as outlined above must be included with this form.

 

                                                                                                                                   

Resident Signature                             Date                         Exemption Number

 

                                                                                                                                   

Resident Signature                             Date                        Exemption Number

 

                                                                                                                                   

Resident Signature                             Date                         Exemption Number

 

                                                                                                                                   

Resident Signature                             Date                         Exemption Number

 

                                                                                                                                   

For Lake County Housing Authority                              Date

 

For certification dated:                                          

 06/08