EPRAP Intake Form

Program Overview

City of AlbanyThis program was developed to assist families who are presently under a lease with a landlord and who have been directly impacted as a result of COVID-19.  The City of Albany/Department of Community and Economic Development and United Way of Southwest Georgia have partnered to administer this program to renters within the city limits of Albany, GA. 

The source of funding for this program is the Community Development Block Grant and the Community Development Block Grant-CV.

The program begins on Monday, November 16, 2020 and ends on December 31, 2021.


EMERGENCY PAYMENT RENTAL ASSISTANCE PROGRAM
Checklist for documentation submittal

This checklist has been provided to assist in providing the necessary documentation needed for verification of income for all members 18 years of age or older and identification of household members. All applicants will be required to provide proof of the following documentation prior to receiving any funding.
 
INCOME VERIFICATION
(per individual over 18 years of age)
 

  • Gross Amount of Wage/Salary - Three pay-stubs showing decrease or loss of income during time affected by COVID 19 (i.e. affected May and June – pay-stubs will reflect those months). The gross amount (before any payroll deductions) of wages and salaries, overtime pay, commissions, fees, tips, bonuses, and other compensation for personal services of all adults in the household (including persons under the age of 18 who are the head, spouse or co-head). Includes salaries of adults received from a family-owned business
     
  • Social Security Income - Recent copy of award letter (less than six (6) months old) The gross amount (before deductions for Medicare, etc.) of periodic social security payments. Include payments received by adults on behalf of individuals under the age of 18 or by individuals under the age of 18 for their own support
     
  • Payment from Annuities, Retirement funds, Pensions - Recent copy of award letter - Full amount of payments from annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts.  Count the total amount of such payments received.  Do not reduce the amount by any amounts the individual previously paid into the account in order to receive the pension, annuity or insurance policy
     
  • Payment in lieu of earning - Recent copy of award letter (if applicable)
    Unemployment and disability compensation, worker’s compensation and severance pay.  Any payments that will begin during the next twelve (12) months must be included
     
  • Self-Employment Income - Recent copy of W’2 and/or 1099 form(s) (if applicable). Applicants must provide the most recent year of W-2’s and/or 1099’s.  If the applicant has a W-2 or 1099, deducting business expenses is not allowed.  Positive net income from a side business will be added to the applicant’s gross income.
     
  • Payment from alimony, Child Support & Gift Income (if applicable) – Most recent award letter and documentation.  Period and determinable allowances, such as alimony, child support payments and regular contributions or gifts received from organizations or from persons not residing in the dwelling.
     
  • Welfare Assistance – Recent copy of award letter (if applicable) This assistance is made under the Temporary Assistance for Needy (TANF) program.  Welfare assistance payment may include an amount specifically designated for shelter and utilities that is subject to adjustment by the agency in accordance with the actual cost of shelter and utilities.
     
  • Bank Statements, etc. for verification of assets – Three months of statements (90 days) provided

IN ADDITION TO ANY SOURCE OF INCOME RECEIVED, ALL APPLICANTS MAY BE REQUIRED TO PROVIDE A COPY OF THE LAST TWO (2) YEARS INCOME TAX RETURNS INCLUDING W-2’s AND/OR 1099’s.  
 
Income is defined as income earned from all household members age 18 years of age or older.  In an event, where a member does not receive any income, he/she is required to complete and submit a Declaration of Zero Income Form. Children 18 years of age or older attending school must submit verification of enrollment.

IDENTIFICATION AND OTHER REQUIREMENTS

  • Recent Copy of a Driver’s License/State Identification – Applies to all adults living in the household
  • Copy of Social Security Cards - Applies to all persons living in household
  • Proof of Children living in the Household - Birth certification or Copy of Court-Ordered Documentation (illustrate custody for surrogate family members such as grandchildren, nephews, nieces, cousins and etc.); or Copy of Tax Return, DFCS Compass Verification

 

Applicant Information
Current Living Situation
Do you currently live in rental housing?
Do you currently live in public housing authority?
Are you the only member of your household?
If no, please fill in other members of your household...
Ethnicity
Emergency Contact Information
Have you recently been infected with COVID-19?
Have you lost your job due to COVID-19?
Have your work hours been reduced due to COVID-19?
Upload requirements
Upload requirements
Are you facing eviction?
Is COVID-19 the reason for you facing eviction?
Monthly Rent
Are you presently delinquent in rent to your landlord?
Income
Have you received funding elsewhere?
Are you receiving assistance from the following sources?
Medicare?
Medicaid?
Please provide the monthly amount you receive from the following.  If you do not receve any assistance please leave blank.
By signing your name below you certify that the above information is correct and understand that any financial assistance provided will be required to be repaid if it is found that you willfully provided misinformation.