How to Write a Hardship Letter and 401K

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					                                  PRE-APPLICATION COVER LETTER
Property Name: Meridian Manor Apartments
Property Address: 10345 Meridian Avenue North, Seattle, WA 98133
Phone/Fax Number: 206-525-2135      Fax: 206-525-0267 TDD 711
Office Hours: Mon-Fri 8:00-5:00    E-mail: meridian_manor@hrg.org
Dear Future Tenant,
Welcome and thank you for applying to live at the Meridian Manor Apartments.
Attached is our rental Pre-Application. This is a short form we use to preliminarily qualify your household for our
waiting list. We use this form when we do not immediately have an opening at our property. If your household is
eligible for our waiting list and your name gets closer to the top of our waiting list, your household will be notified
and required to complete a full application package with additional attachments. It is not until your household
completes the full rental application packet and any HUD required attachments that we can determine your full
eligibility for our HUD-assisted property.
Please take a few minutes to read over our requirements for filling out and returning the Pre-Application package.
We hope that you will soon be calling our apartments your new home. Should you have any questions or concerns
please give me a call at the phone number above. All interested individuals have the right to complete and submit an
application.
Filling out the Pre-Application:
The Pre-Application package includes a rental Pre-Application, income/asset statement and possibly other forms for
your household to complete. One Pre-Application is completed for the household. Each adult must complete a
separate income/asset statement. This cover letter contains information regarding the policies of our apartment
community that relate to eligibility and our procedures for selecting tenants.
When completing the Pre-Application package, please read it over first, then fill it out in its entirety. Please fill it out
to the best of your knowledge. The attached income/asset statement will assist you in determining what is considered
to be income, assets and any adjustments or allowances to income. Please do not leave any blank spaces. If a
question does not apply to you and does not require a Yes or No answer, please write out the words "Not
Applicable". If you make a mistake please cross it out rather than using white out. Be sure to sign and date the
application and the other forms. If you need assistance in completing the application package, we can assist you. If
you have a disability and require assistance related to the completion and return of the application, you can request a
reasonable accommodation.
Once you have completed and signed our Pre-Application package, you will need to return it to our property office
or mail it to the rental office. We will review the completed Pre-Application packet and if your household appears to
be eligible, we will place you on the waiting list. We accommodate persons with disabilities who, as a result of their
disabilities, cannot read or understand our application documents by providing alternative methods of accepting
applications. Please let us know if you need an accommodation.
If your household does not meet our HUD Federal guidelines or our Tenant Selection criteria, your pre-application
will be rejected. Regardless of the disposition of your application, we will advise you in writing with our application
status notification within 10 days of receiving your completed Pre-Application package.
Who is Eligible to live at our Property?
Meridian Manor serves individuals and families who are 62 or older. Meridian Manor must make at least 40% of the
assisted units that become available in each year of the projects fiscal year available for leasing to families whose income
does not exceed 30% of the area median income at the time of admission. In addition, the following income limits
continue to apply:

Not more than 25% of the units available for occupancy prior to October 1, 1981 shall be rented to low income families,
other than very low income families.



                                                                                        Page 1 of Meridian Manor Pre-Application 5/7/09
Not more than 15% of units available for occupancy on or after October 1, 1981 shall be rented to low income families,
other than very low income families.

Rents at this property are HUD subsidized and are equal to 30% of your monthly adjusted income. Water, Sewer and
Garbage are included in your rent. There is a HUD Section 8 required minimum total tenant payment of $25.00 per
month, unless a verifiable qualifying hardship exists. Please contact the manager for details about the rent structure
at this property.
A background screening will be performed on all adult applicants as they get closer to the top of the waiting list. The
property (not the applicant) will pay the cost of the screening. We perform screening to determine acceptable
behavior through prior landlord rental history, criminal history, public records and credit history (poor credit history
is not a major factor in application review). There are certain restrictions for non-citizen household members and
students in HUD subsidized housing. If any of your household members are ineligible non-citizens or students,
management will explain how this may affect you receiving HUD subsidy at this property.
For example, if your household includes family members who do not declare citizenship or non-citizenship status, or
sign a statement electing not to contend non-citizen status, your application may be rejected. If you are denied based
on our screening criteria you will be notified in writing and given the option to appeal the decision.
The Waiting List
We will choose applicants off of our waiting list in chronological order from the date and time they submit their Pre-
Application within the income targeting and/or other criteria associated with this property and HUD. You are
welcome to request any reasonable accommodations or modifications to the units, site property policies or
procedures to accommodate a disability. Please indicate on your application if you believe you qualify for reasonable
accommodations due to a disability.
When you are notified of placement on our waiting list, it will be important that you update us with any changes in
your household. Changes such as change of address, phone number, household size, members or income are very
important to tell us immediately. You will also need to contact us at least every 6 months to let us know that you are
still interested in remaining on our waiting list. If you do not contact us, we may send you a letter (at your last
known address) asking for your continued interest in remaining on our waiting list. If we do not hear back from you,
we may remove your name from our waiting list.
When an Apartment will be coming available:
You will be contacted in chronological order from the waiting list when a unit will be available soon. Please be
available by phone so we may contact you when your name comes to the top of the waiting list. If we have trouble
getting hold of you, we may have to skip over or remove your application based on our policies in our Tenant
Selection Plan.
Once contacted by the manager you will be required to come to the property to view the unit and complete a final
application packet within 10 days of notification. Additional information will accompany the final rental application
regarding our criteria, additional attachments, documentation requirements etc.
A final decision regarding your eligibility cannot be made until all of the above information has been received,
verified, and reviewed. Once you have passed our final application and screening requirements, and an apartment is
available that meets your needs and requirements, you will be notified to start the move-in process.
If you have any questions regarding completing the Pre-Application, about the disposition of your application or
about the property or regulations, please call us. We look forward to serving you.

Resident Manager ___________________________________________________________

Housing Resources Group does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted
programs and activities. The person (agency) named below has been designated to coordinate compliance with the nondiscrimination requirements contained in the
Department of Housing and Urban Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2, 1988).
Housing Resources Group 1651 Bellevue Avenue, Seattle, WA 98122 206-623-0506 TDD 711 (for the hearing impaired).
We do business in accordance with the Federal Fair Housing Act and provide persons with disabilities reasonable accommodation upon request.
Persons with language barriers may request or arrange interpretation alternatives or services.




                                                                                                                   Page 2 of Meridian Manor Pre-Application 5/7/09
                                                                 HRG Date & Time Stamp




                          HRG PRE- APPLICATION for Meridian Manor (HUD)
                                       SUBSIDIZED UNIT

Meridian Manor HUD units are subsidized 1 bedroom apartments, where one household member must be 62 or older.
These units serve people at 30% and 50% of the area median income. They are located at 10345 Meridian Avenue
North, Seattle, WA 98133. Please mail pre- applications to the property address.
                                                      1 bedroom
                         Household Size
                         Requirements                 1-3 people

                       Household Size         1 person          2 people              3 people
                       Income Limit 30%       $ 17,700           $20,220                $22,750
                       Income Limit 50%       $29,500            $33,700                $37,950

Name and Address of Head of Household

    ___________________________________________________________________________
          Last name                  First name                               Middle initial


    _____________________________________________________________________________________
        Mailing address        Apartment #          City         State       Zip code


         (   )      -                                      (    )    -
      _____________________________________               __________________________________
      Area code       Home phone number                   Area code       Cell phone number

     __________________________________________________________________________________
      Case manager or Alternate contact name                        Phone number


List others who will live with you (include unborn children and live in aides.)
 # Relation            First name                          Last names               Under           Disability Y / N
       to Head
                                                                                    18 Y/N
                                                                                      N
1       Head

2

3

4

5
Are there any special accommodations needed due to the disability (wheelchair accessible, etc)?




                                                                                        Page 3 of Meridian Manor Pre-Application 5/7/09
Gross household income (can be hourly wage, monthly gross, or annual gross)

Hourly $___________              Hours worked per week                 Household assets (Bank accounts, investments, real estate)

Monthly $ __________                   ____________                                       $______________________

Annual $ __________

                                                                   Are ALL members of the household full time students?
Has any household member lived in a housing
authority or other federally subsidized housing?                                    Yes         No
                                                                   Has any household member ever been evicted?
         Yes     No                                                                      Yes        No
If Yes, when? From_________To________
                                                                   If yes, when? ___________________
Was there money owed? ________________



Has any household member ever been convicted of a crime?
          Yes       No

If yes, when, and what type of conviction?




      I have received and reviewed the attached Pre-Application Cover Letter and Income Asset
       Statement.

      It is your responsibility to ensure that HRG has the correct contact information and to notify
       HRG about any change in contact information, household size, income, composition, or other
       relevant changes.

      If a housing opportunity that meets your household’s needs becomes available and we cannot
       contact you, your application will be removed from our waiting list.

      If you are offered and then decline two housing units that you have indicated interest in and that
       you qualify for your application will be removed from the waiting list.


     _______________________________________________________________________________________________________
     Applicant Signature (Adult)                                                                    Date


     _______________________________________________________________________________________________________
     Applicant Signature (Adult)                                                                   Date


     _______________________________________________________________________________________________________
     Applicant Signature (Adult)                                                                   Date




Housing Resources Group does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted
programs and activities. The person (agency) named below has been designated to coordinate compliance with the nondiscrimination requirements contained in the
Department of Housing and Urban Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2, 1988).
Housing Resources Group 1651 Bellevue Avenue, Seattle, WA 98122 206-623-0506 TDD 711 (for the hearing impaired).
We do business in accordance with the Federal Fair Housing Act and provide persons with disabilities reasonable accommodation upon request.
Persons with language barriers may request or arrange interpretation alternatives or services.




                                                                                                                   Page 4 of Meridian Manor Pre-Application 5/7/09
INCOME ASSET STATEMENT– HUD Properties Property Meridian Manor
____________________
                                                                       Move-in certification
NAME _______________________________________________________                Recertification
ADDRESS ___________________________________________________Apt# _______
MAILING              ADDRESS             (if          different       than              Property
Address)_______________________________________________
     HOUSEHOLD COMPOSITION: I certify my household consists of the following persons ONLY.
   I certify changes in household AND income will immediately be reported to the management. All
    persons age 18 or older living in the household will complete and sign a separate Income/Asset
                                               Statement.
                                Please complete every YES/NO question.
                                        Relationship                                      Social Security Number
             Full Name                                       D. O. B      Sex
                                             Head




   A. Income:
         1. Are you or any other members of the household currently receiving income from any of
            the following sources?                                                        Yes No
                    Wages/Salaries including tips, bonuses, commissions or overtime       ___ ___
                    Has the employment status of any household member changed?            ___ ___
                    Wages earned through a government program such as: Senior Aides,
                    Older American Community Service Employment Program, AmeriCorps ___       ___
                    Financial Aid, grants, scholarships, tuition assistance or work study ___ ___
                    Income from operation of a business                                   ___ ___
                    Social Security (SSA or SSDI)                                         ___ ___
                    Supplemental Security Income (SSI)                                    ___ ___
                    Disability or WASHCAP monetary income                                 ___ ___
                    Interest, dividends or other income from assets                       ___ ___
                    Pensions/retirement funds                                             ___ ___
                    Annuity payments or payments from a trust                             ___ ___
                    Unemployment or Workman's Compensation                                ___ ___
                    Military pay                                                          ___ ___
                    Public assistance/TANF,GAU or other DSHS Grant                        ___ ___
                    Alimony or Child Support - Either received directly or
                     through an agency?                                                   ___ ___
                         Is there a divorce or separation agreement that states
                         you are entitled to periodic Alimony or Child support?           ___ ___
                    Foster Care or Adoption Care Income                                   ___ ___
                    Income from rent or sale of property                                  ___ ___
                    Periodic payments from lottery winnings                               ___ ___
                    Insurance policies, death benefits or long term care policies         ___ ___
                    Severance pay                                                         ___ ___
                    Other _____________________________________                           ___ ___

        2.    Do you regularly receive monetary gifts or non-cash contributions
              from persons outside your household? (See box** )                                       ___        ___

   ** Monetary or non-monetary contributions include money for or expenses paid on your behalf such
   as: Rent; utilities and telephone; groceries; clothing; misc. household supplies; insurance, car
                                                                             Page 5 of Meridian Manor Pre-Application 5/7/09
   expenses and gas; tuition and education expenses and other expenses. Provide name, address and
   telephone number of paying persons(s)
                                                                                      Yes No
        3. Does anyone in your household receive income from a job training
            program administered by federal, state or local agency?                   ___   ___

        4.   Did you or any other members of the household file a federal tax
             return last year? If not, why not _________________________________                                  ___        ___

        5.   Are there any members of the household under 18 years old receiving
             income not listed above?        (Wages, Social Security, SSI or income from assets etc?)             ___        ___
             If yes, specify the source of the income __________________________

If answered "YES" to any of the above Income questions, please give the name, address and all
potential income for the next 12 months from these sources:_______________________________
________________________________________________________________________________________
________________________________________________________________________________________
_________________________________________________________________________

   B. Assets:
         1. Do you or any other members of the household have any of the following:
                                                                                                                  Yes        No
                      Checking accounts                                                                           ___        ___
                      Savings accounts                                                                            ___        ___
                      Certificates of deposit                                                                     ___        ___
                      Money market funds or Treasury Bills                                                        ___        ___
                      IRA and/or 401K account                                                                     ___        ___
                      Stocks, Bonds                                                                               ___        ___
                      Annuity accounts                                                                            ___        ___
                      Trust funds If yes, is the trust irrevocable?________________                               ___        ___
                      Real estate, land holdings                                                                  ___        ___
                      Whole life or universal life insurance policy (need cash or surrender value)                ___        ___
                      Cash held in safety deposit boxes, personally or at home                                    ___        ___
                      Personal Property held as an investment                                                     ___        ___
                      Assets held in another state or foreign country                                             ___        ___
                      Other _____________________________________________                                         ___        ___

If answered "YES" to any of the above Asset questions, please give the name, address and potential
income (Interest, dividends etc) for the next 12 months from these sources: __________
________________________________________________________________________________________
________________________________________________________________________________________
_________________________________________________________________________

         2. Have you or any other members of the household received any                                           Yes        No
            lump sum payments, such as:
                   Social Security or SSI or VA back payments                                                     ___        ___
                   Inheritance, annuities, lottery winnings, capital gains                                        ___        ___
                   Insurance settlements (health, accident, workman comp etc)                                     ___        ___
                   If Yes, specify who, when and amount: __________________________

         3. Have you or any other household members disposed of any asset(s)
            (Money, bank accounts, real estate etc) for less than fair market value                               ___        ___
            in the past two (2) years? If yes, please list: _______________________

             Date Disposed ______ Fair Market value at time of disposition __________Amount received ________


                                                                                         Page 6 of Meridian Manor Pre-Application 5/7/09
                                                                                                   Yes        No

       4. Do you or any other household members have any assets that                     ___ ___
          are held jointly with another person? Describe who owns jointly and percentage
          of ownership if known.____________________________________________________

C. Elderly and/or Medical Deductions (or allowances):
   This information is voluntary, but some programs offer deductions (allowances) from
   income for household's who's head, co-head or spouse is elderly or disabled.                    Yes        No

       1. Is any household member elderly (age 62 or older) or a person
          with disabilities? Who? ______________________________________                           ___        ___

       2. Do you or anyone in the household have medical or RX coverage under
          Medicare Part D? Explain: ___________________________________                            ___        ___

       3. Do you have medical expenses that are not reimbursed or paid for by
          an outside source such as insurance or other persons?                                    ___        ___

 COMPLETE THIS MEDICAL EXPENSE SECTION ONLY IF THE HEAD, CO-HEAD OR SPOUSE IS 62
                OR OLDER OR DISABLED AND WISH TO DECLARE MEDICAL EXPENSES.
Medical expenses include: All expenses the family anticipates to incur during the 12 months following
certification that are not reimbursed by an outside source, such as insurance. Ongoing expenses the
family paid in the 12 months preceding the certification may be used to estimate anticipated medical
expenses. In addition to anticipated expenses, past one-time nonrecurring medical expenses that have
been paid in full may be included in the calculation of the medical expense deduction for current tenants at
an initial, interim or annual recertification. Past one-time nonrecurring medical expenses that have been
paid in full are not applicable when calculating anticipated medical expenses at move-in. If the tenant is
under a payment plan, the expense would be counted as anticipated.

Medical expenses include but are not limited to: services of physicians or other medical practioners,
medical insurance premiums; prescription medicines; non-prescription supplies, dental expenses; eye
care and glasses; hearing aids and batteries; attendant care or periodic medical care; payments on
accumulated bills etc. See Exhibit 5-3 of the HUD Handbook 4350.3 for examples of allowable and
non-allowable medical expenses.

Please list the sources and amounts of your medical expenses that are not paid for or reimbursed
by any outside source (use additional sheets if needed). All amounts claimed must be verifiable
through 3rd party sources:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
________________________________________________________________
_______________________________________________________________________________


D. Other Information and/or Deductions:                                                            Yes        No

       1. Do you have disability expenses or attendant care expenses that are not                  ____       ____
          paid by an outside source? If yes, is this service necessary to enable a
          family member (including the member with a disability) to be employed?                   ____       ____

      2.   Do you currently pay for childcare services for any children under the
           age of 13 residing in your household? If yes, is this service necessary                 ___        ___
           in order for you to be employed, look for work or to attend school?                     ___        ___
           If yes, please explain ____________________________________________
           If yes, are any of these expenses paid for or reimbursed by an outside source?          ___        ___
                                                                          Page 7 of Meridian Manor Pre-Application 5/7/09
                   If yes, please explain ____________________________________________
                                                                                                                                Yes        No

             3. Are there any foster children, foster adults or live-in care attendants                                         ___        ___
                that are living or going to be living with you? Who? ________________

             4.    Are any members of your household temporarily absent? If so list who
                   and why ________________________________________________                                                     ___       ___

              5. Are there any STUDENTS (part or full time students) in the household                                           ___      ____
                 including children? Who and where attending_____________________
                 _________________________________________________________
                 _________________________________________________________

              6. Will any household members become a full or part time STUDENT in the
                 next 12 months? If so Please explain ____________________________                                               ___       ___
                 __________________________________________________________
                 __________________________________________________________

             7. Expected Changes:
                 Are there any expected changes in the household membership OR
                 household income, assets or expenses in the next 12 months?                                                    ___        ___
                 New Job, change in job or rates, new assets or change in assets,
                 new expenses or change in expenses?                                                                            ___        ___
                 Baby due, adopting a child(ren), obtaining custody of a child(ren),
                 obtaining joint custody of a child(ren), receiving a foster child(ren)
                 or adult or a member of the household moving out?                                                              ___        ___
                 Please explain and give dates. Additional verification may be required.
                 __________________________________________________________
                 __________________________________________________________
                 __________________________________________________________
  Penalties for Committing Fraud: The United States Department of Housing and Urban Development (HUD) program
      places a high priority on preventing fraud. If your application or recertification forms contain false or incomplete
 information, you may be: Rejected  Evicted  Required to repay all overpaid rental assistance you received  Fined up
                                                          to $10,000
                        Imprisoned for up to five years  Prohibited from receiving future assistance.
                       Your State and local governments may have other laws and penalties as well.

By signing below I am certifying that I understand that the above information is required to be
verified from the source. I have completed this questionnaire and that the answers that I have
given are true and complete to the best of my knowledge.
All persons age 18 or older must complete and sign a separate Income/Asset Statement.
_____________________________________                                                 ___/___/__
Head of Household                                                                       Date

_____________________________________                                                 ___/___/__
Co-Head, spouse or other adult family member                                            Date
Housing Resources Group does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its
federally assisted programs and activities. The person (agency) named below has been designated to coordinate compliance with the nondiscrimination
requirements contained in the Department of Housing and Urban Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2,
1988). (Name, address, telephone)__1651 Bellevue Avenue, SEA WA 98122 (TDD 711 for hearing impaired). We do business in accordance with the
Federal Fair Housing Act and provide persons with disabilities reasonable accommodation upon request. Persons with language barriers may request
or arrange interpretation alternatives or service




                                                                                                       Page 8 of Meridian Manor Pre-Application 5/7/09

				
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Description: How to Write a Hardship Letter and 401K document sample