Letter Verifying Employment for Lease - Excel

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Letter Verifying Employment for Lease - Excel Powered By Docstoc
					                                 BRAZOS VALLEY COUNCIL OF GOVERNMENTS
                    HOPWA Short-Term Rental, Mortgage and Utilities Assistance Client File Review Tool
                                                                        CLIENT FILE REVIEWED




                                                               WEIGHT
                    ITEM REVIEWED


  A. EMERGENCY ASSISTANCE
  1. Annual Gross and Adjusted income calculated correctly
                                                                  3
  on the Gross & Adjusted Income Worksheet (Form A)

  2. Documents verifying income (including documentation
  of deductions and income from EID form), or Verification        3
  of No Income Form completed by client (Attachment 1)

  3. Evidence of the client’s inability to make a monthly
  payment (Examples: medical bills, employment                    3
  termination letter or a late payment notice)
  4. Income Exclusions form completed (Attachment 2)              2
  5. Earned Income Disregard (EID) (Form B) and tracking,
                                                                  2
  as needed (Attachment 3 - Instructions)
  6. Verification of No Income is complete, if applicable
                                                                  2
  (Form C)
  7. Signed Client Rights and Responsibilities Statement
                                                                  2
  (Form D)
  8. Signed Consent to Release and/or Obtain Confidential
                                                                  3
  Information (if applicable) (Form E)
  9. Client Demographic/Statistical Form is completed
                                                                  1
  (Form F)
  10. Correct backup documents (lease agreements,
                                                                  3
  mortgage statement, and/or utility bills) in client’s name
  11. Housing Quality Standards (HQS) Certification is
                                                                  3
  completed (Form G)

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  12. Rent Reasonableness Checklist and Certification is
                                                                  3
  completed (Form H)
  13. Shared Housing Rent Calculation Worksheet is
                                                                  3
  completed, if applicable (Form J)
  14. Acknowledgment client received the Lead-Based
                                                                  3
  Paint and Fair Housing pamphlets
  15. Client acknowledgment that a hard-wired or battery
  operated smoke detector is installed in client’s residence
                                                                  3
  (This is not required if client is receiving assistance with
  utilities only.)
  16. Signed and completed HOPWA application                      2
  17. Comprehensive Housing Plan (Form K) that includes
  periodic contact with a case manager and a primary care         3
  physician.
  18. Provider has assured that client’s housing plan
  addresses long-term financial and housing stability after       3
  STRMU Assistance
  19. Appropriate section on STRMU Worksheet calculated
                                                                  2
  correctly (Form L)
  20. STRMU Worksheet signed by client and the case
                                                                  1
  manager
  21. STRMU 21-Week Tracking worksheet is completed
                                                                  3
  (Form M)
  22. HOPWA Termination Form completed correctly each
                                                                  2
  time client leaves the program (Form N)
  23. Failure to Accept Section 8/Other Affordable Housing
                                                                  2
  Waiver is completed, if applicable (Form O)
  24. HOPWA Client File Checklist is completed                    1
  25. Description of client’s emergency situation and
  housing plan fully documented on STRMU Worksheet
                                                                  3
  and reassessed each time client applies for Emergency
  Assistance


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  26. Provider certified client for STRMU Assistance for a
                                                                  2
  maximum of one month at a time

  27. At recertification, new application is completed again,
                                                                  3
  and eligibility and documentation process begin again

  B. CLIENT FILE
  1. Evidence that case manager has explored other
  assistance that might be available to applicant including
  Rental Assistance Program and other community
                                                                  3
  resources; all referrals pertaining thereto have been
  documented.

  2. Evidence that client is already in stable housing prior
  to receiving emergency assistance; Emergency Assistance
  funds have/will not be used for first month’s rent or           3
  security deposit.
  3. Clear statement of reason for termination was provided
  to client, if client was terminated for violating program       2
  requirements or conditions of occupancy

  C. CORE SITE REVIEW ITEMS
  1. HIV-positive status                                          3
  2. Case management and supportive services offered to
  client and are in line with DSHS Minimum Standards for          3
  Case Management Services.

  3. Evidence of continuous re-assessment of client status.
                                                                  3

  4. Case notes are timely, legible and complete                  3
  5. Housing is included in client-based needs assessment         3
  6. Documentation shows that provider offers the
  following options of taking applications:
    * Regular office Interviews
                                                                  3
    * Special Office Interviews conducted outside of regular
    business hours for those unable to apply during these
    hours. Visit Interviews
    * Home
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                                                                               Total Score:    0
                                                                             Possible Score:   0
                                                                             % Compliance:

           CLIENT FILE                                            COMMENTS




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  Item #       Weight   # of M's   Score   # of PM's   Score   # of NM's   Score           Possible Score
   A.1           3         0        0         0         0         0         0                     0
    2            3         0        0         0         0         0         0                     0
    3            3         0        0         0         0         0         0                     0
    4            2         0        0         0         0         0         0                     0
    5            2         0        0         0         0         0         0                     0
    6            2         0        0         0         0         0         0                     0
    7            2         0        0         0         0         0         0                     0
    8            3         0        0         0         0         0         0                     0
    9            1         0        0         0         0         0         0                     0
   10            3         0        0         0         0         0         0                     0
   11            3         0        0         0         0         0         0                     0
   12            3         0        0         0         0         0         0                     0
   13            3         0        0         0         0         0         0                     0
   14            3         0        0         0         0         0         0                     0
   15            3         0        0         0         0         0         0                     0
   16            3         0        0         0         0         0         0                     0
   17            2         0        0         0         0         0         0                     0
   18            3         0        0         0         0         0         0                     0
   19            3         0        0         0         0         0         0                     0
   20            2         0        0         0         0         0         0                     0
   21            1         0        0         0         0         0         0                     0
   22            3         0        0         0         0         0         0                     0
   23            2         0        0         0         0         0         0                     0
   24            2         0        0         0         0         0         0                     0
   25            1         0        0         0         0         0         0                     0
   26            3         0        0         0         0         0         0                     0
   27            2         0        0         0         0         0         0                     0
   B.1           3         0        0         0         0         0         0                     0
    2            3         0        0         0         0         0         0                     0
    3            2         0        0         0         0         0         0                     0
   C. 1          3         0        0         0         0         0         0                     0
    2            3         0        0         0         0         0         0                     0
    3            3         0        0         0         0         0         0                     0
    4            3         0        0         0         0         0         0                     0
    5            3         0        0         0         0         0         0                     0
    6            3         0        0         0         0         0         0                     0
                                                                                   Total          0

Total Score:               0

Possible Score:            0
% Compliance:

				
DOCUMENT INFO
Description: Letter Verifying Employment for Lease document sample