GIVING TRUE AND COMPLETE INFORMATION
I certify, under penalty of perjury, that all the information provided on household composition, income, family assets, items for allowances and deductions, is accurate and complete to the best of my knowledge. I have reviewed the application form and the HUD Form or 50058 , which ever applies to me, and certify the information provided is true and correct. 50059
REPORTING ON PRIOR HOUSING ASSISTANCE
I certify, under penalty of perjury, that I have disclosed where I received any previous Federal housing assistance and whether or not any money is owed. I certify that for this previous assistance I did not commit any fraud, knowingly misrepresent any information, or vacate the unit in violation of the lease.
NO DUPLICATE RESIDENCE OR ASSISTANCE
I certify, under penalty of perjury, the house or apartment will be my principal residence and will not obtain duplicate Federal housing assistance while I am in this current program.
CRIMINAL AND ADMINISTRATIVE ACTIONS FOR FALSE INFORMATION
Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly making false statements or misrepresentation to any department or agency of the United States.
I understand and agree that knowingly supplying false, incomplete, or inaccurate information is punishable under Federal and/or State criminal law. I understand that knowingly supplying false, incomplete, or inaccurate information is grounds for termination of housing assistance and/or termination of tenancy.
I understand and agree that I am required to cooperate in supplying all information needed to determine my eligibility, level of benefits, or verify my true circumstances.I understand and agree that cooperation includes attending pre-scheduled meetings and/or completing and signing needed forms.I understand and agree that failure or refusal to do so may result in delays, termination of assistance, or eviction.
REPORTING CHANGES IN INCOME OR HOUSEHOLD COMPOSITION
I understand and agree that I am required to report changes in income and any changes in the housing size when a person moves in or out of the unit. I understand the rules regarding guests/visitors and when I must report anyone who is staying with me.
CONSENT FOR RELEASE OF INFORMATION
I hereby authorize and direct any Federal, State, or local agency, organization, business, or individual to release any information or materials to Carroll County Housing Authority that are needed to complete and verify my application for participation, and/or maintain my continued assistance under the Section 8, Rental Rehabilitation, Low-Income Public and/or Indian Housing, and/or housing assistance programs. I understand and agree this authorization or the information obtained with its use may be given to and used by the Department of Housing and Urban Development (HUD) in administering and enforcing program rules and policies.
I understand and agree that, depending on program policies and requirements, previous or current information regarding me or my household may be needed. Verifications and inquires that may be requested, include but are not limited to: Identity, Marital Status, Employment, Income, Assets, Residences & Rental Activity, Medical and Child Care Allowances, Credit, and Criminal Activity. I understand and agree this authorization cannot be used to obtain any information about me that is not pertinent to my eligibility for and continued participation in housing assistance program.
GROUPS OR INDIVIDUALS THAT MAY BE ASKED
I understand and agree the groups or individuals that may be asked to release the above information (depending on program requirements) include but are not limited to: Previous Landlords (including Public Housing Agencies), Courts & Post Offices, Schools & Colleges, Law Enforcement Agencies, Past and Present Employers, Welfare Agencies, State Unemployment Agencies, Social Security Administration, Medical & Childcare Providers, Veterans Administration, Retirement Systems, Banks & Other Financial Institutions, Credit Providers & Bureaus, and Utility Companies.
COMPUTER MATCHING NOTICE & CONSENT
I understand and agree that HUD or the Public Housing Authority may conduct computer matching programs to verify the information supplied for my application or recertification. If a computer match is done, I have a right to notification of any adverse information found and a chance to disprove that information. HUD may in the course of its duties exchange such automated information with other Federal, State or local agencies, including but not limited to: State Employment Security Agencies, Department of Defense, Office of Personnel Management, the U.S. Postal Service Agency, and State welfare and food stamp agencies.
I understand and agree that a copy of this authorization may be used for the purposes stated above. The authorization will stay in affect for a year and one month from the date signed. ELECTRONIC SIGNATURE
I understand and agree that, under the Uniform Electronic Transactions Act (UETA) and the Electronic Signatures in Global and National Commerce Act (ESIGN) [Title 15 Chapter 96 of the United States Code], submitting this application constitutes an electronic signature and possesses the same legal effect and consequence as a handwritten signature.