Voucher U.S. Department of Housing Housing Choice Voucher ...

1 Public Reporting Burden for this collection of information is estimated to average hours per response, including the time for reviewing instructions,searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may notconduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB controlnumber. Assurances of confidentiality are not provided under this collection. This collection of information is authorized under Section 8 of the HousingAct of 1937 (42 1437f). The information is used to authorize a family to look for an eligible unit and specifies the size of the unit. The information alsosets forth the family's obligations under the Housing Choice Voucher Act Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form by Section 8of the Housing Act of 1937 (42 1437f).

2 Collection of family members names is mandatory. The information is used to authorize a family to look foran eligible unit and specifies the size of the unit. The information also sets forth the family s obligations under the Housing Choice Voucher Program. HUD maydisclose this information to Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions. It will not beotherwise disclosed or released outside of HUD, except as permitted or required by law. Failure to provide any of the information may result in delay or rejectionof family Voucher readentiredocument before completing formFill in all blanks below. Type or print Number1. Insertunit sizein number of bedrooms. (This is the number of bedrooms for which the Family qualifies,and is used in determining the amount of assistance to be paid on behalf of the Family to the owner.)

3 Voucher Issued (mm/dd/yyyy)Insert actual date the Voucher is issued to the Issue Date (mm/dd/yyyy) Voucher Expires (mm/dd/yyyy)Insert date sixty days after dateVoucher is issued. (See Section 6 of this form .) Date(mm/dd/yyyy) Extension Expires(if applicable)(mm/dd/yyyy)(See Section 6. of this form )4. Date Extension Expires (mm/dd/yyyy)5. Name of Family Representative6. Signature of Family RepresentativeDate Signed (mm/dd/yyyy)7. Name of Public Housing Agency (PHA) and Title of of PHAO fficialDate Signed (mm/dd/yyyy)1. Housing Choice Voucher public Housing agency (PHA) has determined that theabove named family (item 5) is eligible to participate inthe Housing Choice Voucher program. Under this program,the family chooses a decent, safe and sanitary unit to livein.

4 If the owner agrees to lease the unit to the familyunder the Housing Choice Voucher program, and if thePHA approves the unit, the PHA will enter into a housingassistance payments (HAP) contract with the owner tomake monthly payments to the owner to help the familypay the PHA determines the amount of the monthly housingassistance payment to be paid to the owner. Generally, themonthly Housing assistance payment by the PHA is thedifference between the applicable payment standard and30 percent of monthly adjusted family income. Indetermining the maximum initial Housing assistancepayment for the family, the PHA will use the paymentstandard in effect on the date the tenancy is approved bythe PHA. The family may choose to rent a unit for morethan the payment standard, but this Choice does notchange the amount of the PHA s assistance payment.

5 Theactual amount of the PHA s assistance payment will bedetermined using the gross rent for the unit selected bythe issuing this Voucher the PHA expects that if thefamily finds an approvable unit, the PHA will have themoney available to enter into a HAP contract with theowner. However, the PHA is under no obligation to thefamily, to any owner, or to any other person, to approve atenancy. The PHA does not have any liability to any partyby the issuance of this Voucher does not give the family any right toparticipate in the PHA s Housing Choice Voucher pro-gram. The family becomes a participant in the PHA shousing Choice Voucher program when the HAP contractbetween the PHA and the owner takes the initial or any extended term of this Voucher ,the PHA may require the family to report progress inleasing a unit at such intervals and times as determined bythe editions obsoletePage 1 of 3formHUD-52646(04/2015)ref.

6 Handbook Choice Voucher Department of HousingOMB No. 2577-0169and Urban DevelopmentOffice of Public and Indian Housing (Exp. 04/30/2018)3. PHA Approval or Disapproval of Unit or the family finds a suitable unit where the owner iswilling to participate in the program, the family must givethe PHA the request for tenancy approval (on the formsupplied by the PHA), signed by the owner and thefamily, and a copy of the lease, including the HUD-prescribed tenancy : Both documentsmust be given to the PHA no later than the expirationdate stated in item 3 or 4 on top of page one of The family must submit these documents in the mannerthat is required by the PHA. PHA policy may prohibit thefamily from submitting more than one request for tenancyapproval at a lease must include, word-for-word, all provisions of thetenancy addendum required by HUD and supplied by the is done by adding the HUD tenancy addendum to the leaseused by the owner.

7 If there is a difference between any provisionsof the HUD tenancy addendum and any provisions of the owner slease, the provisions of the HUD tenancy addendum shall After receiving the request for tenancy approval and a copyof the lease, the PHA will inspect the unit. The PHA may notgive approval for the family to lease the unit or execute theHAP contract until the PHA has determined that all thefollowing program requirements are met: the unit is eligible;the unit has been inspected by the PHA and passes thehousing quality standards (HQS); the rent is reasonable; andthe landlord and tenant have executed the lease including theHUD-prescribed tenancy If the PHA approves the unit, the PHA will notify thefamily and the owner, and will furnish two copies of theHAP contract to the The owner and the family must execute the owner must sign both copies of the HAP con-tract and must furnish to the PHA a copy of theexecuted lease and both copies of the executed PHA will execute the HAP contract and return anexecuted copy to the If the PHA determines that the unit or lease cannot beapproved for any reason, the PHA will notify the ownerand the family that:1.

8 The proposed unit or lease is disapproved forspecified reasons, and2. If the conditions requiring disapproval are remediedto the satisfaction of the PHA on or before the datespecified by the PHA, the unit or lease will beapproved. Previous editions obsolete Page 2 of 3 4. Obligations of the FamilyA. When the family s unit is approved and the HAP contractis executed, the family must follow the rules listed belowin order to continue participating in the Housing choicevoucher The family any information that the PHA or HUD deter-mines to be necessary including evidence of citizen-ship or eligible immigration status, and informationfor use in a regularly scheduled reexamination orinterim reexamination of family income and verify social security numbers and signand submit consent forms for obtaining any information requested by the PHA toverify that the family is living in the unit orinformation related to family absence from the notify the PHA in writing when the familyis away from the unit for an extended period of timein accordance with PHA the PHA to inspect the unit at reasonable timesand after reasonable the PHA and the owner in writing beforemoving out of the unit or terminating the the assisted unit for residence by the family.

9 Theunit must be the family s only notify the PHA in writing of the birth,adoption, or court-awarded custody of a PHA written approval to add any otherfamily member as an occupant of the Promptly notify the PHA in writing if any familymember no longer lives in the unit. Give the PHA acopy of any owner eviction Pay utility bills and provide and maintain anyappliances that the owner is not required to provideunder the Any information the family supplies must be true The family (including each family member) must or have any interest in the unit (other than in acooperative, or the owner of a manufactured homeleasing a manufactured home space). any serious or repeated violation of fraud, bribery or any other corrupt orcriminal act in connection with the in drug-related criminal activity or violentcriminal activity or other criminal activity thatthreatens the health, safety or right to peacefulenjoyment of other residents and persons residing inthe immediate vicinity of the or let the unit or assign the lease or transferthe unit.

10 form HUD 52646 (04/2015) ref. Handbook formHUD-52646(04/2015)Previous editions are obsoletePage 3 of 3ref. Handbook housingchoice Voucher programhousingassistance while receiving another Housing subsidy,for the same unit or a different unit under any otherFederal, State or local Housing assistance the unit or premises (other than damagefromordinary wear and tear) or permit any guest todamage the unit or housingchoice Voucher programhousingassistance while residing in a unit owned by a parent,child, grandparent, grandchild, sister or brother ofany member of the family, unless the PHAhasdetermined (andhas notified the owner andthefamily of such determination)