|
Attachment 1 Page 3 |
|
|
| PART 2 (Continued) ADDITIONAL SCREENING CRITERIA (To be completed by Office of Public Housing) |
YES |
NO |
N/A |
Need
Info. |
|
| (n)The application contains estimates of the average adjusted income of prospective participants for each bedroom size for each program. | |||||
| (o)The application contains an executed Certification regarding Equal Opportunity, Lobbying, and Drug-Free Workplace Requirements. | |||||
| (p)The application includes Section 213 comments. (If not, the local HUD Field Office must request comments from local government providing a 30-calendar day comment period.) | |||||
| (q)The application includes a certification from the owner of a covered development(s) that the development is a covered development, was developed primarily for occupancy by elderly families, the owner has established preferences for the admission of elderly families, and indicating the number of non-elderly disabled families on the owner's waiting list for the development. Also, if the PHA is requesting rental vouchers or certificates for non-elderly disabled families in excess of the number on the owner's waiting list, the PHA has submitted information supportive of the number of such families residing within its community who would qualify for zero-bedroom or one-bedroom units. | |||||
|
[ ]Pass Continue Processing |
[ ]Fail Identify Deficiencies |
|
|
|
|
|
|
| Reviewers Signature & Date | |
|
|
|
| [ ]Agree with Screening |
|
| Supervisor's Signature & Date |
ANY CHANGE MADE TO THE APPLICATION REVIEW CHECKLIST MUST BE EXPLAINED; E.G., MISSING OR CORRECTED INFORMATION WAS SUBSEQUENTLY RECEIVED FROM THE PHA WITHIN THE ALLOWED 14 DAY PERIOD AND WAS DETERMINED ACCEPTABLE. INDICATE NAME AND TITLE OF INDIVIDUAL CHANGING THE CHECKLIST AND DATE OF CHANGE.
| [ ]Disagree/change Screening |
|
| Supervisor's Signature & Date |
Explanation for change: