Forms

Rental Assistance Forms

Local Information Sheet Effective 4/1/24 and Payment Standards Effective 1/1/2025

Utility Allowance Effective 1/1/2025

HCV-Landlord-Handbook New PWC with Direct Deposit 4-22-24

Statement of Tenants Rights and Responsibilities

Briefing Package

Housing Choice Voucher Program Brochure ​R-1 Statement of Family Obligation and Grounds for Denial 4.15.2024
L-1 HUD Fraud Form 1141 English 12-2005 ​R-2 PHA Plan Chapter 5 Briefings and Voucher Issuance Pages 13-19 Revised 3-28-24
L-1a HUD Fraud Form 1141 Spanish 2-8-2024 R-3 Voucher OMB 2577-0169 Expires 7-31-22
L-2 HUD Form A Good Place to Live R-4 What You Should Know About EIV HUD July 2009
L-3 Protect Your Family From Lead In Your Home (English) March 2021 R-5 PHA Plan Chapter 10 Moving with Continued Assistance and Portability Pages 1-24 Revised 03-24
L-3a Protect Your Family From Lead In Your Home (Spanish) March 2021 R-6 Port Out Request Form 2-28-18 Fillable
L-4 HAP Contract OMB 2577-0169 Expires 4-30-2026 R-7 Virginia Housing Search Information
L-5 Complete Guide to Landlord - Tenant Rights R-8 Request for Tenancy Approval HUD 2577-0169 (English) Exp 7-31-22
L-6 HUD Resident Rights and Responsibilities HUD R-9 Home Search Log
L-7 HUD Form 5380 VAWA Notice of Occupancy Rights 6-30-17

​R-10 PHA Plan Chapter 8 NSPIRE and Rent Reasonableness Pages 1-26 Revised 3-28-24

L-7a HUD Form 5382 Certification of Domestic Violence 6-30-17

R-11 Local Information Sheet Income Revised 4-1-24 Payment Standards Revised 1-1-24

R-12 PHA Plan Chapter 6 Income and Subsidy Determinations Pages 57-76 Revised 3-28-24

L-7b OHCD VAWA Lease Addendum 3-1-24 ​R-13 Utility Allowance Charts 1-1-24
L-8 Fair Housing Equal Opportunity for All HUD (English) 1686 Published 2011 R-14 Map of PWC HCV with Poverty Areas 2021
L-9 Are You a Victim - Reporting Discrimination (English) HUD 2529-0011 Exp 12-31-23 R-15 Virginia Tenant Rights and Responsibilities Landlord Tenant Act As of July 2023 (English) DHCD 8-9-23
L-9a Are You a Victim - Reporting Discrimination (Spanish) HUD 2529-0011 Exp 12-31-23 ​R-15a Virginia Tenant Rights and Responsibilities Landlord Tenant Act of July 2023 (Spanish) DHCD 8-9-23
L-10 PHA Plan Chapter 16 Informal Hearing Pages 11-30 Revised 3-28-24  
​L-11 Community Resource List - ARPA Partners and Services
​L-12 Register as Vendor Direct Deposit and W-9 2004  

Recertification 

Affidavit of Understanding Applicant Tenant Unauthorized Persons Revised 4-9-18.pdf Applicant Tenant Certification Statement 4-6-18.pdf Authorization to Release Information and other forms 4-6-18.pdf
Briefing Declaration - 2018 legal 4-6-18.pdf Earned Income Disallowance.pdf IVT Authorization to Release Information
Recertification Verification Need Checklist 4-14-18.pdf School Attendance Verification 4-19-18.pdf Self Certification Do Not Received Child Support 6-11-18.pdf
Self Certification of Child Support Payments Received 6-11-18.pdf Statement of Family Obligation and Grounds for Denial 4-9-18.pdf ​TIF Legal with Supplement 4-4-24.pdf
 

Reasonable Accommodations

Vendor Registration and Direct Deposit

iSupplier.pdf Register as Vendor, Direct Deposit and W-9 (2024) W-9 Request for Taxpayer ID Number and Certification 2014.pdf

Income Verification

Applicant Tenant Certification Statement 4-6-18.pdf Bank Verification 2-28-18.pdf EXHIBIT 6 Income.pdf
FamilyDeclarationofAssetsunder$5000.pdf IVT Authorization to Release Information.pdf School Attendance Verification 4-19-18.pdf
Self Certification Do Not Received Child Support 6-11-18.pdf Self Certification of Child Support Payments Received 6-11-18.pdf Self Employment Certification 6-11-18.pdf
Statement of Family Obligation and Grounds for Denial 4-9-18.pdf Verification of Income Loss of Income 6-27-18.pdf Zero Income Certification.pdf
Zero Income Checklist.pdf Zero Income Worksheet.pdf  

Other Forms

Change Form for Applicant and Participant 7-5-18.pdf FamilyDeclarationofAssetsunder$5000.pdf Home Search Log 7-5-18.pdf
Informal Hearing Procedures for Participants.pdf Mutual Agreement to Terminate Lease and HAP Contract 7-5-18.pdf Owner Certification Form 6-18-18.pdf
Port Out Request Form 2-28-18.pdf Rent Increase Request Form 2017.pdf Self Certification Do Not Received Child Support 6-11-18.pdf
Self Certification of Child Support Payments Received 6-11-18.pdf Self Employment Certification 6-11-18.pdf Verification of Income Loss of Income 6-27-18.pdf
Waiting List Update Form