FEDERAL PRIVACY ACT STATEMENT
PURPOSE: The information is being collected by HUD to determine an applicant's eligibility, the recommended unit size, and the amount the tenant(s) must pay toward rent and utilities.
USE: HUD uses this information to assist in managing certain HUD properties, to protect the Government's financial interest, and to verify the accuracy of the information furnished. HUD or a Public Housing Authority (PHA) may conduct a computer match to verify the information you provide. This information may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory investigators and prosecutors. However, the information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law.
PENALTY: You must provide all of the information requested by the public housing agency/Indian housing authority, including all social security numbers for all members of the household. Providing the social security numbers of all household members is mandatory. Failure to provide any information may result in a delay or rejection of your eligibility approval.
AUTHORITY FOR INFORMATION COLLECTION: The Department of Housing and Urban Development (HUD) is authorized to collect this information by the U.S. Housing Act of 1937, as amended (42 U.S.C. 1437 et. seq); the Housing and Urban-Rural Recovery Act of 1983 (P.L. 98-181); the Housing and Community Development Technical Amendments of 1984 (P.L. 98-479); and by the Housing and Community Development Act of 1987 (42 U.S.C. 3543).
8. APPLICANT CERTIFICATION: I/We affirm that I/we have read the above Federal Privacy Act Statement, and all other information contained in this document. I/We certify that the information given to the Stillwater Housing Authority on household composition, net family assets, allowances and deductions are accurate and complete to the best of my/our knowledge and belief. I/We understand that false statements or information are punishable under Federal law. I/We also understand that false statements of information are grounds for termination of housing assistance and termination of tenancy.
CONSENT: I consent to allow HUD or the Stillwater Housing Authority to request and obtain information from the sources listed on this form for the purpose of verifying my eligibility and level of benefits under HUD’s assisted housing programs. I also authorize the housing authority to use a photocopy of my signature and this application to obtain necessary information.
All applicants who content for have immigration status must provide the following documentation.
* Resident Alien Card (Form I-551)
* Conditional Resident Alien Card (Form I-551)
* Arrival-Departure Record (Form I-94)
* Temporary Resident Card (Form I-688)
* Employment Authorization Document (Form I-688B)
* Alien Registration Receipt Card (Form I-551)