EP RAP
TRUE
FALSE
Additional Tenant Documents
Hidden Prefilled Fields
Case ID
Contact Id
Status
Please select...
Application Submitted
Application Selected
In Progress
Eligibility Review Issue
Proof of Residency Verification
Please select...
Verified
Not Verified
ID Verification
Please select...
Verified
Not Verified
Salary/Wages Verification
Please select...
Verified
Not Verified
Funding Source
Please select...
City
County
# of Rooms
0
1
2
3
4
5
6
7+
Files needed for verification
Missing copy of photo ID
Missing proof of residence within the rental property
Missing copy of lease
Eviction notice OR past due rent statement
Requested assistance multiple times for the same month
Requested over $3000 for one or more months
Requested less than $100 for one or more months
Requested more than the monthly rent amount for one or more months of back due rent
Proof of wages/salary
Proof of self-employment income (monthly financial statement or self-attestation)
Proof of unemployment income (TWC unemployment check or termination letter)
Proof of retirement/pension income
Proof SSI/disability income
Proof of Social Security Income
Proof of alimony/child support income
Proof of other income
Missing proof of economic hardship: Unemployment statement OR employer letter OR pre-COVID income
Proof of public benefit participation
Proof of economic hardship
Benefits receiving
Missing direct assistance payment information
Eviction case documentation
Notice to vacate
Proof of housing instability
Public Benefit identified during application
Medicaid
Children’s Health Insurance Program (CHIP)
Public Housing Assistance (Houston Housing Authority or Harris County Housing Authority)
Harris Health Gold Card
Supplemental Nutrition Assistance Program (SNAP) – Food Stamps – Lone Star Card
Temporary Assistance for Needy Families (TANF)
Supplemental Security Income (SSI)
Head Start or Early Head Start
National School Lunch Program (NSLP)
Women, Infant, and Children Program (WIC)
Federal Pell Grant
VA Pension or Disability
Low Income Home Energy Assistance Program (LIHEAP)
Tribal Assistance
Social Security Disability Insurance (SSDI)
None
Direct Assistance Status
Please select...
Pending Property Check
Property Found
First Attempt Made
Second Attempt Made
Third Attempt Made
Direct Assistance Confirmed
Tenant First Name
Tenant Last Name
Please upload the required documents below. If you need additional information on accepted documents, please visit
https://houstonharrishelp.org/renters/
.
Please upload the required documents below. If you need additional information on accepted documents, please visit
our website
.
Proof of Residence
Proof of residence with the Participating Landlord property
Valid photo identification with address of current rental location
OR: Current utility bill with name of applicant & address of rental location (water, gas, cell phone, internet, other utilities)
OR: Lease with name of applicant and address of rental location
Please upload proof of residency documentation
Proof of Identification
Proof of identification - acceptable photo identification documents:
Passport
State ID
School ID
Nonprofit membership ID
US visa
Work permit
Green card
Current or expired foreign government issued ID
Matr
í
cula consular
Work ID
Office of Refugee Resettlement ID
Please upload proof of identification
Proof of Public Benefit
Public Benefit identified during application:
Do you have an award letter or other proof of enrollment for the program selected above:
Note: award letters must be dated on or after January 1, 2020.
Yes
No
Please upload a copy or photo of the award letter or other proof of enrollment
Eviction Case Documentation
Please
upload eviction documentation received from Court
Notice to Vacate Documentation
Please
upload the notice to vacate received from your landlord
Proof of Housing Instability
Please
upload one of the following documents
- Past Due Rent Notice - Letter or other communication from landlord indicating past due rent amount or eviction risk - Lockout notice - Past due utility bill (water, electricity, gas) - Notice to vacate - Eviction citation or petition for eviction
Current Sources of Household Income
On your application, you reported that your current total monthly gross household income (before taxes) was $
Which of the following sources of income make up your current monthly income? Please include income types for ALL members of the household who are 18 years of age or older.
Wages/Salary
Self-employment income (monthly financial statement or self-attestation)
Unemployment income (TWC unemployment check or termination letter)
Retirement/pension income
SSI/disability income
Social Security income
Alimony/child support income
Other income
None of the above. My household does not currently receive any income.
Please explain.
Proof of Income
Are you able to provide proof of current income documentation?
Yes
No
If your household cannot provide proof of current household income, please select one of the following reasons:
My employer cannot provide or refuses to provide documentation
I am self-employed
I get paid in cash
I do not have any income
Please upload a letter of termination from a former employer or other proof of no income.
Proof of Salary/Wages
Please upload proof of salary and wages income for all household members 18 years of age or older who receive this type of income. Acceptable documents are documents demonstrating 2020 income: -2020 tax return listing all adult household members -2020 W2(s) for every job held by each adult household member -Unemployment compensation statement showing 2020 income OR -
Paystubs for the last 30 days
-
Letter from employer verifying monthly salary/wages
Proof of Self-Employment Income
Please upload a Profit and Loss ledger for the last 30 days for all household members
18 years of age or older
who receive this type of income
Proof of Unemployment Income
Please upload a current TWC unemployment check or unemployment compensation statement OR letter from employer of termination from employment
for all household members 18 years of age or older
who receive this type of income.
Proof of Retirement and/or Pension Income
Please upload current proof of retirement and/or pension income
for all household members 18 years of age or older
who receive this type of income.
Proof of Social Security Income
Please upload a current award letter or other proof of Social Security income
for all household members 18 years of age or older
who receive this type of income.
Proof of SSI/Disability Income
Please upload a current award letter or statement of benefits of SSI/SSDI
for all household members 18 years of age or older
who receive this type of income.
Proof of Alimony and/or Child Support Income
Please upload a current award letter or other proof of alimony and/or child support income
for all household members 18 years of age or older
who receive this type of income.
Proof of Other Income
Please upload proof of other current income
for all household members 18 years of age or older
who receive this type of income.
Proof of Economic Impact
Please provide proof that your household experienced a negative economic impact due to COVID-19. Please choose from the following list of documents:
Unemployment statement dated on or after March 1, 2020.
Letter from an employer indicating termination of employment, furlough, or a reduction in work hours dated on or after March 1, 2020.
Loss of business income, if self-employed or own your own business
Two different pay stubs showing a reduction in work hours or income over time
Notice of business closure (letter of closure from employer, closure announcement in a newspaper or online publication, etc.)
I am not able to provide any of these documents
Please provide a reason for why you are not able to provide documents:
My employer cannot provide or refuses to provide documentation
My previous employer closed and there is no one to contact
I am self-employed
I get paid in cash
I do not have any income
My household is on a fixed income, and during the COVID-19 pandemic, my household expenses increased due to personal protective equipment (gloves, masks, hand sanitizer, etc.), grocery delivery fees, or higher prices for food and other basic household goods
Upload proof of negative economic impact
Upload paystub #1
Upload paystub #2
Confirm Assistance Amounts
Monthly Rent Amount
Month
Please select...
August 2021
June 2021
May 2021
April 2021
March 2021
February 2021
January 2021
December 2020
November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
Balance Due
$
Assistance ID
Month
Please select...
August 2021
June 2021
May 2021
April 2021
March 2021
February 2021
January 2021
December 2020
November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
Balance Due
$
Assistance ID
Month
Please select...
August 2021
June 2021
May 2021
April 2021
March 2021
February 2021
January 2021
December 2020
November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
Balance Due
$
Assistance ID
Month
Please select...
August 2021
June 2021
May 2021
April 2021
March 2021
February 2021
January 2021
December 2020
November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
Balance Due
$
Assistance ID
Month
Please select...
August 2021
June 2021
May 2021
April 2021
March 2021
February 2021
January 2021
December 2020
November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
Balance Due
$
Assistance ID
Number of Bedrooms
How many bedrooms does your home have?
Efficiency
1
2
3
4
5
6
7+
Additional Information
If your application meets the eligibility requirements and is approved to receive a payment, please select your preferred method of payment.
Electronic Funds Transfer – payment is directly deposited into the bank account within 3-5 business days after your application is approved for payment
Certified mail-payment is mailed to your home address via certified mail, payment is received at the address provided within 10 business days after your application is approved for payment
Electronic Funds Transfer
Please note: If you enter a prepaid account, be aware that your bank or financial institution may charge fees and/or use these funds to cover any negative balances on your account.
First Name of Account Holder
Last Name of Account Holder
Name of Bank/Financial Institution
Account Type
Please select...
Checking
Savings
Routing Number
Confirm Routing Number
Routing #
Account Number
Confirm Account Number
Account #
I understand that I will be receiving an ACH to the bank account provided
I understand that if the incorrect amount is deposited, I will have to inform the agency and return funds (if necessary)
I understand that rental assistance will be paid directly to me if my landlord fails to enroll in the program and that the program funds must be used for past due rent and up to two months of future rent as requested in this application.
Click here to get an example on how to find your account and routing number on a check
How to find your account and routing number on a check
You can find your routing number and account number on a voided check. Please see the example below.
Certified Mail Payment
I understand that rental assistance will be paid directly to me if my landlord fails to enroll in the program and that the program funds must be used for past due rent and up to two months of future rent as requested in this application.
A check will be mailed to your address.
Contact Information