Thank you for your interest in the Senior Public Housing program (50+ or older). Enclosed please find:

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1 Thank you for your interest in the Senior Public Housing program (50+ or older). Enclosed please find: Public Housing brochure Information the applicant must bring to an application appointment Eligibility Requirements PLEASE READ Criminal Self-Certification of Past Activity (Complete and bring the form with you to your appointment). Do not mail it in. Appointments are required to complete an application for the Public Housing Program. Contact Debbie Breitenfeldt at to schedule appointment. It is important to bring all required information to your appointment in order to complete the process in a timely manner. Applicants must meet eligibility requirements. 50 years or older Provide original copy of photo ID, Social Security Card and Birth Certificate or Naturalization documentation Applicants must be a legal resident of the United States Meet income guidelines 1 person household - $47,600 2 person household - $54,400 Provide copies of all income and assets documentation Provide good landlord references with complete address information Ability to pass a criminal background check If you are interested in viewing the apartments before applying feel free to do so. To schedule a time to view the apartment, please contact: at Nan McKay- 200 Marie Ave at John Carroll Grand Ave. W. Thank you, Debbie 125 Third Avenue North South St. Paul, MN Phone (651) Fax (651)

2 For Information Call or Debbie Breitenfeldt City of South St. Paul 125 Third Avenue North South St. Paul, MN Third Avenue North South St. Paul, MN EQUAL HOUSING OPPORTUNITY City of South St. Paul Phone: Fax:

3 Who Is Eligible? Amenities Accessibility Applicants must meet eligibility requirements prior to becoming a resident. This includes being 50 years or older, meeting program income guidelines, providing good landlord references and passing a criminal background check. Applicants must also be legal residents of the United States. An applicant s annual income must not exceed the following: One person $47,600 Two persons $54,400 (effective ) Rental Charge Each apartment has one bedroom, living/dining room, kitchen and bathroom. Nan McKay Building John Carroll Building 500 s.f. 515 s.f. Each apartment is furnished with a refrigerator, stove, window blinds and air conditioner. Fire sprinkler and a smoke detector in each unit. Laundry facilities on the first floor. Community Room with a Kitchen. On-site resident caretaker. Sixteen apartments are handicapped accessible. Miscellaneous To comply with HUD regulations, buildings will become Smoke Free in Trash chute located on each floor, corridors have handrails, Entry Guard telephone system for security. Residents pay 30% of their adjusted annual income toward rent. Rent includes utilities except telephone, cable television and an extra $5.00 per month, year around for an air conditioner. A security deposit of $ or the monthly rent amount (whichever is greater) is required prior to moving in. The deposit will be refunded with interest when the tenant moves out if the apartment is left in a clean and damage free condition. The pet policy allows for ONE pet (under 20 lbs.). Pet must be licensed by the City of SSP and current on vaccinations. The pet deposit is $ Nan McKay Building The has contracted with DARTS to provide an Independent Living Program that offers affordable meals and services to residents who are looking for extra help so that they may remain in their apartments. Services are coordinated by staff and tailored to each individual s needs and require an added fee based on the residents monthly income. DARTS provides volunteers to assist with tax forms, peer counseling and provides transportation to the grocery store each week. Many other services are provided by Neighbors, Inc., Meals on Wheels and Dakota County Nursing Services. John Carroll Building

4 ITEMS AND/OR INFORMATION TO BRING TO YOUR PUBLIC HOUSING APPLICATION APPOINTMENT Make sure all information is brought to your appointment. Applications will not be processed until all information is received. APPLICANT(S) MUST BE 50 OR OLDER TO APPLY 1. * Current Picture Identification, Social Security Card & Birth Certificate. 2. * Addresses and the dates of where you have lived during the last 5 years. 3. *Names and addresses of landlords you have had during the last 5 years. PLEASE NOTE: If you are unable to provide verifiable rental references you will be required to enlist the service of a rep payee which is a professional company that manages your money and makes certain your rent is paid on time. 4. *If you lived in non-traditional housing such as a shelter, community residence, or halfway house, please have name(s) and address(es). 5. If you have been a homeowner, name & address and account number of major utility company. 6. *If you have lived in a state other than Minnesota in the last 10 years, name of the county you lived in within that state. 7. *Information about your income such as name, address and account number of pension, grant, employment or other income source. If your income is from Social Security or SSI you will need to provide verification of this income in written form from the Social Security Administration. 8. *Information about your assets. This should include name(s) and address(es) of bank(s). Bring 6 months of bank statements. If you have mutual funds, please bring copies of your most current statement showing value and earnings. 9. *If you own Real Estate, please bring a copy of the most current County Tax statement showing Fair Market Value. 10. *If you have Whole Life Insurance, please bring name(s), address(es), and policy number(s) of life insurance(s). 11. *If you have U.S. Savings Bonds or stocks, please bring copies of the bonds and/or stocks. 12. *Other information which would be helpful to verify any other income or assets. 13. *Optional for Veteran's Preference: If you were a veteran or are a surviving spouse of a veteran, please bring verification of veteran's status. 14. *If you were born outside of the United States and are now a citizen, provide your Naturalization document. 15. *Non-citizens of the United States are required to provide the original INS Document or Permanent Resident Card. 16. Criminal Self-Certification of Past Activities form completed. Please be advised as part of the application process a criminal history check, sex offender database check, credit history check and an out of state criminal check (if needed) review will be conducted to see if a pattern of criminal history is present on record. The Pet Policy allows one animal (under 20 lbs.). Proof of City license and current vaccinations required before pet is allowed into the building. All dogs & cats must be spayed and neutered. Pet deposit of $200 required. Initial payment of $50 at move-in and $10 payments per month until paid in full are permitted.please remember to telephone Debbie Breitenfeldt at for an appointment if you have not already done so. 125 Third Avenue North South St. Paul, MN Phone (651) Fax (651)

5 ELIGIBILITY REQUIREMENTS FOR SOUTH ST. PAUL S SENIOR PUBLIC HOUSING PROGRAM To be eligible for admission to South St. Paul s Senior Public Housing Program, an applicant must meet the following qualifications: Income Limits To be financially eligible, the applicant(s) must meet the income limits in effect on the date of application. The income limits are determined by the Department of Housing & Urban Development and updated at least annually. The current income limits are as follows: (effective ) One-bedroom household - $47,600 Two-person household: $54,400 The income limit represents gross annual income from all sources before deductions for all members of the household. Elderly Designation To meet the criteria for admission the applicant must be at least 50 years of age or older. Those applicants age 62 or older will receive a priority on the waiting list regardless of date of application. Elderly applicants will be housed before near elderly applicants whenever it is possible and feasible to do so. Non-Economic Criteria In determining eligibility, the following factors shall apply: A. Persons evicted from public housing, Indian Housing, Section 23 or any Housing Choice Voucher program due to a drug-related criminal activity are ineligible for admission to public housing for a three-year period beginning on the date of such eviction. B. Whether the conduct of the applicant in present or prior housing has been such that admission to the program would adversely affect the health, safety, or welfare of other residents, or the physical environment, or the financial stability of the project. A record of any of the following may be sufficient cause for the to deny eligibility: An applicant s past performance in meeting obligations especially rent; A record of disturbance of neighbors, destruction of property, or unacceptable living or housekeeping habits; A determination by the that an applicant is illegally using a controlled substance; A determination by the that there is reasonable cause to believe that an applicant abuses alcohol in a way that may interfere with the health, safety, or right to peaceful enjoyment of the premises by other residents; and A history of criminal activity involving crimes of physical violence to persons or property or a record of other criminal acts which would adversely affect the health, safety, or welfare of other residents; 125 Third Avenue North South St. Paul, MN Phone (651) Fax (651)

6 C. In determining eligibility for admission, the shall rely upon sources of information which may include, but are not limited to, the applicant (by means of interviews and/or home visits), records, previous landlords, employers, family social workers, parole officers, court records, drug treatment centers, clinics, physicians or police departments where warranted by particular circumstances. D. Prior to the execution of any lease between the and applicant, it will be determined that the family meets all conditions governing eligibility. E. In the event of the receipt of unfavorable information with respect to an applicant, consideration shall be given to the time, nature, and extent of the applicant s conduct and to factors which might indicate a reasonable probability of favorable future conduct or financial prospects for example: evidence of rehabilitation; evidence of the applicant family s participation in or willingness to participate in social service or other appropriate counseling service programs and availability of such programs; evidence of the applicant family s willingness to attempt to increase family income and the availability of training or employment programs in the locality. Notification of Ineligibility: The must promptly notify any applicant determined ineligible for admission to a project of the basis for such determination, and must provide the applicant upon request, within a reasonable time after the determination is made, an opportunity for an informal review on such determination.

7 Adult Household Member Social Security # Criminal Self-Certification of Past Activity (Bring this completed form with you to your appointment). Please read and complete the attached forms. You will need to bring both pages with you to your appointment. 1. Have you or another household member ever been questioned by police or law enforcement about any of the following kinds of criminal conduct: a. Domestic violence. Yes No b. Other violence against a person. Yes No c. Illegal drugs (possession, use, sale, distribution, manufacture) Yes No 2. In the last 7 years, have you or any household member been in prison or jail, or on probation for a criminal offense or other unlawful act? Yes No 3. Have you or any household member EVER been evicted from a federally subsidized housing program? Yes No 4. Have you or any household member EVER been found ineligible for rent assistance by another housing authority due to violence or drug-related criminal activity? Yes No 5. Are you or is any member of your household required to register under any state s sex offender registration program? Yes No. If yes, is this a lifetime registration requirement? Yes No. 6. Are you currently on probation/parole due to a conviction for a criminal offense or other unlawful act? Yes No. a. If yes, state name and address of probation/parole officer:. b. Dates of probation/parole: from: to. IF YOU ANSWERED YES to any of the questions above, you may explain the circumstances on the attached questionnaire titled Explanation of Circumstances. CERTIFICATION I have read this form and I understand it, and I have had the opportunity to ask someone to explain it to me. I certify that the information I provided here is true. Print Name Signature Date 125 Third Avenue North South St. Paul, MN Phone (651) Fax (651)

8 Explanation of Circumstances The SSP will consider the time, nature and extent of your conduct (or a household member s conduct), and other factors which might indicate that you are not likely to repeat such criminal activity. If you or any other household member answered YES to Questions 1-6 on the Public Housing Self- Certification form, you or the household member(s) may complete this form to explain any circumstances that you want the SSP to consider. The SSP will consider whatever information you provide here, to decide if you are eligible to live in public housing. You are not required to complete this Explanation of Circumstances form. Also, if you have more information to share than will fit on this form, please attach pages as necessary. If there is more than one criminal case for the SSP to review, you or any other household member may use a separate copy of this form for each case. 1. Since this criminal activity happened have you been involved in any rehabilitation programs? You may provide any proof of rehabilitation at any time during the application process. 2. Since your past criminal conduct, have you received any social services or other counseling that has helped you change the behavior that led to this conduct? 3. Do you have any other proof that you have successfully changed your behavior since your past criminal conduct? Please describe your proof here and provide any documents of proof that you have. I certify that the information provided in this questionnaire is true. Print Name Signature Date WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentation to any department or agency of the U.S. as to any matter within its jurisdiction. Form HD /2016

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