250 FRANK H. OGAWA PLAZA, SUITE 5313 * OAKLAND, CALIFORNIA

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1 CITY of OAKLAND 250 FRANK H. OGAWA PLAZA, SUITE 5313 * OAKLAND, CALIFORNIA Housing and Community Development Agency (510) Residential Lending and Housing Rehabilitation Services FAX (510) TDD (510) Dear Applicant(s): Thank you for your interest in the Access Improvement Program (AIP) for rental properties. Enclosed is the application packet you requested. Please complete the enclosed application and the attachments thoroughly. Mail the completed application, related attachments and the following applicable documents to the above address: Property Owner to provide: Proof of Ownership: copy of Grant Deed, Quitclaim Deed, etc. Copy of current property tax bill Current Mortgage Statement Copy of current fire insurance policy Copy of City of Oakland Business License Contractor s bid and detailed work description (If available) Copy of Code Violations from the City s Code Compliance Division, if applicable Disabled Tenant to provide: (Applicant to submit with the above documents) Physician s Statement Documentation of income for all family members who are 18 years or older: Complete Tax Returns for two years, including W-2s, 1099s and all schedules Current paycheck stubs, if employed Copies of award letters, disability pension, or retirement checks Copies of all bank/credit union statement with all pages If you have any questions, please call (510) THE PROCESSING OF YOUR APPLICATION MAY BE DELAYED IF THE APPLICATION IS INCOMPLETE, THE ATTACHMENTS ARE NOT COMPLETED, OR THE APPLICABLE DOCUMENTS ARE NOT ENCLOSED. MyDocs/Applications/AIP-R Cover Ltr. Rev. 8/2/18

2 City of Oakland 250 Frank H. Ogawa Plaza, Suite 5313 Housing and Community Development Agency Oakland, California Residential Lending and Housing Rehabilitation Services (510) Fax (510) ACCESS IMPROVEMENT PROGRAM (AIP) Program Description PURPOSE: The ACCESS IMPROVEMENT PROGRAM (AIP) is a City of Oakland program that provides grants for accessibility modifications to both owner-occupied and rental properties. REQUIREMENTS: LOCATION: Property must be located in one of the seven Community Development Districts. ELIGIBLE ITEMS: Eligible repairs include: wheelchair ramps or lifts, bathroom modification for wheelchair accessibility, and entry modifications. MAXIMUM GRANT AMOUNT: OWNER-OCCUPIED The maximum grant is $15,000, except in cases where a lift is required, the maximum amount is $24,000. OCCUPANCY Applicant must occupy the property and maintain the access improvements for at least five years. If the owner sells the property, fails to occupy the property, or removes the access improvements within the five-year period, the Owner shall reimburse the City on a prorated basis. INCOME Owner-Occupant s annual household income cannot exceed 80% of the area median income. Income of all household members who are 18 years or older will be considered to determine income eligibility. INCOME LIMITS CURRENTLY IN EFFECT Family Size RENTAL PROPERTIES For existing construction, the maximum grant is $15,000 per unit, except in cases where a lift is required, the maximum amount is $24,000. For new construction, the maximum grant is $4,000 per unit or $16,000 per 4 unit property. Property owner must agree to rent unit(s) made accessible to disabled person(s) for a minimum of five years. If the owner (or his or her successor) terminates the agreement, the owner (or his or her successor) shall reimburse the City on a prorated basis. In the event of change of ownership, the obligation remains through the term of the Agreement. Tenant s annual household income cannot exceed 80% of the area median income. Income of all household members who are 18 years or older will be considered to determine income eligibility of the tenant. Maximum Income 1 $56,300 2 $64,350 3 $72,400 4 $80,400 5 $86,850 6 $93,300 7 $99,700 8 $106,150 In accordance with Federal, State, and local disability-related laws and regulations, it is the policy of the City of Oakland not to discriminate on the basis of disability in employment or any of its programs, activities, or services. Auxiliary aids and services will be provided upon request Matrix\AIP Rev. 8/2/18

3 APPLICANT S AUTHORIZATION Privacy Act Notice: This information is to be used by the Grantor, in determining your eligibility and qualification under its program. It will not be disclosed outside the Grantor except as required and permitted by law. You do not have to provide this information, but if you do not, your application may be delayed or rejected. Part I General Information 1. Applicant(s): 2. Name and Address of Grantor: City of Oakland Housing and Community Development Agency Residential Lending Services 250 Frank H. Ogawa Plaza, Suite 5313 Oakland, CA Part II Applicant's Authorization I hereby authorize the Grantor to verify my past and present employment, earning records, benefits and any income on my application; bank and credit union accounts, stock holdings, and any other asset balances that are needed to process my grant application. I further authorize the Grantor to verify any information on my application to determine my eligibility under its program. It is understood that a copy of this form will also serve as authorization. Applicant Co-Applicant 20B:\AIP Applicant's Authorization Rev. 8/2/18

4 City of Oakland 250 Frank H. Ogawa Plaza, Suite 5313 Housing and Community Development Agency Oakland, CA Residential Lending Services (510) Access Improvement Program (AIP) Grant Application for Rental Properties Instructions: Section I to be completed by Property Owner(s). Section II to be completed by disabled tenant who occupies the unit to be modified or prospective disabled tenant who will occupy the unit after it has been modified. SECTION I: [To be completed by Property Owner(s)] Property Information Subject Property Address (street, city, state, zip) Total Project Cost: $ Applicant s Name Grant Amount Requested: $ Applicant Applicant Information Co-Applicant Co-Applicant s Name Social Security No. Birthdate: Age: Social Security No. Birthdate: Age: Married Family Members (not listed by Married Co-Applicant) Unmarried (include single, divorced, Unmarried (include single, divorced, widowed) widowed) Separated No.: Ages: Separated No.: Ages: Family Members (not listed by Applicant) Present Address (street, city, state, zip) No. Yrs. Present Address (street, city, state, zip) No. Yrs. Home phone No. Oakland Business License No. Business Phone No. Home phone No. Expiration : Business Phone No. No. of Units in building: Size of Units No. Amounts of Rents per month Studio No. of Vacant Units: 1BR 2BR No. of Occupied Units: 3BR Other Nearest Relative Not Living With You Name: Address: Tel. No. Name and Address of Bank or Credit Union: Balance Checking Savings Declarations Applicant Co-Applicant Are you or any member of your immediate family a director or officer of a Community Development District? yes no yes no Have you previously received any financial assistance from the City of Oakland? yes no yes no Have you received a List of Violations on the subject property from the City of Oakland s Code Compliance Division? yes no yes no Certification: I/We certify that the information provided in this application is true and correct as of the date opposite my/our signature(s) and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in a civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section Race Information for Government Monitoring Purposes Borrower Co-Borrower I do not wish to furnish this information Race I do not wish to furnish this information American Indian or Alaskan Native American Indian or Alaskan Native Sex: Male Female Sex: Male Female Applicant s Signature Co-Applicant s Signature X Tenant s Name: X SECTION II: (To be completed by Tenant) Present Address: Page 1 of 2 Rev. 8/01/02

5 Page 2 of 2 Home Phone No.: Work or other Phone No.: Birthdate: Age: Employer: Address: Tel. No. No. of years: Family Members (other than Tenant) Relationship Age Monthly Income Information Gross Mo. Income Tenant Family Member(s) Base Salary $ Overtime Social Security Retirement/Pension Disability Alimony/Child Support Other Gov t Assistance Interest/Dividends/Other TOTAL $ Name and Address of Bank or Credit Union: Checking Balance Savings Nearest Relative Not Living With You Name and Address: Relationship: Tel. No. Describe your disability (you must provide a doctor s statement describing the disability): What assistive devices do you use? (wheelchair, cane, walker, etc.): Declarations Are you or any member of your immediate family a director or officer of a Community Development District? yes no Have you previously received any financial assistance from the City of Oakland? yes no Certification: I/We certify that the information provided in this application is true and correct as of the date opposite my/our signature(s) and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in a civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section Race Information for Government Monitoring Purposes Borrower Co-Borrower I do not wish to furnish this information Race I do not wish to furnish this information American Indian or Alaskan Native American Indian or Alaskan Native Sex: Male Female Sex: Male Female Tenant s Signature: : X For Office Use Only Received: Application No.: District: Census Tract: Flood: Yes No Rev. 8/2/18

6 City of Oakland 250 Frank H. Ogawa Plaza, Suite 5313 Housing and Community Development Agency Oakland, CA Residential Lending Services (510) Fax (510) Access Improvement Program (AIP) Physician s Statement The City of Oakland s Access Improvement Program (AIP) provides grants for accessibility modifications to owner-occupied and rental properties located in the City s seven Community Development Districts. Section I To be completed by the property owner only, if owner occupied, or both property owner and disabled tenant, if rental property. Property Owner: Address Tel. No. For rental property only: to be completed by disabled tenant. Name of disabled tenant: Address: Tel. No. Authorization: (To be signed by disabled property owner or by disabled tenant). The undersigned hereby authorizes the release of information regarding my disability and accessibility needs to determine the property owner s eligibility for financial assistance under the Access Improvement Program of the City of Oakland. Signature Section II (To be completed by Physician) Patient s Name: Brief description of patient s disability: Patient s accessibility needs: Physician s name (please print): Address: Tel. No. Physician Signature