Documentation to collect and submit to DHCD with your EA application This is list is only a partial list of required DHCD documentation for EA approval. DHCD will determine if the documentation submitted is sufficient and may contact the participant directly to request additional documentation. Current Massachusetts Picture ID (if your ID is not issued in the State of Massachusetts go to City Hall and register to vote. Bring with you proof you live in Massachusetts. Submit the voter registration card along with your other documentation) Birth Certificates for all minor children in the home under the age of 21 Proof of Social Security Number for all household members. Copy of the social security cards or official print out of the number issued by the social security office. Income Documentation. Need four week s pay or benefit letters from SSI/DTA/child support no older than 60 days. Documentation needed depending on the cause of the housing crisis: If Fleeing Domestic Violence, such as proof of DV via police reports, court reports or retraining orders, letter from a professional domestic violence agency, medical documentation of injuries. If Doubled up with Family or Friends, proof the primary lease holder s tenancy is in jeopardy via a 14-day notice to quit or eviction notice If living in a Hotel/Motel, need copies of motel receipts. If being Evicted: o For a no fault eviction property is in foreclosure, condemnation by eminent domain, condemnation for safety o reasons. Need a copy of eviction notice, sheriff notice, condemnation, etc. For Fault Eviction: Eviction for conduct of household member or guest, proof the participant had no control of that person s behavior. Proof of eviction for non-payment caused by medical condition or diagnosed disability or proof of significant reduction in household income If Pregnant, need pregnancy letter issued by medical office and signed by an RN or a Doctor indicating the due date. If DCF is involved due to Unsafe Environment, need letter from DCF. Fire/Flood/Natural Disaster, need proof of disaster i.e. fire report, Red Cross letter, government agency letter, DCF If the Apartment is Unsafe/Unhealthy, need a Condemnation Order issued by the Board of Health. A letter of citations is not sufficient as it allows time for the landlord to make repairs. F:\WPDATA\BHDC\HomeBASE Program\HB FY'16\HB Forms\DHCD Checklist of docs for EA app.docx
Commonwealth of Massachusetts DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT Charles D. Baker, Governor Karyn E. Polito, Lt. Governor Chrystal Kornegay, Undersecretary DHCD EMERGENCY ASSISTANCE (EA) APPLICATION PROCESS STEP 1 ARE YOU QUALIFIED FOR EA? QUALIFIED APPLICANT MUST MEET THE GROSS INCOME STANDARDS OF EA HOUSEHOLD MUST CONSIST OF NEEDY CHILD(REN) UNDER THE AGE OF 21 OR A PREGNANT WOMAN MUST BE A RESIDENT OF MASSACHUSETTS MUST MEET ASSETS LIMITS STEP 2 ARE YOU ELIGIBLE FOR EA? NO FAULT FIRE, FLOOD, NATURAL DISASTER, CONDEMNATION OR FORECLOSURE FLEEING DOMESTIC VIOLENCE, CURRENT OR WITHIN PAST 12 MONTHS NO FAULT EVICTION CHILD(REN) ARE EXPOSED TO A SUBSTANTIAL HEALTH AND SAFETY RISK STEP 3 STEP 4 STEP 5 PROVIDE ALL REQUESTED VERIFICATIONS WITHIN 30 DAYS HEALTH AND SAFETY ASSESSMENT WILL BE CONDUCTED TO VERIFY HOUSING INSTABILITY IF YOU ARE DETERMINED ELIGIBLE FOR EA, YOU MAY BE OFFERED TO CHOOSE HOMEBASE BENEFITS OR SHELTER PLACEMENT IF YOU ARE DETERMINED INELIGIBLE FOR EA, YOU WILL RECEIVE A DENIAL LETTER ALONG WITH A LIST OF COMMUNITY RESOURCES. ALL DENIALS MAY BE APPEALED. INSTRUCTIONS TO REQUEST AN APPEAL ARE ON THE BACK OF THE DENIAL LETTER. For additional questions, please contact DHCD REMOTE ACCESS LINE AT (866) 584-0653 100 Cambridge Street, Suite 300 www.mass.gov/dhcd Boston, Massachusetts 02114 617.573.1100
Commonwealth of Massachusetts DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT Charles D. Baker, Governor Karyn E. Polito, Lt. Governor Chrystal Kornegay, Undersecretary NOTICE: TO FAMILIES APPLING FOR EMERGENCY SHELTER AND SHELTER RESIDENTS IN NEED OF ASSISTANCE If you need to apply for shelter please call (866) 584-0653 STEP 1 CALL (866) 584-0653 STEP 2 SPEAK WITH A HOMELESS COORDINATOR TO COMPLETE AN INTAKE ASSESSMENT OR EMERGENCY ASSISTANCE APPLICATION TELEPHONICALLY OR APPLY IN PERSON AT ANY OF THE DTA/DHCD OFFICES LISTED 8:00AM 4:00PM BOSTON, 2201 Washington Street BROCKTON, 60 Main Street CHELSEA, 90 Everett Avenue, 3rd Floor FALL RIVER, 1567 North Main Street FRAMINGHAM, 300 Howard Street HYANNIS, 181 North Street LAWRENCE, 280 Merrimack Street LOWELL, 131 Davidson Street NEW BEDFORD, 160 West Rodney French Boulevard SALEM, 45 Congress Street, Suite 1176 SPRINGFIELD, 310 State Street WORCESTER, 13 Sudbury Street 100 Cambridge Street, Suite 300 www.mass.gov/dhcd Boston, Massachusetts 02114 617.573.1100
~ Berkshire Housing Development Corporation One Fenn Street 3rd Floor. Pittsfield Massachusetts 01201 Tel 413 499-1630 Fox 4 13 496-9831 www berl<shirchousing.com Emergency Assistance Data E ntry And Tracking Form (To l3c Completed In Initial EA Screen) Name: ~ E-mail 1\ddrcss: Telephone/ Cellphone 0:umber: --------------------- I. HOUSEHOLD COMPOSITION List all persons living in your unit 50% or more of the time (use the back of this sheet if necessary) Full Name (last, first) DOB Relationship to Sex Ethnic- Race Elderly Mo/day/yr Head of ity Oi\ablt d H ousehold OM 0 H DI OF OF DNll 02 DD 0 3 011 04 05 OM OH DI DE OF D Nll 02 DD 03 0 II 04 05 OM Oil DI D E OF 0 II 02 OD DJ 0 II 04 05 OM DH DI 0 1: OF 0 t'-.11 02 DO I I 03 O il 04 05 OM 0 II DI DE OF ONll 02 DD I I 03 0 II 04 05 List a ny additional members on the back of form, giving same information Citi7.C ll ship DEC 0 EN DIN 0 PV DEC O EN 0 IN 0 PV EC DE DIN OPV D EC 0 I: 0 IN OPV 0 EC DEt-. DIN 0 PV SS Nbr *Srx Categor ies: t:thnicit) Categories: * Rncr Ca ICJ!orics: *Elderly Ca t ego rie ~ *Ci1i1enship C'alCJ!Ories: M Male F = Female 11= I lispanic NI I= Non I lispanic. I- While. 2=Blacl.. Africru1 American. )=American lndianfal:bl..a Native. -l - \s1an. 5- Nativc I lawaiian/other Pacific Islander I Elder I). D=D1sablcd, 11 Handicapped I C'= Eligible Cit11en. EN l:ligiblc Non-C'H1Len. ll\- lnelig1blc non-c11izen. PV= Pcndmg Vcrifica11on Date Laurel Called Date Application Given Dates(s) Followed Up Notes F:\ WPDAT A \131 IDC\HomeBASE Program\HB FY' 15\HomeBASE rorms FY' 15\EA Data Entry Form