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Ho-Chunk Housing Community Development P. O. Box 730, Tomah, WI 54660 608-374-1245 toll free 800-236-2260 ext. 8809

Section 1  Eligibility Requirements

Section 2  Eligible Repairs under Emergency T.R.I.P.

Section 3  Ineligible Repairs under Emergency T.R.I.P.

Section 4  Emergency T.R.I.P. Process

Section 5  Stipulation of Lien

Section 6  Assistance Application

Section 7  Household member information

Section 8  Annual Household Income

Section 9  Asset information

Section 10  Fair Housing and Equal Opportunity Section

Section 11  Federal Privacy Act

Section 12  Authorization for the Release of Information

Section 13  Federal Authorization for the Release of Information/Privacy Act Notice

Section 14  Required applicant information

Section 15  Annual Income Limits Guideline

• You may qualify for this program if you meet the following conditions:
• You are an enrolled Ho-Chunk member or an enrolled member of a federally recognized Native American tribe. Enrolled Ho-Chunk members will be given preference for services.
• Your home is located within the service area of the Ho-Chunk Housing and Community Development Agency.
• You own your own home, and the title names as owner a Ho-Chunk tribal member or an enrolled member of a federally recognized Native American tribe.
• You meet income guidelines.
• You have not yet reached the maximum lifetime forgivable loan amount of $7,500 repairs for emergency home repairs.
• Home must not be in a flood plain unless there is flood insurance on the property

Examples of services HHCDA may provide include but may not limited to the following:

• Roof repair/replacement
• Wheelchair ramps
• Electric and other fire hazards
• Hand railings/grab bars
• Plumbing repairs and sump pumps
• Bathroom modification
• Repair/replacement of furnace
• Doorway widening
• Repair/replacement of A/C systems

All accessibility repairs must be made in compliance with the current American Disability Act (ADA) Standards.

Examples of repair services HHCDA cannot provide include but are not limited to the following:

• Building/repair garage or storage sheds
• Make/correct structural changes to a home
• Construction of additions onto home
• Build decks or porches
• Repair or replace household appliances
• Cosmetic repair(s)
• Any non-emergency repairs
• Repair any home that has been listed as condemned or unsafe for occupancy by a local government agency or municipality
• Repair any home that is damaged due to homeowners neglect and/or failure to maintain homeowners insurance

This program is funded by the United States Department of Housing and Urban Development and compliance with applicable federal requirements must be adhered to.

The Ho-Chunk Housing and Community Development Agency service area covers the Ho-Chunk Nation 14-county service area and all of Area 5. Funds allocated for this program are limited and are granted on a first-come-first-serve basis for eligible applicants. Preference is granted to enrolled Ho-Chunk Nation tribal members.

1. Interested parties should contact the HHCDA for an application or questions at: 1-(800) 236-2260 ext. 233.
2. Applications may be picked up, mailed or faxed to interested parties.
3. Completed applications must be returned by email, mail, faxed or in person.
4. Applicants not meeting eligibility requirements will be denied.
5. Incomplete applications will not be processed.
6. Once an applicant is determined eligible, an environmental review is conducted on the home. Homes built before 1978 will be assessed for lead-based paint.
7. Completed and eligible applications are submitted to the Modernization/Development Director for a scheduled home inspection. Homes located outside of the HHCDA service area will be inspected by a licensed home inspector. Emergency repair request must be verified by an independent third party.
8. The HHCDA Inspector and homeowner will review the inspection report for necessary repair(s) or replacement(s). If the price estimation exceeds the loan amount, the homeowner will have to make decision(s) in order to meet the loan amount. (Some home(s) may be beyond repair in which case the D/M Director and Inspector will determine that repairs to the home would not be beneficial.)
9. The homeowner is required to obtain a minimum of 2 (two) bids from reputable licensed contactors and submit them to the HHCDA with a written request of contractor preference. (If a contractor or sub-contractor is selected for a price over two thousand dollars, Davis Bacon Wages must be used on the project.)
10. Colors and styles of materials are made by the homeowner. (Brand name selection is not allowed under HUD guidelines, without the phrase “or equal to”.)
11. The contractor is not allowed to place liens against the homeowner’s home.
12. Any repairs or improvements outside of the “agreement for services” between the Development Agency and the contractor with a scope of work that increase the contract cost must be paid by the homeowner.
13. All work performed will have a one-year workmanship and a material warranty. The warranty will be the responsibility of the homeowner. Any warranty work shall be requested by the homeowner to the contractor. The one-year period starts when the final inspection is completed and is accepted by the homeowner and the HHCDA.
14. Grievances or disputes will be submitted to the Contracting Officer in writing.

The Tribal Repair Improvement Program (T.R.I.P.) Emergency Repairs was intended to repair the homes of low-income tribal members. It is not intended to repair a home prior to sale. The Board of Commissioner passed the “Stipulation of Lien” on August 8, 2002 and further clarified the policy on June 19, 2008 in order to secure the meaning of the forgivable loan. The Ho-Chunk Housing and Community Development Board of Commissioners will file a lien against your home for the cost of the repairs and or improvements through T.R.I.P.

Removal of Lien

1. The lien will be released after a 5 (five) year period, or
2. If you sell your home within five years of T.R.I.P. emergency home repairs funded by the Ho-Chunk Housing and Community Development Agency, you will be required to pay back the full amount of the loan before your home is released, or
3. If you fail to use your house as your primary residence or default on your mortgage causing foreclosure of the home for a five year period upon receipt of the loan, repayment of the loan will be required. For each full year the repayment obligation will be forgiven by 20% of the loan amount, or
4. An appeal may be written by the homeowner to the Ho-Chink Housing and Community Development Board of Commissioners for an “emergency” exception sale of home.

What types of Housing Assistance have you received from the Ho-Chunk Nation in the past five years?

List any repairs and or improvements that have been done to the house since you have lived there? Also indicate whether you did this work yourself or if this work was hired out.

List any repairs and or improvements that have been done to the house since you have lived there? Also indicate whether you did this work yourself or if this work was hired out.

APPLICANTS STATEMENT: I/We certify that the information given to Ho-Chunk Housing and Community Development Agency on household composition, income, allowances and deductions is accurate and complete to the best of my/our knowledge and belief. I/We understand that false information is punishable under federal law; I/We understand that false statements or information will make me ineligible for housing services.

If you believe you have been discriminated against, you may call the Fair Housing and Equal Opportunity National Toll-free Hot Line at 1-800-424-8590. After verification by this Housing and Community Development Agency, the information will be submitted to the Department of Housing and Urban Development of form HUD 50058 Family Report, a computer-generated facsimile. Se the Federal Privacy Act Statement for more information about its use.

The U.S. Department of Housing and Urban Development (HUD) will be collecting information you gave to the Ho-Chunk Housing and Community Development Agency at application or reexamination. HUD will collect the information on Form HUD 50058. The data it will collect includes name, sex, birth date, Social Security Number (SSN), income (by source), assets, certain deductible expenses, and rental payment.

The Privacy Act of 1974, as amended, requires us to tell about this. We also are required to tell you what HUD will do with the information.

HUD will use the information to manage and monitor HUD assisted housing programs. It also may verify whether the information is accurate and complete by doing a computer match.

HUD may give the information to Federal, State, and local agencies when it will be used for civil, criminal or regulatory investigations and prosecutions. HUD also may make summaries of resident data available to the public. Other than these uses, HUD will not release the information outside HUD, except as permitted or required by law.

The Housing and Community Development Act of 1987, 42 U.S.C. 3543 requires applicant and residents to give the HHCDA the SSN(s) of household members at least six (6) years old. If you are an applicant and you have been issued or use SSN(s) and you do not give them to the HHCDA, the HC Housing and Community Development Agency is required to reject your application for housing assistance. If you are receiving housing assistance and you have been issued or use SSN(s) and you do not give them to the HHCDA, the HC Housing and Community Development Agency is required to evict your family or withdraw your housing assistance.

The U.S. Housing Act of 1937, as amended 42 U.S.C. et. Seq., and the Housing and Community Development Act of 1981, P.L. 97-35, 85 stat., 348,408 require applicants and residents to provide the other information listed in the first paragraph to the HC Housing and Community Development Agency. If you are an applicant and you fail to give the HHCDA this information, the HHCDA may have to reject your application or delay acting on it. If you are receiving housing assistance and you do not give the HC Housing and Community Development Agency this information the HHCDA may have to evict you or withdraw your housing assistance.

I have read and fully understand the Federal Privacy Act Statement:

I/we, the undersigned, with this, authorize the Ho-Chunk Housing and Community Development Agency and their agents to obtain any information, necessary, to process the HUD housing application. This information may be obtained from the following sources, any of the programs of the Ho-Chunk Nation, federal, state, and local governments and any of their agencies and representative, law enforcement agencies, financial institutions and current and prior landlords. This list is not all-inclusive and may include any additional agency, government, or private source, as deemed necessary by the Ho-Chunk Housing and Community Development Agency and/or their agents.

I/we, the undersigned, with this, release the Ho-Chunk Housing and Community Development Agency and/or their agents any requested information from the following agencies: federal, state and local governments, law enforcement agencies, financial institutions, and current or prior landlords.

This information requested may be given by fax, telephone or in writing. This release is valid for fifteen (15) months from the date of the applicant’s signature. This release is valid if photocopied and does not have to have an original signature.

I/we, have read the terms and conditions of the AUTHORIZATION FOR THE RELEASE OF INFORMATION and with this, give consent for the release of any requested information.

to the U.S. Department of Housing and Urban Development (HUD) and the Housing Agency/Authority (HA) Persons who apply for or receive assistance under the following programs are required to sign this consent form: PHA-owned rental public housing, Turnkey III Homeownership Opportunities, Mutual Help Homeownership, Opportunity Section 23 and 19(c) leased housing, Section 23 Housing Assistance Payments, HA-owned rental Indian housing, Section 8 Rental Certificate, Section 8 Rental Voucher, Section 8 Moderate Rehabilitation,

Failure to Sign Consent Form:

Your failure to sign the consent form may result in the denial of eligibility or termination of assisted housing benefits, or both. Denial of eligibility or termination of benefits is subject to the HA’s grievance procedures and Section 8 informal hearing procedures.

Sources of Information To Be Obtained

State Wage Information Collection Agencies. (This consent is limited to wages and unemployment compensation I have received during period(s) within the last 5 years when I have received assisted housing benefits.) U.S. Social Security Administration (HUD only) (This consent is limited to the wage and self employment information and payment of retirement income as referenced at Section 6103(l) (7) (A) of the Internal Revenue Code.) U.S. Internal Revenue Service (HUD only) (This consent is limited to unearned income [i.e., interest and dividends].) Information may also be obtained directly from: (a) current and former employers concerning salary and wages and (b) financial institutions concerning unearned income (i.e., interest and dividends). I understand that income information obtained from these sources will be used to verify information that I provide in determining eligibility for assisted housing programs and the level of benefits. Therefore, this consent form only authorizes release directly from employers and financial institutions of information regarding any period(s) within the last 5 years when I have received assisted housing benefits.

Authority:

Section 904 of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988, as amended by Section 903 of the Housing and Community Development Act of 1992 and Section 3003 of the Omnibus Budget Reconciliation Act of 1993. This law is found at 42 U.S.C. 3544. This law requires that you sign a consent form authorizing: (1) HUD and the Housing Agency/Authority (HA) to request verification of salary and wages from current or previous employers; (2) HUD and the HA to request wage and unemployment compensation claim information from the state agency responsible for keeping that information; (3) HUD to request certain tax return information from the U.S. Social Security Administration and the U.S. Internal Revenue Service. The law also requires independent verification of income information. Therefore, HUD or the HA may request information from financial institutions to verify your eligibility and level of benefits.

Purpose:

In signing this consent form, you are authorizing HUD and the above-named HA to request income information from the sources listed on the form. HUD and the HA need this information to verify your household’s income, in order to ensure that you are eligible for assisted housing benefits and that these benefits are set at the correct level. HUD and the HA may participate in computer matching programs with these sources in order to verify your eligibility and level of benefits.

Uses of Information to be Obtained:

HUD is required to protect the income information it obtains in accordance with the Privacy Act of 1974, 5 U.S.C. 552a. HUD may disclose information (other than tax return information) for certain routine uses, such as to other government agencies for law enforcement purposes, to Federal agencies for employment suitability purposes and to Has for the purpose of determining housing assistance. The HA is also required to protect the income information it obtains in accordance with any applicable State privacy law. HUD and HA employees may be subject to penalties for unauthorized disclosures or improper uses of the income information that is obtained based on the consent form. Private owners may not request or receive information authorized by this form.

Who Must Sign the Consent Form:

Each member of your household who is 18 years of age or older must sign the consent form. Additional signatures must be obtained from new adult members joining the household or whenever members of the household become 18 years of age.

PHA requesting release of information; (Cross out space if none) IHA requesting release of information: (Cross out space if none) (Full address, name of contact person, and date) (Ho-Chunk Housing and Community Development Agency)

U.S. Department of Housing and Urban Development Office of Public and Indian Housing Original is retained by the requesting organization. form HUD-9886 (7/94) ref. Handbooks 7420.7, 7420.8, & 7465.1 Signatures:

PHA requesting release of information; (Cross out space if none) IHA requesting release of information: (Cross out space if none) (Full address, name of contact person, and date) (Ho-Chunk Housing and Community Development Agency)

Consent: I consent to allow HUD or the HA to request and obtain income 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 understand that HAs that receive income information under this consent form cannot use it to deny, reduce or terminate assistance without first independently verifying what the amount was, whether I actually had access to the funds and when the funds were received. In addition, I must be given an opportunity to contest those determinations. This consent form expires 15 months after signed.

Penalties for Misusing this Consent: HUD, the HA and any owner (or any employee of HUD, the HA or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on the form HUD 9886 is restricted to the purposes cited on the form HUD 9886. Any person who knowingly or willfully requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, against the officer or employee of HUD, the HA or the owner responsible for the unauthorized disclosure or improper use.

Privacy Act Notice. Authority: The Department of Housing and Urban Development (HUD) is authorized to collect this information by the U.S. Housing Act of 1937 (42 U.S.C. 1437 et. seq.), Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), and by the Fair Housing Act (42 U.S.C. 3601-19). The Housing and Community Development Act of 1987 (42 U.S.C. 3543) requires applicants and participants to submit the Social Security Number of each household member who is six years old or older. Purpose: Your income and other information are being collected by HUD to determine your eligibility, the appropriate bedroom size, and the amount your family will pay toward rent and utilities. Other Uses: HUD uses your family income and other information to assist in managing and monitoring HUD-assisted housing programs, to protect the Government’s financial interest, and to verify the accuracy of 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 HA, including all Social Security Numbers you, and all other household members age six years and older, have and use. Giving the Social Security Numbers of all household members six years of age and older is mandatory, and not providing the Social Security Numbers will affect your eligibility. Failure to provide any of the requested information may result in a delay or rejection of your eligibility approval.

To process your application, please include the following information:

____Application – complete and signed

____Copies of Social Security Card(s) for each person over 6 years of age living in the home

____Copies of most recent U.S. Federal tax returns for each adult living in the home

____Copies of verification of Tribal enrollment

____Copy of deed/title to home

____Copy of homeowner current insurance policy

____Signed lien acknowledgement

____Signed Release of Information

____Signed Privacy Act Statement

Only application packets that have the above-mentioned documents complete, can be submitted to the Ho-Chunk Housing and Community Development Agency.

Please check and include this with your application packet. Questions about the submission of information please contact the Ho-Chunk Housing and Community Development Agency.