• Ho-Chunk Housing and Community Development Agency

  • COVID-19 EMERGENCY RENTAL ASSISTANCE PROGRAM

  • Rental Assistance and Utility Assistance Application

    Before you start using this online platform, please be sure to either take a picture of all required submissions. This includes a picture or electronic copy (PDF) of the following:

    • Tribal ID (or other tribal member verification)
    • Current Residential Lease
    • Current Income Information or 2020 Federal Income Tax Return (1040 Form)
    • For Rental Arrears Payments, copy of rent statement or rent ledger.
    • Current Utility Bills.

    Having copies of this information, prior to the start this application will aid you in completing this submission. 

    Applicants must submit this Form and supporting documentation for each additional month (or three-month prospective period) that they seek Financial Assistance under the ERA Program.

    All applications must be completely filled out for processing to begin.

  • If you have checked Yes, continue filling out application. If no, you are not eligible for Emergency Rental Assistance. Please visit HHCDA.com about additional covid assistance that you may be eligible for.
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  • Emergency Rental Assistance Program funds will be used for the following activities:

    a. Rent (current)--Applicants can apply for rental assistance for current month’s rent. Up to $1,000.00 per month.

    b. Prospective Rent (future rent)--Financial assistance for a period up to 12 months, up to 12,000.00 maximum. Must re-certify income eligibility every 3 months.

    c. Rental arrears--ERAP assistance can pay for arrears as far back as March 13, 2020. 12,000.00 maximum.

    d. Utilities and home energy costs--Current month’s utility statement amount. Up to $300. e. Utilities and home energy costs arrears--ERAP assistance can pay for arrears as far back as March 13, 2020, $3,600 maximum amounts.

  • Household member 1.
    Income Data, (Fill out for each member of household.)
    Name * . Date of Birth * Last 4 digits of social security number.   *   Tribal Enrollment Number   *   .Monthly Income,   *   , Income Source,   *   

  • Household Member 2.
    Income Data, (Fill out for each member of household.)
    Name . Date of Birth Last 4 digits of social security number.      Tribal Enrollment Number      .Monthly Income,      , Income Source,      

  • Household Member 3.
    Income Data, (Fill out for each member of household.)
    Name . Date of Birth Last 4 digits of social security number.      Tribal Enrollment Number      .Monthly Income,      , Income Source,      

  • Household Member 4.
    Income Data, (Fill out for each member of household.)
    Name . Date of Birth Last 4 digits of social security number.      Tribal Enrollment Number      .Monthly Income,      , Income Source,      

  • Household Member 5.
    Income Data, (Fill out for each member of household.)
    Name . Date of Birth Last 4 digits of social security number.      Tribal Enrollment Number      .Monthly Income,      , Income Source,      

  • Household Member 6.
    Income Data, (Fill out for each member of household.)
    Name: . Date of Birth    Last 4 digits of social security number.      Tribal Enrollment Number      .Monthly Income,      , Income Source,      

  • Household Member 7.
    Income Data, (Fill out for each member of household.)
    Name . Date of Birth Last 4 digits of social security number.      Tribal Enrollment Number      .Monthly Income,      , Income Source,      

  • Household Member 8.
    Income Data, (Fill out for each member of household.)
    Name . Date of Birth       Last 4 digits of social security number.      Tribal Enrollment Number      .Monthly Income,      , Income Source,      

  • Household Member 9.
    Income Data, (Fill out for each member of household.)
    Name . Date of Birth Last 4 digits of social security number.      Tribal Enrollment Number      .Monthly Income,      , Income Source,      

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  • Housing Instability Information

  • Rent Arrears and Utility Costs Arrears:

    Only includes Rent Arrears and Utility Costs Arrears incurred on or after March 13, 2020.

    Arrears includes: interest charges and penalties accrued from the date on which the first missed payment after March 13, 2020

    doesinclude: Arrearsnotinterest charges or penalties accrued for Rent Arrears or Utility Costs Arrears incurred before March

  • Rent Arrears and Utility Cost Arrears

    Do you have any Rent Arrears or Utility Costs Arrears? (check all that apply) If you check any of the boxes below, attach supporting documentation for each arrears payment (rental lease, documents showing rent or utility costs arrears and interest accrued, etc.)
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  • Utility Arrears

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  • Other Housing Expense

  •         Payment is due:

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  • Certifications and Signature Section

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    By my signature below, I hereby certify that all of the foregoing information and attached documentation is true and correct. I understand that providing any false statements, false information, any misleading statements or information, or if I fail to notify Ho-Chunk Housing and Community Development Agency of changes to my household's eligibility, will be grounds for denial of the application or, if assistance has already been granted, recapture of any funds granted, and may be grounds civil or criminal prosecution if Ho-Chunk Housing Community Development Agency determines it is appropriate to do so.

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  • If a landlord or owner of a residential dwelling submits this Form on behalf of the Applicant:

    , the Applicant's landlord/residential dwelling owner, understand that I am

    required to provide this application to the Applicant after completing and submitting it.

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  • Additional Requirements

    Applicants must sign a release of information form allowing the Ho-Chunk Housing and Community Development Agency to verify any and all information required to participate in the COVID-19 Emergency Rental Assistance Program. For each additional month that applicants seek Financial Assistance under the ERA Program, they must submit information and documentation for the rent and utility costs for that month and prospective months for which they
  • Attestation Applicant Acknowledgements

    I understand that I am required to update my application whenever any determining factor of eligibility changes. This includes employment/annual income, contact information, no longer qualifying for unemployment benefits, no longer experiencing a reduction in household income or other financial hardship, no longer facing a risk of homelessness or housing instability, or having a household income that is above 80 percent of the Area Median Income for the household.
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  • AUTHORIZATION FOR THE RELEASE OF INFORMATION

  • 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 Emergency Rental Assistance Program (ERAP) application. This information may be obtained from the following sources, and of the Programs of the HO-CHUNK NATION, Federal, State, and Local governments and any of their agencies and representatives, Law Enforcement Agencies, Financial Institutions and current and prior landlords. This 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.

    The information request 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.

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  • Check List

    Please check of the items listed if you have attached your items to assist you in submitting your application. Applications that are turned in without the supporting documentation can not be processed for payment.
  • COVID-19 Emergency Rental Assistance Program

  • All required documents must be attached in order to be considered for assistance.

    HO-CHUNK HOUSING AND COMMUNITY DEVELOPMENT AGENCY

    P. O. BOX 730, TOMAH, WI 54660

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