HCV Forms – Clearwater Housing Authority

To view, complete, and electronically sign these forms please click on the forms below to be taken to the electronic form. Once you complete the form you will be emailed a confirmation. Please verify the confirmation email. Once you have verified the completed form a copy will be emailed to you and to the Clearwater Housing Authority.

These forms are NOT for individuals interested in applying for any Clearwater Housing Authority program. You cannot apply for the waiting list by completing any of these forms. These forms are for existing housing choice voucher participants and housing choice voucher landlords.

Form Name	Description
Affidavit of Family Contribution	A person(s) or family member(s) who does not reside in the assisted unit completes this form if they pay bills on behalf of the tenant or make recurring contributions to the tenant family.
Affidavit Of Residency	Tenants complete this form if they are requesting to remove someone from their household composition.
Authorization for Release	Tenants complete this form once a year to give CHA permission to obtain income from current and former employers, unemployment, IRS and financial institutions (i.e. banks, credit unions, etc.). All household members 18 years or older are required to sign this release form at least once a year.
Change Form	The formal name of this form is the Interim Change Form. Current program participants and applicants who have received a voucher complete this form to report any and all changes in household income and family composition (removing household members or requests to add household members). The below forms will also be needed for the following changes: • Gain or Loss of Employment • Remove a Household Member • Loss of All Household Income • Loss of all income for an adult member of the household but there is still other income in the household
Debts Owed	Adverse information is collected on all participants once housing participation has ended, whether the household voluntarily or involuntarily move out of an assisted unit. PHA’s are required to report this adverse information to HUD. This notice provides you with information on what information the PHA is required to provide HUD, who will have access to this information, how this information is used and your rights. PHA’s are required to provide this notice to all applicants and program participants and you are required to acknowledge receipt of this notice by signing page 2. Every household member 18 years and older must sign this form.
Declaration 214	Applicants and tenants complete this form for each member of the household to indicate how that member is lawfully within the United States. This form is completed whenever a new member of the household is added.
Employment Verification Form	Tenants provide this form to their new or previous employer to verify the gain or loss of employment. This form must be completed and returned to CHA directly from the Employer or Business Establishment. Tenant completed or submitted forms will not be accepted.
FSS Application	Tenants complete this form if they are interested in joining the Family Self-Sufficiency Program.
Important Notice	Tenants complete this form to acknowledge the penalties that could result if they commit fraud while on the Housing Choice Voucher (HCV) Program. This form is completed annually.
Mutual Termination	Tenants and landlords who mutually agree to terminate their existing lease and HAP contract must complete this form. It is your responsibility to complete the form and obtain the other party’s signature.
New Landlord Packet	This packet explains the Housing Choice Voucher (HCV) Program and gives guidelines for participation as a new HCV landlord. Interested parties are required to complete and submit all of the forms and checklist items listed for review and approval.
Non-Renewal Clearance	Tenants must complete this form if they choose not to renew their existing lease with their landlord. Landlords must sign and acknowledge this notice. It is your responsibility to complete the form and obtain the other party’s signature.
Portability Request	Tenants complete this form when they want to move to a location that is outside the jurisdiction of the Clearwater Housing Authority.
Portability Statement	This form explains portability to tenants. It provides tenants with their rights and the requirements to qualify for portability. This form is completed annually.
Supplement to Application	Applicants and tenants complete this form to list an emergency contact person or agency. If an applicant or tenant chooses not to identify an emergency contact, they are still required to sign the form indicating they were given the chance to complete the form. This form is completed annually.
Tenancy Addendum Acknowledgement	Applicants complete this form to acknowledge they received a copy of the HUD Tenancy Addendum.
Tenant Agreement	This notice details the rights, requirements, and obligations of the housing choice voucher participant and their participating family members. This form is completed annually.
Utility Verification Form	Tenants complete this form when they have moved into a new unit and are submitting verification of their new utility account numbers.
Voluntary Withdrawal	Tenants complete this form when they no longer wish to participate in the HCV Program.
Voucher Extension Request	Tenants complete this form if they were issued an active housing voucher and are searching for a new unit. This form must be received prior to the voucher expiration but no earlier than 30 days remaining on the voucher.
Voucher Release Notification	Tenants complete this form if they were issued an active housing voucher, were searching for a new unit but have decided they no longer wish to participate in the HCV Program.
Zero Income Affidavit	Members of the household who are 18 years of age or older must also complete this form if they have no current source of income.
Zero Income Checklist & Affidavit	Tenants must complete this form if the household has no source of income other than social agencies, donations, family or friends.

Form Name

Description

Affidavit of Family Contribution

A person(s) or family member(s) who does not reside in the assisted unit completes this form if they pay bills on behalf of the tenant or make recurring contributions to the tenant family.

Affidavit Of Residency

Tenants complete this form if they are requesting to remove someone from their household composition.

Authorization for Release

Tenants complete this form once a year to give CHA permission to obtain income from current and former employers, unemployment, IRS and financial institutions (i.e. banks, credit unions, etc.). All household members 18 years or older are required to sign this release form at least once a year.

Change Form

The formal name of this form is the Interim Change Form. Current program participants and applicants who have received a voucher complete this form to report any and all changes in household income and family composition (removing household members or requests to add household members).

The below forms will also be needed for the following changes:
• Gain or Loss of Employment
• Remove a Household Member
• Loss of All Household Income
• Loss of all income for an adult member of the household but there is still other income in the household

Debts Owed

Adverse information is collected on all participants once housing participation has ended, whether the household voluntarily or involuntarily move out of an assisted unit. PHA’s are required to report this adverse information to HUD. This notice provides you with information on what information the PHA is required to provide HUD, who will have access to this information, how this information is used and your rights. PHA’s are required to provide this notice to all applicants and program participants and you are required to acknowledge receipt of this notice by signing page 2. Every household member 18 years and older must sign this form.

Declaration 214

Applicants and tenants complete this form for each member of the household to indicate how that member is lawfully within the United States. This form is completed whenever a new member of the household is added.

Employment Verification Form

Tenants provide this form to their new or previous employer to verify the gain or loss of employment. This form must be completed and returned to CHA directly from the Employer or Business Establishment. Tenant completed or submitted forms will not be accepted.

FSS Application

Tenants complete this form if they are interested in joining the Family Self-Sufficiency Program.

Important Notice

Tenants complete this form to acknowledge the penalties that could result if they commit fraud while on the Housing Choice Voucher (HCV) Program. This form is completed annually.

Mutual Termination

Tenants and landlords who mutually agree to terminate their existing lease and HAP contract must complete this form. It is your responsibility to complete the form and obtain the other party’s signature.

New Landlord Packet

This packet explains the Housing Choice Voucher (HCV) Program and gives guidelines for participation as a new HCV landlord. Interested parties are required to complete and submit all of the forms and checklist items listed for review and approval.

Non-Renewal Clearance

Tenants must complete this form if they choose not to renew their existing lease with their landlord. Landlords must sign and acknowledge this notice. It is your responsibility to complete the form and obtain the other party’s signature.

Portability Request

Tenants complete this form when they want to move to a location that is outside the jurisdiction of the Clearwater Housing Authority.

Portability Statement

This form explains portability to tenants. It provides tenants with their rights and the requirements to qualify for portability. This form is completed annually.

Supplement to Application

Applicants and tenants complete this form to list an emergency contact person or agency. If an applicant or tenant chooses not to identify an emergency contact, they are still required to sign the form indicating they were given the chance to complete the form. This form is completed annually.

Tenancy Addendum Acknowledgement

Applicants complete this form to acknowledge they received a copy of the HUD Tenancy Addendum.

Tenant Agreement

This notice details the rights, requirements, and obligations of the housing choice voucher participant and their participating family members. This form is completed annually.

Utility Verification Form

Tenants complete this form when they have moved into a new unit and are submitting verification of their new utility account numbers.

Voluntary Withdrawal

Tenants complete this form when they no longer wish to participate in the HCV Program.

Voucher Extension Request

Tenants complete this form if they were issued an active housing voucher and are searching for a new unit. This form must be received prior to the voucher expiration but no earlier than 30 days remaining on the voucher.

Voucher Release Notification

Tenants complete this form if they were issued an active housing voucher, were searching for a new unit but have decided they no longer wish to participate in the HCV Program.

Zero Income Affidavit

Members of the household who are 18 years of age or older must also complete this form if they have no current source of income.

Zero Income Checklist & Affidavit

Tenants must complete this form if the household has no source of income other than social agencies, donations, family or friends.