Housing Authority of the City of Muskogee Housing Authority

ATTN: Section 8 Pre- Application

220 North 40th Street

Muskogee, OK 74401

Telephone: (918) 687-6301   Fax: (918) 682-0446

The Muskogee Housing Authority provides reasonable accommodations on request.  If you require a reasonable accommodation, please notify this office in writing of the reason for and type of accommodation being requested.

 

Social Security Number: _________________________Last Name: _____________________________

 

First Name: ___________________________________Middle Initial: _________

 

Other Name(s) Used: ___________________________________________________________________

 

Phone Number: (home) (___) -______-__________ (work) (____) - _____- _________

                            (message)  (___) - ______-__________

 

Present Address:                                                                                                                                                                

 

City, State, Zip Code _____________________________________________________                                            

 

Mailing Address (if different) _______________________________                                                                              

 

City, State, Zip Code _____________________________________________________                                            

 

List each person who will be living in the household.  Give legal name.  Begin with yourself.

 

Last, First, MI

Gender

Race

**

Hispanic

Yes/No

SSN

Student

Yes/No

Relation

To Head

Birthday

 

 

 

 

 

 

Head

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

** White = 1, Black =2, American Indian = 3, Asian/Pacific Islander = 4, Hispanic = 5

 

List each person’s source of income that will be living in the household.  Begin with yourself.

 

Name

Income Code **

Source of Income

Monthly Gross Income

Hourly Pay Rate

Number of hours per week

Example: Jane Doe

W

AAA Company

$576.00

$6.00

24

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

** Income Type Codes:                                                                                                                

P = Pension                 S = SSI                      G = General Assistance            I = Indian Trust/per capita        

B = Own Business      F = Federal Wages    W = Other Wages                     N = Other Non-wage Source  

SS = Social Security   T = TANF                 C = Child Support                    E = Medical Reimbursement   

M = Military Pay       HA = PHA Wages     U = Unemployment  Benefits   IW = Annual Imputed Welfare Income

 

 

Enter the assets that your household currently possesses, or has disposed of within the last two years for less than fair market value.

Enter the anticipated or actual income from each asset next to Annual Income.

__________________________________________________________________________________________

Family Member Name_________________________             Source_______________________________  
Description of Asset   _________________________           Contact_______________________________

Cash Value                  _________________________         Address________________________________

Annual Income            _________________________   City, State Zip_____________________________

Telephone_______________________________

__________________________________________________________________________________________

Family Member Name_________________________             Source_______________________________  
Description of Asset   _________________________           Contact_______________________________

Cash Value                  _________________________         Address________________________________

Annual Income            _________________________   City, State Zip_____________________________

Telephone_______________________________

__________________________________________________________________________________________

 

 

 

 

 

 

 

Enter any Medical, Child Care or Handicapped Expenses that your household currently has.

___________________________________________________________________________________________


Family Member Name_________________________            Payee  _______________________________  
Type of expense          _________________________           Contact_______________________________

Expense per                ____Week_____Month_____Year    Address________________________________

Expense Cost             _________________________   City, State Zip______________________________

Telephone_______________________________

___________________________________________________________________________________________


Family Member Name_________________________            Payee  _______________________________  
Type of expense          _________________________           Contact_______________________________

Expense per                ____Week_____Month_____Year    Address________________________________

Expense Cost             _________________________   City, State Zip______________________________

Telephone_______________________________

___________________________________________________________________________________________


Family Member Name_________________________            Payee  _______________________________  
Type of expense          _________________________           Contact_______________________________

Expense per                ____Week_____Month_____Year    Address________________________________

Expense Cost             _________________________   City, State Zip______________________________

Telephone_______________________________

___________________________________________________________________________________________


Family Member Name_________________________            Payee  _______________________________  
Type of expense          _________________________           Contact_______________________________

Expense per                ____Week_____Month_____Year    Address________________________________

Expense Cost             _________________________   City, State Zip______________________________

Telephone_______________________________

___________________________________________________________________________________________


Family Member Name_________________________            Payee  _______________________________  
Type of expense          _________________________           Contact_______________________________

Expense per                ____Week_____Month_____Year    Address________________________________

Expense Cost             _________________________   City, State Zip______________________________

Telephone_______________________________

___________________________________________________________________________________________

1.       Has anyone in your household been arrested or convicted for the use, sale, manufacture,
or distribution of controlled substances (drugs)?     YES         NO

     If yes: Who? When?  For What? ____________________________________________________

     ______________________________________________________________________________

2.       Does anyone in your household currently use a controlled or illegal drug?            YES            NO

           If yes, please explain.  ____________________________________________________________

           _______________________________________________________________________________

3.       Has anyone in your household ever been convicted of a felony or arrested for  violent criminal activity?          YES      NO

     If yes:  Who?  When?  For What?  __________________________________________________

     ______________________________________________________________________________

4.       Does anyone outside your household pay for any of your bills or expenses?             YES         NO                         

           If yes:  Who?  When?  For What?  ___________________________________________________

           _______________________________________________________________________________

5.       Do you or any family member claim handicapped or disabled status for eligibility purposes?   

                                  YES          NO

6.       Do you or a member of your family request housing with special accommodations?

                                 YES          NO

Applicants who qualify for a special preference admission will be offered Section 8 assistance before those applicants who do not qualify for a special admission preference.  Preference claims must be in effect and verified at the time assistance is offered.  The preferences are as follows:

 

Family Unification Program

The applicant family is referred by the Department of Human Services Child Welfare department.  Are you referred by the Department of Human Services Child Welfare?                              YES          NO

 

Non-Elderly Disabled Family

Please be aware that the program definition of “disabled” must apply in order to be considered eligible for these special purpose admission vouchers.  These vouchers are only available for non-elderly disabled families qualifying according to actual grant language.  You must provide proof of legal disability to be considered for these preference points.  One preference point will be awarded for non-elderly disabled adult status; one preference point will be awarded for non-elderly disabled adult transitional status; one preference point will be awarded for non-elderly disabled adult homeless status.

 

Are you and/or your spouse under the age of 65?                      YES          NO

 

Are you and/or your spouse disabled?                                           YES         NO

 

Are you presently homeless?                                                            YES         NO

 

Are you presently living in transitional housing?                          YES         NO

 

Muskogee Resident/Work Preference

The Board of Commissioners of the Muskogee Housing Authority have approved the granting of one preference point for persons who live and/or work in the City of Muskogee city limits.  You must provide proof of residence/work status in order to qualify for this preference point

Are you presently working and/or living in the City of Muskogee?                       YES           NO

Your eligibility to receive housing assistance is dependent upon your submitting to the Muskogee Housing Authority verification of your citizenship/national status or eligible immigration status.  Verification for citizenship/national status will be supplied upon request.

 

All contact by the Muskogee Housing Authority is made by mail, so if your address changes, please notify our office in writing promptly.  Remember, it is your responsibility to update your application information when needed.

 

 

WARNING!  Title 18, Section 1001 of the United States Code, states that a person who knowingly and willingly makes false or fraudulent statements to any Department or Agency of the U.S. government is guilty of a felony.  I understand that any misrepresentation of information or failure to disclose information requested in this application may disqualify me from consideration for admission or participation, and may be grounds for eviction or termination of assistance.

I do hereby certify that the above information is true, accurate, and complete to the best of my knowledge.

 

                    Applicant__________________________________________ Date____________________

 

              Co-applicant___________________________________________Date____________________

 

Other member over 18__________________________________________Date____________________

 

   Other member over 18__________________________________________Date____________________

 

Before an offer of assistance is made to an applicant who has been selected from the waiting list on the basis of admission preference, the Housing Authority must require the applicant to provide verification that he or she qualifies for each of the preferences outlined above at the time of selection.  The Housing Authority will verify the preference you claim at the time your name is selected from the waiting list.

After completing, mail, fax, or drop off the pre-application to the Muskogee Housing Authority, Attn: Section 8 Pre-Application Program, 220 North 40th Street, Muskogee, OK 74401.

 

If you believe you have been discriminated against, you may call the Fair Housing and Equal Opportunity National toll-free hotline at: 1-800-424-8590.