King County Housing Authority

PLEASE READ:

Thank you for applying for Public Housing with the King County Housing Authority. Please note that you need to complete ONE application for Public Housing.

Applications must be completed in ink and should be mailed to:

King County Housing Authority

Central Applications Processing Center

20126 Ballinger Way N.E., PMB #151

Shoreline, WA 98155-1290

Applications will also be accepted at KCHA management offices. Hours and/or days of operations may vary for individual offices. Applications will NOT be accepted at offices after 12:00 p.m. unless there are extenuating circumstances.

INFORMATION ON OUR APPLICATION PROCESS CAN BE FOUND AT OUR WEBSITE:

WWW.KCHA.ORG

OR BY CONTACTING ANY KCHA MANAGEMENT OFFICE

INFORMATION ABOUT OUR PROPERTIES CAN BE FOUND AT:

WWW.KCHA.ORG/LOOKINGFORHOUSING/MASTERLIST.ASPX

Please remember to only select properties listed on the back page of this application.

THINGS TO KNOW:

1. Prior to being offered a unit, each applicant will be screened for tenant suitability. The screening consists of, but is not limited to, a criminal background check (including drug-related criminal activity), credit check, and a landlord history screening.

2. Disability Status/Right to Reasonable Accommodation (Does not apply to Project Based Properties)

IF YOU HAVE A DISABILITY as outlined under Section 504 of the Americans with Disabilities Act or State or Local Fair Housing Laws and require an accommodation that would allow you to live and use your apartment or access facilities in a manner equal to that of a non-disabled tenant, you may qualify for a Reasonable Accommodation. For example, if you need:

A structural change or repair in your apartment, or special type of apartment;

A change or repair in some other part of the housing development; or Housing Authority facilities; or,

A change in our rules, policies, or how we do things (i.e.: how we communicate with you or give you information),

You may request a Reasonable Accommodation from your local Housing Authority representative, and they will direct you on how to proceed with the process.

3. It is illegal to Discriminate Against Any Person Because of Race, Color, Religion, Sex, Handicap, Familial Status, or National Origin.

Initial Application Instructions

Personal information (head of household)

The head of household’s Social Security number will be used to identify your family’s application in our Data Base. If the head of household does not have a Social Security number, a random account number will be assigned.

Name and Address (head of household)

We must have a current mailing address to contact you at all times. If we are unable to contact you by mail, you may be removed from the Public Housing waiting list without further notice.

Occupancy Guidelines

In determining the proper bedroom size for each family, generally speaking, children of the opposite sex over the age of 4 may not be required to share a bedroom in most cases. Please carefully analyze your family composition and select a property or region with the appropriate bedroom size for your family.

Central Applications offers an auto attendant telephone number. You may leave a message and a Housing Authority representative will return your call. You may also visit the property management office nearest you for assistance. The property management offices are noted in the property list, page 4, of your application.

The Auto Attendant telephone number is 206-574-1248. Calls are returned within 24 hours of receipt.

Waitlist Selections

KCHA policy allows applicants to be on the Site-Based Waiting List or the Regional Waiting List. The Site-Based Waiting List allows you to choose one (1) or two (2) specific properties from the list on page 4. These will be the specific properties you wish to live at, OR a Regional Waiting List, where you choose one (1) or two (2) of our three regions you would like to live in. Important: if you choose the Regional Waiting list, you are offered the first available unit anywhere within your selected region. Do not choose both Regional and Site-Based Waiting List.

Ethnicity and Race

The housing authority collects statistical data on ethnicity and race in accordance with federal regulations. This is for statistical purposes only.

List all members who will live with you

(fill in all requested fields)

List everyone who will be living with you, including aides and any unborn children you are expecting.

Additional Housing Program

If you are interested in any of our additional housing programs, please complete only the programs for which your family composition qualifies for according to the instructions provided.

Current living situation: waitlist preferences

Please select any or all of the waitlist preferences listed on page two as they apply to your current situation.

Please note:

Incomplete or incorrect applications will be returned to the applicant. Complete applications will receive an acceptance letter within 2-4 weeks.

INITIAL APPLICATION FOR HOUSING

MAIL COMPLETED APPLICATION TO:

CENTRAL APPLICATION PROCESSING CENTER

20126 BALLINGER WAY NE, PMB 151 * SHORELINE, WA 98155-1290

Or return to any KCHA Management Office

I. Applicant Information:      Please Print NEATLY In Ink

________________________________________________________________________________________________________________

LAST NAME                                                                             FIRST NAME                                                                  MIDDLE INITIAL

_________________________________________________________________________________________________________________

MAILING ADDRESS                                                 APT. NO.                 CITY                                         STATE                                  ZIP

(              )__________________________________________(             )________________________________________________________

HOME PHONE                                                                        WORK PHONE

______________________________________________________
EMAIL ADDRESS

PLEASE LIST ANY OTHER NAMES YOU MAY HAVE USED IN THE PAST                               PRIMARY LANGUAGE: _____________________

(MAIDEN NAME, ALIAS, ETC.): _______________________________                                TRANSLATION SERVICES NEEDED:   oYES     oNO

II. Household Information:

1. Please list ALL HOUSEHOLD MEMBERS who will be living in the assisted unit. List the Head of Household on line #1 (list additional Members on a separate page if more space is needed):

2. Does anyone live with you who is not listed above or are you expecting a baby?

o YES     o NO

If YES, please list the names(s) and explain: __________________________________________

III. Family Information:

1) FAMILY STATUS: Check all that apply:

o Head of Household or Spouse is age 62 over

o Head of Household or Spouse is Disabled or Handicapped

o Other Family Member is Disabled or Handicapped

o None of the Above

2) RACE: Please check one of the following:

o Caucasian

o African American

o Asian

o Hispanic

o Native American/Eskimo

o Hawaiian/Pacific Islander

This information is requested to comply with Equal Opportunity requirements and will not affect your application for housing assistance.

3) INCOME SOURCE(S): Please list ALL sources of income received by ALL adult members of your household: Examples: Wages, Pension, Child Support, SSI, SSA, L&I, TANF, and Regular Gifts. List additional income on a separate page if more space is needed

III. Family Information (continued):

1. Does anyone listed on your application have a Criminal Record? Answering YES will not automatically exclude you from housing. A Criminal History background check will be run on you and your adult family members. o YES  o NO

If YES, please list any criminal history, which will appear on your records and where it occurred: ______________________________________________________________________________

2. Has anyone listed on the application served in the U.S. Armed Forces? o YES   o NO

3. Has anyone listed on the application previously lived in Public Housing? o YES   o NO

If YES, please list who, along with when and where they lived in Public Housing: _____________

4. Does your family require a handicapped-modified unit? (Examples: roll-in shower, wheelchair accessible, etc.) o YES  o NO

5. Does any family member require a reasonable accommodation? (Example: live-in aid, etc.)

o YES  o NO

If YES, please complete a Reasonable Accommodation form, available from any KCHA office.

IV. Preferences:

Extremely Low Income Preference (Does not apply to Section 8 New Construction applicants)

1) Do you currently live in subsidized housing or receive a government rent subsidy?

o YES   o NO

• If you answered “YES” you do not qualify for the Extremely Low Income preference. Go to Question 3.
• If you answered “NO” go to Question 2.

2) Is your yearly income at or below the limits given for your family size on the chart below?

o YES   o NO

If you answered “YES,” you appear to qualify for the “Extremely Low Income” preference, continue onto Question 3.

If you answered “NO,” you may still qualify for one of KCHA’s other preferences, continue onto Question 3.

Substandard Housing, Displaced, and Rent Burden Preferences (This Section applies to all applicants)

3a) Are you currently homeless, live in a dilapidated home or live in a home without one of the following: plumbing, toilet, tub/shower, kitchen, electricity, or heat? o YES   o NO

b) Are you currently displaced from your home by natural disaster, government action, domestic violence, or forced to move to avoid reprisal, due to hate crimes, owner action, or unit inaccessibility? o YES   o NO

c) Have you been paying more than 50% of your Gross Income (income before taxes are taken out) for rent and utilities for the last 90 days? Utilities do not include phone or cable.

o YES   o NO

• If you answered “YES” to any of the above questions (3a-c), you appear to qualify for a preference.

PLEASE NOTE: All preferences will be verified prior to an offer of housing.

• If you did not answer “YES” to any of the above questions, then you do not appear to qualify for a preference at this time and will be placed on our waiting list as a non-preference.

V. Wait List Choice: KCHA allows applicants to select the type of housing waiting list they would like to be on. You may be on either a Site-Based Waiting List, where you choose which of our properties (listed below) you would like to live in, OR a Regional Waiting List, where you choose which of our three regions you would like to live in and are offered the first available unit anywhere in that region. With both lists, you have up to two choices.

Please place my application on the waiting list indicated:                       CHOOSE ONLY A or B

A. Site-Based Waiting Lists: Using the list below, select up to two (2) separate public housing developments in which you wish to live and write their name(s) on the lines below. You will only be offered housing in the location(s) that you select. You will be offered a unit in whichever property has a vacancy first, when your name reaches the top of the waiting list. These are not order of preference. (If you are selecting specific properties, please select properties that have the bedroom size to meet your needs.)

1. ______________________________________________________

OR

2. ______________________________________________________

OR

B. Regional Waiting Lists: Using the list below, select up to two (2) regions and write their name(s) on the lines below. You will be offered the first available unit of appropriate size that becomes available in that region. Regions are large areas within King County and you must be more flexible about where you will live. You must take the first unit offered to you or risk cancellation of your application.

1. _________________________________________________________

2. _________________________________________________________

VI. Signature:

I hereby certify that the information provided in this application is true to the best of my knowledge and belief. I understand that any false statements made on this application may result in cancellation of my application and if housed, my family will be subject to eviction. I also understand I must report any changes in the above information to the housing office in writing. Failure to report accurate information with regards to my family circumstances and any changes that may occur may result in delays in the application process and could ultimately lead to cancellation of my application, without further notice. I certify that I have read and understand this declaration and I understand that I will be required to successfully complete a criminal background check, a credit history check, provide landlord history (does not apply to Section 8 New Construction applicants) for the past three years and update my local preference and income status, which will be verified by the Housing Authority before a final determination regarding the suitability of my application will be made. Failure to respond to any correspondence from the Housing Authority may result in delays in the application process and could ultimately lead to cancellation of my application without further notice.

Head of Household Signature_______________________________________ Date___________

Please continue reading below for information about our properties and regions. For detailed information about the properties, please see our website at: http://www.kcha.org, or any KCHA office.

KING COUNTY HOUSING AUTHORITY PUBLIC HOUSING PROPERTIES

North/East Region

Southwest Region

Southeast Region

Site Based Lists Only

√ Locations with KCHA Management Offices        **Preferences for seniors and the disabled         

+ Preference for homeless families                      ‡ Preference for current KCHA tenants

• Building participates in the Low Income Housing Tax Credit program. Additional restrictions may apply.  

PLEASE NOTE: Choosing a Regional List will place you in the first available apartment in the region when your name comes to the top of the waiting list. Each region contains several cities so you may be offered an apartment in any one of the buildings in any one of the cities.

KING COUNTY HOUSING AUTHORITY

CENTRAL APPLICATION PROCESSING CENTER

20126 BALLINGER WAY NE PMB 151 * SHORELINE, WA 98155-1290

PHONE (206) 574-1248 FAX (206) 574-1241

ADDITIONAL HOUSING TYPES

The Programs listed below are separate from Public Housing. Each program has its own requirements. You may apply for as many of these programs as you qualify for. Being on these waiting lists will NOT affect your status on the Public Housing waiting list.

SECTION 8 NEW CONSTRUCTION

(Elderly (62+) Households may apply) – 1-bd units only

You may check as many properties as you are interested in:

For questions about these properties, please contact the management office at the number listed below.

o Burien Park: 500 SW 148th Street, Burien WA 98166

                        Telephone #: (206) 957-1069

o The Northwood: 18128 73rd NE, Kenmore WA 98028

                        Telephone #: (206) 574-1226

o Northlake House: 18219 96th NE, Bothell, WA 98011

                        Telephone #: (206) 574-1226

LOCAL PROGRAMS

(Elderly (60+) Households may apply) – 1 bd units only Flat rent of $330 per month

You may check as many properties as you are interested in, however, you must have income to support the rent of $330 per month.

o Campus Green: 501 S 320th Street, Federal Way, WA 98003

o Echo Cove: 19428 Aurora Avenue N, Shoreline, WA 98133

o Harbour Villa: 7217 NE 175th Street, Kenmore, WA 98028

o Slater Park: 12604 NE 119th Street, Kirkland, WA 98033

PRESERVATION PROGRAM

The properties listed below require a SEPARATE APPLICATION. Please contact the Preservation Program at 206-315-4380 for more information.

Hidden Village: 14508 SE 24th Street, Bellevue, WA 98007 – 1, 2, 3, and 4 bd units

Newport Apartments: 12646 SE 42nd Street, Bellevue WA 98006 – 1,2, and 3 bd units

Parkway Apartments: 3970 W Lake Sammamish Parkway NE, Redmond, WA 98052 – 1, 2, and 3 bd units

Spiritwood Manor: 1424 148th Avenue SE, Bellevue, WA 98007 – 1,2, and 3 bd units

IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT ANY KCHA MANAGEMENT OFFICE.

SUBSIDIZED PRIVATE HOUSING

• King County Housing Authority contracts with Private Landlords to subsidize a limited number of units for which you can apply. These units are found in various private apartment complexes around the region. You may apply for this program along with the Public Housing Program. Rent is based on household income.

• The private management company screens applicants for these units. There is often a screening fee for each adult household member

• More information about these developments is available at the KCHA property management office. Please ask to see the “Private Housing Binder” for a description of the properties. You may also find additional information at our web site www.kcha.org

1. Private Housing Wait List Options

A. Any Unit in the North/East Region of King County. (Primarily 2,3, & 4 bedroom units)

Locations may include, but are not limited to: Bellevue, Kirkland, Issaquah, and Lake Forest Park. You will be offered the first available unit of appropriate size that becomes available in this region.

B. Laurelwood Apartments in Federal Way. (3 & 4 bedroom units available)

C. Eernisse Apartments located on Vashon Island. (Primarily 2 & 3 bedroom units)

This housing is on an island and requires ferry transportation to and from Seattle. Ferry prices are at least $14.40 per round trip for a vehicle and $4.20 per passenger. There are limited employment opportunities on the island, and residents who work off the island have a round-trip commute that averages 3 hours each day. Please carefully consider choosing this option.

Using the list above, select up to two (2) options and write them on the lines below. Be sure that the lists that you choose have the bedroom size that meets your need.

1. ____________________________________________________________________________

2. ____________________________________________________________________________

2. Head of Household Information PLEASE PRINT:

I understand that if I am not eligible for a list I have chosen, I will not be added to that list. I understand that I am required to update the information on my initial application with KCHA if any of this information changes.

LAST NAME: _______________________________________  FIRST NAME: ________________

SOCIAL SECURITY #: __________________________________________________

KING COUNTY HOUSING AUTHORITY

CENTRAL APPLICATION PROCESSING CENTER

20126 Ballinger Way NE, PMB 151, Shoreline, WA 98155-1290

PHONE (206) 574-1248 FAX (206) 574 1241

ANNOUNCEMENT

The King County Housing Authority is pleased to announce we now have two ways to gather information about our waiting lists.

The Web Tool:

The Waiting List Lookup tool is now available on our web site www.kcha.org. It can be located by clicking on “Looking for Housing” and then “Subsidized Housing.” You will be taken through a few steps to choose the area or property and bedroom size you are interested in. This will then provide you the date of the application at the top of the waiting list. From this information, you can gauge how long the wait might be. Check out the Waiting List Lookup Tool.

Automated Telephone Line:

The Automated Telephone Line works much like the Wait List Lookup tool. You dial the Central Applications telephone number, (206) 574-1248, Press 4, then follow the menu items, selecting the Region and bedroom size you are interested in. The auto attendant will then list the date of the application at the top of the waiting list for the properties with the bedroom size you selected within the region you chose. If at any time you wish to start over, you will need to hang up and dial the telephone number again, press “4” again to select a different region or bedroom size. The automated telephone line is updated quarterly.

If you have questions about either of these tools, please contact the property management office nearest you for assistance.

Supplement and Optional Contact Information for HUD-Assisted Housing Applicants

SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING

This form is to be provided to each applicant for federally assisted housing

Instructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing the name, address, telephone number, and other relevant information of a family member, friend or social, health, advocacy, or other organization. This contact information is for the purpose of identifying a person or organization that may be able to help in resolving any issues that may arise during your tenancy or to assist in providing any special care or services you may require. You may update, remove, or change the information you provide on this form at any time. You are not required to provide this contact information, but if you choose to do so, please include the relevant information on this form.

Applicant Name: _______________________________________________________________

Mailing Address: _______________________________________________________________

Telephone No: ___________________________  Cell Phone No: _________________________

Name of Additional Contact Person or Organization:

Address: _______________________________________________________________________

Telephone No: ___________________________  Cell Phone No: _________________________

E-Mail Address (if applicable):  ____________________________________________________

Relationship to Applicant: ________________________________________________________

Reason for Contact: (Check all that apply)

o Emergency                                                 o Assist with Recertification Process

o Unable to contact you                                o Change in lease terms

o Termination of rental assistance               o Change in house rules

o Eviction from unit                                       o Other: __________________________________

o Late payment of rent

Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the issues or in providing any services or special care to you.

Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the applicant or applicable law.

Legal Notification: Section 644 of the Housing and Community Development Act of 1992 (Public Law 102-550, approved October 28, 1992) requires each applicant for federally assisted housing to be offered the option of providing information regarding an additional contact person or organization. By accepting the applicant’s application, the housing provider agrees to comply with the non-discrimination and equal opportunity requirements of 24 CFR section 5.105, including the prohibitions on discrimination in admission to or participation in federally assisted housing programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on age discrimination under the Age Discrimination Act of 1975.

o Check this box if you choose not to provide the contact information.

________________________________________________________________________________________________________________________

Signature of Applicant                                                                                         Date

The information collection requirements collected in this form were submitted to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The public reporting burden is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed. Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers participating in HUD’s assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option to include in the application for occupancy the name, address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such information is to facilitate contact by the housing provider with the person or organization identified by the tenant to assist in provide any delivery of services or special care to the tenant and assist with resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application for information is to be maintained by the housing provider and maintained as confidential information. Providing the information is basic to the operations of the HUD Assisted-Housing Program and is voluntary. It supports statutory requirements and program and management controls that prevent fraud, waste and mismanagement. In accordance with the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless the collection displays a currently valid OMB control number.

Privacy Statement: Public Law 102-550, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be used by HUD to protect disbursement data from fraudulent actions.