Resilient and Ready Home Repair Program
Homeowner Application

Primary Applicant




 












 










Co-Applicant





 




 









Additional Household Member #1













Additional Household Member #2













Additional Household Member #3














Additional Household Member #4














Additional Household Member #5













*If you still have additional household members please notify the LIHP in your next meeting.
 

Supply each income source the Applicant receives. Sources of income include earned income from employment as well as benefits, social security and child support.
Applicant Primary Income Source






Additional Applicant Employment / Income #2 






Additional Applicant Employment / Income #3 






Supply each income source the Co-Applicant receives. Sources of income include earned income from employment as well as benefits, social security and child support.

Co-Applicant Employment / Income 






Additional Co-Applicant Employment / Income #2 






Additional Co-Applicant Employment / Income #3 






Please list the current information for each bank account held by any household member(s) age 18 or older and upload or send copies of all pages of the last two (2) months bank/financial statements for each account listed below. Please list all accounts, including any retirement accounts, such as 401-K accounts, stocks, bonds, money market accounts, IRA accounts, certificates of deposit (CD accounts), etc.  Please enter numbers without dollar signs.






























STOP HERE!
It appears you are not qualified for the program.
You MUST be the owner of the property to be eligible for this assistance.

STOP HERE!
It appears you are not qualified for the program.
You MUST occupy the property to be eligible for this assistance.

STOP HERE!
It appears you are not qualified for the program.
The property MUST be located in Suffolk or Nassau County to be eligible for this assistance.



STOP HERE!
It appears you are not qualified for the program.
You MUST be current on all property taxes to be eligible for this assistance.

STOP HERE!
It appears you are not qualified for the program.
You MUST be current on your homeowner's insurance to be eligible for this assistance.




STOP HERE!
It appears you are not qualified for the program.
This property MUST have been damaged in the August 18-19, 2024 storm to be eligible for this assistance.


 
 

REQUIRED DOCUMENTS UPLOAD SECTION

.PDF FORMAT DOCUMENTS ARE PREFERRED!
DOCUMENTS WILL NOT BE ACCEPTED VIA EMAIL!

Only use this secure form for sending documents.

Resilient and Ready Home Repair Program Required Document Checklist

DO NOT UPLOAD DOCUMENTS TO THE SECTIONS BELOW IF THEY ARE NOT THE CORRECT ITEMS THAT BELONG IN EACH OF THE ITEM CATEGORIES. 
EXAMPLE: DO NOT UPLOAD SOMETHING ELSE IN THE PAYSTUBS AREA, OTHER THAN PAYSTUBS.
DOING SO WILL CAUSE DELAYS FOR THE CASEWORKER IN REVIEWING YOUR FILE

HOME IMPROVEMENT PROGRAM REQUIRED UPLOADS

Click on right side to upload additional documents. You are not limited to how many documents you can upload.

Click on right side to upload additional documents. You are not limited to how many documents you can upload.

Click on right side to upload additional documents. You are not limited to how many documents you can upload.

Click on right side to upload additional documents. You are not limited to how many documents you can upload.

Click on right side to upload additional documents. You are not limited to how many documents you can upload.

Click on right side to upload additional documents. You are not limited to how many documents you can upload.

Click on right side to upload additional documents. You are not limited to how many documents you can upload.

Click on right side to upload additional documents. You are not limited to how many documents you can upload.





Page 6

ACKNOWLEDGEMENT: 

 

I/We understand that the Long Island Housing Partnership, Inc. (LIHP) is relying on this information to prove my/our household’s eligibility for the program.  I/We certify that all information and answers to the questions are true and complete to the best of my/our knowledge.  If any of the information provided in this application changes prior to an eligibility determination, it is my/our responsibility to notify LIHP in writing so that an updated determination can be made regarding my eligibility status.  If the income documentation submitted becomes more than six (6) months old, I/we understand that I/we may be required to resubmit current financial information and documentation to determine that I/we still meet the eligibility requirements of the program.  Program eligibility must be maintained from the point of application to the awarding of all grant assistance. I/We understand that we may be required to submit updated, additional and/or clarifying documentation to determine eligibility and that the information provided may be verified.

  

 

CERTIFICATIONS:

 

1)         I/WE CERTIFY THAT I/WE HAVE READ AND UNDERSTAND THE PROGRAM GUIDELINES FOR THE PROGRAM AND UNDERSTAND THAT, IF DEEMED ELIGIBLE, THE PROPERTY WILL BE SUBJECT TO RECORDED COVENANTS AND FUNDS MAY BE SUBJECT TO RECAPTURE. SUBMISSION OF AN APPLICATION DOES NOT GUARANTEE ELIGIBILITY AND ELIGIBILITY IS SUBJECT TO COMPLIANCE WITH ALL PROGRAM GUIDELINES.

 

 

2)         I/WE CERTIFY THAT I/WE HAVE BEEN PROVIDED WITH A CHECKLIST OF DOCUMENTS AND INFORMATION REQUIRED TO BE PROVIDED TO BE CONSIDERED FOR ELIGIBILITY FOR THE PROGRAM.  I/WE UNDERSTAND THAT FAILURE TO PROVIDE SUCH DOCUMENTS AND INFORMATION WILL MAKE ME/US INELIGIBLE FOR SUCH PROGRAM.

 

 

3)         I/WE CERTIFY, UNDER THE PENALTIES OF PERJURY AND LAW, AND PROVISIONS OF U.S.C. TITLE 18 SECTION 1001, AND OTHER APPLICABLE FEDERAL, STATE AND LOCAL LAWS, THAT THE INFORMATION SUBMITTED HAS BEEN EXAMINED BY US AND APPROVED AND IS TRUE, CORRECT, AND COMPLETE.  I/WE ALSO UNDERSTAND THAT APART FROM THE PENALTIES AND PROVISIONS OF U.S.C. TITLE 18, SECTION 1001, AND ANY OTHER APPLICABLE LAWS, FALSIFICATION OF ANY ITEM IN THIS APPLICATION MAY BE A CRIMINAL OFFENSE.

 

FAIR HOUSING AND NON-DISCRIMINATION

LIHP is committed to promoting fair housing, equal opportunity, and non-discrimination in compliance with all federal, state and local laws, including, but not limited to, the Fair Housing Act, as amended by the Housing for Older Americans Act, the Americans with Disabilities Act, the Civil Rights Act, and the New York State Human Rights Law.  The LIHP staff is available to assist with the application, and answer questions about eligibility requirements.  In furtherance of this policy, LIHP shall not discriminate on the basis of race, creed, color, national or ethnic origin, sex, sexual orientation, gender identity, familial status, source of income, religion, disability, veterans’ status, age, or any other basis prohibited by law.


LIMITED ENGLISH PROFICIENCY AND ACCOMMODATIONS

Applications and Program Guidelines are available in English and Spanish and will be made available in other languages as requested. LIHP will take reasonable steps to ensure that persons with Limited English Proficiency (LEP) and persons who need assistance or who have a limited ability to speak, read, or write English, will have meaningful access and an equal opportunity to participate in the Program.  Interpreters, translators and other aids needed to comply with this policy shall be provided as reasonably necessary.  If you have any questions regarding the guidelines, or need assistance including language assistance such as translation and/or oral interpretation services, please contact the LIHP at info@lihp.org.


ELECTRONIC SIGNATURE:

You agree, and it is your intent, to sign this record/document by inserting/typing your name below and by electronically submitting this record/document.  You understand that by signing and submitting the record/document in this fashion, you are affirming the truth of the statements contained therein and that it is the legal equivalent of having placed your handwritten signature on the submitted record/document and all the parties may rely on same. 

Electronic Signatures
Applicant



Co-Applicant 



Additional Household Member 1



Additional Household Member 2



Additional Household Member 3



Additional Household Member 4



Additional Household Member 5



You have not met the requirements of this program. Please see Program Guidelines for more details.