DUPLICATION OF BENEFITS AGREEMENT AND SUBROGATION:
This Certification is necessary to assist with determining that assistance received from the Program does not duplicate or overlap with assistance received from other sources and the total amount of assistance does not exceed the amount of need in connection with the assistance awarded pursuant to the application submitted for the Program. Therefore, to be considered for the Program and in consideration of payments that may be received pursuant to the Program, the undersigned states, certifies and agrees as follows:
1) No other funds have been received or awarded for the assistance for the tenant/unit. If the undersigned has been, or is awarded or receives any funding for assistance that provides rental assistance for the tenant/unit, the undersigned will immediately advise LIHP in writing. Such amounts, if determined to be a duplication of benefits, will reduce the award that may be payable under the Program and, if disbursed, will be re-paid by the undersigned. The obligation to re-pay any duplication of benefits is an on-going obligation.
NOTE: IF THE HOUSEHOLD RECEIVES AN ADJUSTMENT OF THE HOUSEHOLD’S TENANT PORTION SUCH THAT THE PUBLIC HOUSING AUTHORITY/AGENCY OR ENTITY PROVIDING THE SUBSIDY COVERS THE TENANT PORTION BEING PAID PURSUANT TO THIS PROGRAM, THEN SUCH WILL BE A DUPLICATION OF BENEFITS THAT IS REQUIRED TO BE REPAID.
2) The undersigned hereby assigns to the Town, or its agents, and HUD all of the undersigned’s future rights to reimbursement and all payments received from any grant, subsidized loan, public assistance payment, voucher payment or reassessment, or assistance under any assistance programs that are determined in the sole discretion of the Town and/or LIHP or HUD to be a duplication of benefits.
3) The undersigned shall cooperate with the Town, or its agents, and/or HUD and such cooperation shall include, but shall not be limited to, executing and delivering such additional documentation as may be requested to further and better assign to the Town, or its agents, and/or HUD any amounts paid under the Program that are determined to be a duplication of benefits or in connection with the collection or enforcement thereof.
4) Each of the undersigned explicitly allows the Town, or its agents, HUD, or any agency of the federal government, to request of any agency or organization with which the undersigned has applied for or is receiving funds, any information determined to be reasonably necessary to monitor/enforce its interest in the rights assigned to it under this Agreement and hereby give consent to such agency/organization to release said information to the Town or its agents, HUD, or any agency of the federal government.
5) The undersigned shall defend, indemnify, and hold harmless, LIHP, the Town, HUD, the federal government, and each of their officers, directors, members, employees, agents, and affiliates, from and against any and all losses, claims, judgements, assessments, charges, liens or other costs and expenses, including without limitation reasonable attorneys’ fees, arising out of or connected with any duplication of benefits or the collection or enforcement thereof.
6) If unemployment benefits, federal or state stimulus payments, Paycheck Protection Program funds, or other assistance were/are being received for general, non-specific purposes, or for a different purpose, you certify that the benefits were/are utilized for other necessary items and were/are not available to pay the assistance needed pursuant to the Program.
7) The undersigned agrees that LIHP and the Town will rely on the foregoing in its assessment of eligibility and determination of award and the representations and agreements set forth herein shall survive the submission of the Application or any award.
ADDITIONAL TERMS:
1) If approved for an award, tenants, landlord and Town must execute a Rental Assistance Agreement and tenant and landlord must executed a Lease Addendum in accordance with HUD requirements including the Violence Against Women’s Act.in substantially the form attached hereto. By accepting funds under the Program, if eligible, the undersigned agrees that such funds will be paid by the Town directly to the owner of record of the premises as set forth in the Town/municipal records to the address provided by the landlord.
2) As a condition of review for eligibility, the undersigned shall permit LIHP, the Town and/or their agents, to inspect the premises for purposes of confirming compliance with Housing Quality Standards required by HUD and Lead Based Paint regulations, if applicable, prior to any determination of eligibility. The undersigned acknowledges that If the unit fails inspection, landlord must complete the required repairs including lead-based paint clearance, at landlord’s sole expense, within thirty (30) days of determination, otherwise the unit will be ineligible for the Program and the undersigned will be removed from the waitlist with no right of appeal.
DISCLAIMERS:
The submission of documentation does not constitute acceptance, approval of qualification criteria, or a guarantee of a Program award. Please consult the Program Guidelines for all the Program requirements
PROGRAM GUIDELINES:
By signing below, I agree to participate in the Program and confirm that I have read the Program Guidelines and agree to all the terms and conditions contained therein.
AUTHORIZATION AND CONSENT:
1) LIHP, its program partners, and/or the Town is hereby authorized and permitted to disclose and verify any and all information contained in my application and on other documents submitted for the Program, to or with any third party, including but not limited to the Town, HUD, any agency or representative of the U.S. government, any representative or agency of New York State, my landlord or property management company, any member of my household, any o LIHP’s program partners, or any municipal agency or other entity providing rental or utility assistance (a “Third Party”), as applicable, either during the process or as part of the ongoing Program compliance. Without limiting the foregoing, LIHP, its program partners, and/or the Town may share information regarding my application and Program award, if applicable, with any other Third Party and are authorized to obtain information on me from any such Third Party regarding my application with such Third Party and my eligibility or award from such Third Party for rental assistance.
2) The undersigned authorizes any such Third Party to provide to LIHP, its program partners, the Town, any agency or representative of the U.S. government, or any representative or agency of New York, any and all information and documentation that they may request, including but not limited to, information and documentation on rent, utilities, payment history, employment history and income; bank, money-market, and similar accounts balances, credit history, copies of income tax returns, and application, status and award information regarding any rental or utilities assistance.
3) A copy of this authorization may be accepted as an original.
FAIR HOUSING AND NON-DISCRIMINATION:
LIHP is committed to furthering and 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. LIHP will have staff available to assist and answer questions about eligibility requirements. In furtherance of this policy, LIHP will 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:
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 or other assistance needed to comply with this policy shall be provided as reasonably necessary.
ATTESTATION/SELF-CERTIFICATION
Each of the undersigned, does hereby affirm and attest, under the penalties of perjury and law, that (1) all of the information and certifications provided herein are true, correct and complete; and (2) the undersigned is a member of a Qualifying Population as stated above.
VIOLATION OF FEDERAL LAW:
THE APPLICANT CERTIFIES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. THE INFORMATION PROVIDED IS SUBJECT TO VERIFICATION BY LIHP, THE MUNICIPALITY, PROGRAM PARTNERS AND/OR ANY AGENCY OF NEW YORK STATE OR THE U.S. GOVERNMENT. BY SUBMITTING AN APPLICATION AND SUPPORTING DOCUMENTS, THE APPLICANT ACKNOWLEDGES AND UNDERSTANDS THAT TITLE 18 OF THE UNITED STATES CODE SECTION 1001: (1) MAKES IT A VIOLATION OF FEDERAL LAW FOR A PERSON TO KNOWINGLY AND WILLFULLY (A) FALSIFY, CONCEAL, OR COVER-UP A MATERIAL FACT; (B) MAKE ANY MATERIALLY FALSE, FICTITIOUS, OR FRAUDULENT STATEMENT OR REPRESENTATION; OR (C) MAKE OR USE ANY FALSE WRITING OR DOCUMENT KNOWING IT CONTAINS A MATERIALLY FALSE, FICTITIOUS OR FRAUDULENT STATEMENT OR REPRESENTATION, TO ANY BRANCH OF THE UNITED STATES GOVERNMENT; AND (2) REQUIRES A FINE, IMPRISONMENT FOR NOT MORE THAN FIVE (5) YEARS, OR BOTH, WHICH MAY BE RULED A FELONY, FOR ANY VIOLATION OF SUCH SECTION.
IF 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.