This program was established to mitigate financial hardships associated with the coronavirus pandemic by providing funds to eligible entities for the purpose of preventing homeowner mortgage delinquencies, defaults, foreclosures, loss of utilities or home energy services, and displacements of homeowners experiencing financial hardship after January 21, 2020, through qualified expenses related to mortgages and housing.

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* 1. Are you an enrolled Tribal Member?

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* 2. If "yes", which Tribe are you enrolled with?

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* 3. Do you own your home?

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* 4. Where is your home located?

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* 5. Have you been impacted by COVID-19 (after January 21, 2021)?

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* 6. If you answered "yes", please select all that apply to how you have been impacted.

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* 7. What services could benefit you in your current situation? Select all that applies.

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* 8. Did you file taxes in 2020 ( Internal Revenue Services form 1040)?

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* 9. What kind of income have you received since January 21, 2020? Select all that apply.

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* 10. What is your estimated total household income (total income from all individuals 18 years of age and older)?

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* 11. If you are a homeowner that has been impacted by COVID-19 and would like to be contacted by one of AMIHA's staff for more information about the Homeowner's Assistance Fund Program, please list your contact information below. Thank you for your time.

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