Bedford OOR Pre-Application Form - Due Friday, October 9th at 4:00 pm EST.

The City of Bedford is applying for a $350,000 grant through the Indiana Office of Community and Rural Affairs (OCRA) to bring back its local home repair program! The City is also contributing $39,000 in local match toward the success of this program.

This pre-application form is the first step for homeowners who may be interested in participating if funding is awarded. Once a funding decision is made by OCRA, completed pre-applications will be reviewed and scored using program guidelines to determine eligibility and participant selection. To learn more about the Bedford Owner-Occupied Rehabilitation (OOR) Program, please review the FAQ document available at this LINK.

Paper copies of the form are also available at Bedford City Hall, located at 1102 16th Street, Bedford, IN 47421, Monday through Friday from 8:00 a.m. to 4:00 p.m.

All questions on this form require a response. When you have finished, please click DONE to ensure your responses are properly saved and submitted.

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1. Please provide us with your contact information. (Required.)

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2. Do you live within Bedford city limits? (Required.)

Yes

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3. Do you own your home? (Required.)

Yes

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4. Is your home on a permanent foundation? (Required.)

Yes

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5. Do you have an active mortgage? (Required.)

Yes

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6. Do you have homeowners' insurance? (Required.)

Yes

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7. Are your property taxes up to date? (Required.)

Yes

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8. How many household members aged 18 or older live in your home? (Required.)

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9. What is your family's total annual income before taxes? (Required.)

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10. What is your family's primary source(s) of income? Please check all that apply. (Required.)

Employment (full-time or part-time)

Social Security

Disability Benefits

Retirement Income

Unemployment

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11. When was your home built?

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12. Which type of repair assistance are you requesting? Please check all that apply. (Required.)

Roof Repair or Replacement

Heating/Cooling System Replacement

Water Heater Replacement

ADA Accessibility Modifications to the home's entry

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13. In the past 3-5 years, have you received any quotes or estimates for these types of repairs? (Required.)

Yes

If yes, what was the approximate cost for repairs

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14. In the past 3-5 years, have you experienced any of the following issues at home? (Required.)

Roof leaks or visible roof damage

Heating or cooling system not working properly

Water heater not working properly/unreliable hot water

Difficulty entering/exiting the home due to mobility limitations

None of the above

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15. In the past 3-5 years, how often have these issues affected your household? Please select one. (Required.)

Daily

Weekly

Monthly

Seasonally

Occasionally

Never

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16. Have any of these issues created health or safety concerns for your household? Please check all that apply. (Required.)

Unsafe temperatures during hot or cold weather

Water damage or moisture inside the home

Difficulty entering or exiting the home

Increased risk of falls or injuries

Lack of reliable hot water for bathing or cleaning3

None of the above

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17. Does your current financial status impact your ability to make these home repairs? (Required.)

Yes

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18. Enter any comments you have about the urgency of your repair request. (Required.)

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19. Does anyone in your household belong to the following groups? (Required.)

Individuals with Disabilities

Elderly (62+ years or older)

Veterans

Single Parent Heads of Households

None of the above

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20. What is your race/ethnicity?

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Another race

Bedford OOR Pre-Application Form - Due Friday, October 9th at 4:00 pm EST.

Question Title

* 1. Please provide us with your contact information. (Required.)

Question Title

* 2. Do you live within Bedford city limits? (Required.)

Question Title

* 3. Do you own your home? (Required.)

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* 4. Is your home on a permanent foundation? (Required.)

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* 5. Do you have an active mortgage? (Required.)

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* 6. Do you have homeowners' insurance? (Required.)

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* 7. Are your property taxes up to date? (Required.)

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* 8. How many household members aged 18 or older live in your home? (Required.)

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* 9. What is your family's total annual income before taxes? (Required.)

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* 10. What is your family's primary source(s) of income? Please check all that apply. (Required.)

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* 11. When was your home built?

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* 12. Which type of repair assistance are you requesting? Please check all that apply. (Required.)

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* 13. In the past 3-5 years, have you received any quotes or estimates for these types of repairs? (Required.)

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* 14. In the past 3-5 years, have you experienced any of the following issues at home? (Required.)

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* 15. In the past 3-5 years, how often have these issues affected your household? Please select one. (Required.)

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* 16. Have any of these issues created health or safety concerns for your household? Please check all that apply. (Required.)

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* 17. Does your current financial status impact your ability to make these home repairs? (Required.)

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* 18. Enter any comments you have about the urgency of your repair request. (Required.)

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* 19. Does anyone in your household belong to the following groups? (Required.)

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* 20. What is your race/ethnicity?

1. Please provide us with your contact information. (Required.)

2. Do you live within Bedford city limits? (Required.)

3. Do you own your home? (Required.)

4. Is your home on a permanent foundation? (Required.)

5. Do you have an active mortgage? (Required.)

6. Do you have homeowners' insurance? (Required.)

7. Are your property taxes up to date? (Required.)

8. How many household members aged 18 or older live in your home? (Required.)

9. What is your family's total annual income before taxes? (Required.)

10. What is your family's primary source(s) of income? Please check all that apply. (Required.)

11. When was your home built?

12. Which type of repair assistance are you requesting? Please check all that apply. (Required.)

13. In the past 3-5 years, have you received any quotes or estimates for these types of repairs? (Required.)

14. In the past 3-5 years, have you experienced any of the following issues at home? (Required.)

15. In the past 3-5 years, how often have these issues affected your household? Please select one. (Required.)

16. Have any of these issues created health or safety concerns for your household? Please check all that apply. (Required.)

17. Does your current financial status impact your ability to make these home repairs? (Required.)

18. Enter any comments you have about the urgency of your repair request. (Required.)

19. Does anyone in your household belong to the following groups? (Required.)

20. What is your race/ethnicity?