This is an attempt to address Pasco County citizens' needs in terms of rental and/or utility assistance.

This is only for Pasco County Residents with a valid Pasco County address. This will not assist with Hotel/Motel Costs.

This program is for those residents that can provide documentation of an income loss due to COVID-19 and are under 80% AMI. Clients that have experienced unemployment and are under 50% AMI will be prioritized.


By completing this portal, there is no guarantee of assistance.

Please answer all of the following questions to be placed in a queue for consideration for assistance. All questions are required. Failure to answer all questions will prevent the Screening from being submitted.

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* 1. Name of the Head of Household Seeking Assistance?

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* 2. What is the Date of Birth of the Head of Household?

Date

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* 3. Contact Phone Number (if you do not have a phone number. please enter "NA").

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* 4. Contact Email Address (if you do not have an email address. please enter "NA").

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* 5. Alternate Contact Method

If someone is filling this out for you, please enter their information as they would be your point of contact.

Please note that if both a Contact Phone Number and Email Address are missing, it will be very difficult for us to contact you.

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* 6. If you are working with another agency for this assistance, please enter the name of that agency here.

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* 7. Total Number of People in the Household.

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* 8. Total Number of Children in the Household under 18 years of age.

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* 9. Are you, or anyone in your household, a Veteran?

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* 10. Have you or someone in your household experienced homelessness in the last three (3) years?

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* 11. Does someone in your household fall into a High Risk Category for COVID-19, including, but not limited to, aged 65 and older, high medical need, etc.

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* 12. Street Address of Property. Please Note: Address must be within Pasco County.

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* 13. Do you have a current lease?

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* 14. What assistance are you pursuing?

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* 15. Monthly Rent Amount.

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* 16. How many months behind on rent or utilities are you?

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* 17. Is your landlord pursuing or threatening an eviction?

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* 18. Have you faced an eviction in the past at this address or any other address?

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* 19. What is your household's monthly income?

Income Information: Annual family income is required to determine eligibility for public services funded with federal Consolidated Appropriation Act of 2021 money. Income is defined as the total gross income for of all family and non-family members 18+ years old living within the household. All sources of income must be counted from all persons in the household, to include, but is not limited to gross income from employment, net income from self-employment, rental income, interest and dividends, Social Security, annuities, retirement funds, pensions, unemployment benefits, disability benefits, TANF, public assistance, alimony, child support, cash assistance, etc. Food Stamps are not considered income.

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* 20. For the number of people in your household (including children), where does your household fall in regards to Area Medium Income (AMI)? Please see chart below for information.

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Maximum Area Median Income (April 2021)

Maximum Area Median Income (April 2021)

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* 21. Which employment statement best describes your situation? Please note: Documentation will be Required.

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* 22. Have you had any income loss due to COVID-19?

For Example Job Loss, Decrease in Hours of Work, Quarantining, Furlough, Loss of Child Care, Daycare/School closure, etc. If unsure, please explain the situation. Please note: Documentation will be Required.

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* 23. After this screening, a service provider will contact you for all documentation that is required for approval of assistance. The following documentation may be asked for. Please have it ready or available upon contact from the agency. A delay in providing documentation may delay or deny assistance.

  • Driver's License/Identification for all members of household 18 and older
  • Identification for Household Members under 18 years old (Birth Certificates, shot record, or school ID)
  • Proof of Income or Loss of Income
  • Employment/Unemployment Information
  • Full Copy of Signed Lease
  • Utility Bill in Household Member's Name
  • 3-Day Notice and/or Eviction Notice

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* 24. By checking this box, you affirm that all information submitted is accurate and honest. If the information has been found to be false, a delay or denial of assistance could occur.

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* 25. This Identification Portal is exactly that. It is a way of identifying potential clients within the Pasco County system. By completing this Portal, you understand that there is no guarantee of service or assistance. Service providers will make every attempt to provide assistance but it depends on many factors including, but not limited to, requirements of grants/funding streams, availability of funds, etc.

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* 26. How were you referred to this Program?

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