Seymour Owner-Occupied Rehabilitation Application

Homeowner Application

The purpose of this application is for the city's grant administrator, Administrative Resources association (ARa), to get in touch with you about completing the income verification process for participation in the Seymour OOR Program.

Once this first step is complete, a licensed home inspector will visit your home and assess your eligible repair requests, which include: Roof Repairs or Replacements, HVAC Replacements, Water Heater Replacements, and ADA Accessibility Modifications to your front door. Below is an overview of the program:

1. Income Verification
2. Initial Home Inspection
3. Contractor Selection
4. Construction
5. Final Home Inspection
6. Lien & Restrictive Covenant

To learn more about the OOR Program and how each step of the process works, please CLICK HERE to access the post-award FAQ.

When you have provided your information, please press DONE so that your responses will be properly saved.

Question Title

* 1. Please provide the following contact information

Applicant Name *

Co-Applicant Name

Home Address *

City *

County *

Email Address *

Cell Phone Number *

Question Title

* 2. Do you own your home?

Yes

Question Title

* 3. Is your home on a permanent foundation?

Yes

Question Title

* 4. Do you live within city limits?

Yes

Question Title

* 5. Is the address you provided your primary residence?

Yes

Question Title

* 6. Do you have a mortgage for the address you provided?

Yes

Question Title

* 7. Do you have home insurance?

Yes

Question Title

* 8. Are your property taxes up to date?

Yes

Question Title

* 9. Is your home located in a floodplain?

Yes

Don't Know

Question Title

* 10. What types of home repairs are you requesting financial assistance for?

Roof Repair or Replacement

Heating and Cooling Replacement

Water Heater Replacement

ADA Modifications to the threshold of the home

Question Title

* 11. Enter any comments you have about the urgency of your repair request.

Question Title

* 12. What is your primary source of income?

Employment (full-time or part-time)

Social Security

Disability Benefits

Retirement Income

Unemployment

Question Title

* 13. What is your total annual household income before taxes?

Question Title

* 14. How many people live in your home?

Question Title

* 15. How many people over the age of 18 live in your home?

Question Title

* 16. Please provide the NAMES of everyone living in your home, including yourself.

Person 1

Person 2

Person 3

Person 4

Person 5

Question Title

* 17. Please provide the DATES OF BIRTH of everyone living in your home, including yourself.

Person 1

Person 2

Person 3

Person 4

Person 5

Question Title

* 18. Please provide the MONTHLY SALARY/WAGES of everyone living in your home, including yourself.

Person 1

Person 2

Person 3

Person 4

Person 5

Question Title

* 19. Does anyone in your household belong to the following groups:

Individuals with Disability

Elderly (62+ years or older)

Veterans

Single Parent Head of Household

Question Title

* 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

By submitting this application, I pledge the following:

· I certify that all information provided in this document is true and accurate to the best of my knowledge.

· I acknowledge that providing incomplete or inaccurate information may result in delays or disqualification from the program.

· I authorize the City of Greensburg and its representatives to verify any information contained herein.

· I understand that if I receive assistance, I must comply with all program requirements, including future income verifications and home inspections.

· I understand that I must allow a licensed home inspector to conduct both an initial and final inspection of my home while I am present.

· I acknowledge that I do not have the option to select the contractor assigned to perform the work on my home.

· I understand that radon testing and mitigation are required for this program and will be provided at no cost to the homeowner.