Private Security Camera Voucher Program Application

Program Description
The Private Security Camera Voucher Program identifies DC residents that are eligible to receive a private security camera system without cost. These residents are either an owner or tenant of a property that is used as a residence (the Applicant) and who is receiving public assistance under the District of Columbia Public Assistance Act of 1982, effective April 6, 1982 (D.C. Law 4-101; D.C. Official Code § 4-201.01 et seq.). Upon determining eligibility, a third party entity will arrange time with the applicant to install the camera system. Please answer the following questions and if you have additional questions, please contact the program at security.cameras@dc.gov or 202-727-5124.

Requirements

An Applicant must live in the District of Columbia and provide proof of current receipt of public assistance pursuant to the District of Columbia Public Assistance Act of 1982, effective April 6, 1982 (D.C. Law 4-101; § 4-201.01 et seq.), under one of the following programs:
(1)        General Assistance for Children;
(2)        Emergency Shelter Family Services;
(3)        Temporary Assistance for Needy Families;
(4)        Program on Work, Employment, and Responsibility; or
(5)        Interim Disability Assistance.

(Note: Residents who only receive Supplemental Nutrition Assistance Program (SNAP) benefits are not eligible for this program.)

Restrictions

Applicants must be an owner or tenant of a residential property located in the District of Columbia. Applicants who are tenants must provide documentation from the property owner approving the installation of the security camera system on the property.

Only one (1) security camera system per property address shall be eligible for this program. Residents of properties owned by the District of Columbia Housing Authority shall not be eligible for a voucher.

By participating in this program, the Applicant acknowledges that he or she will not use the security camera for any unlawful or harassing purposes and will comply with all applicable building requirements.

Question Title

* 1. Applicant Information

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. Do you have Wireless Internet Access (i.e. Wifi)?

Yes

Question Title

* 3. Are you the property owner or a tenant?

Property Owner

Tenant

Question Title

* 4. Ward? (To find your Ward number, please visit http://geospatial.dcgis.dc.gov/PSAFinder/).

Question Title

* 5. PSA?
Priority PSAs include: 104, 105, 107, 108, 202, 207, 208, 302, 303, 305, 402, 403, 405, 409, all 500s, 602, 603, 604, 608, and all 700s. Until September 1, applications will be accepted only from the listed PSAs. To find your PSA number, please visit http://geospatial.dcgis.dc.gov/PSAFinder.

Question Title

* 6. Proof of Public Assistance

Please upload proof that you receive public assistance from the eligible programs. These include 1) General Assistance for Children; 2)Emergency Shelter Family Services; 3) Temporary Assistance for Needy Families; 4)Program on Work, Employment, and Responsibility; or 5) Interim Disability Assistance.

DOCX, DOC, JPG, GIF, JPEG, PDF, PNG file types only.

Choose File

Question Title

* 7. Permission from Property Owner (if applicable)

Please upload authorization from the property owner to install cameras if you are a tenant.

DOCX, DOC, JPG, GIF, JPEG, PDF, PNG file types only.

Choose File

Question Title

* 8. Do you live in a property owned by the DC Housing Authority?

Yes

Question Title

* 9. WHEREAS, a voucher will be issued through the Neighborhood Engagement Achieves Results Amendment Act of 2016 (“Act”), which is funded by District taxes to APPLICANT by the Office of Victim Services and Justice Grants (OVSJG), the Office charged with and empowered to carry out the responsibilities imposed by the aforesaid law; and NOW, THEREFORE, I the APPLICANT agree to the following.
· The APPLICANT is the property owner, or if not, has received consent of the property owner to install the camera system.
· The APPLICANT must maintain all financial data applicable to the voucher award and voucher agreement for a period not less than three (3) years from date of the issuance of the voucher.
· The APPLICANT acknowledges that he or she will not use the security camera for any unlawful or harassing purposes and will comply with all applicable building requirements.
· The APPLICANT agrees to indemnify, defend and hold harmless the Government of the District of Columbia and its authorized officers, employees, agents and volunteers from any and all claims, actions, losses, damages, and/or liability arising out of this voucher from any cause whatsoever, including the acts, errors or omissions of any person and for any costs or expenses incurred by the District on account of any claim therefore, except where such indemnification is prohibited by law.
· The APPLICANT may publish or announce the results of voucher activity provided that there is prior review and approval by OVSJG and provided that any publication (written, visual, or sound) contains an acknowledgment of OVSJG.
· The voucher program coordinator, or designee, may make at least one on-site visit to the address of the APPLICANT.

I agree.

Applicant Name: