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Step One

City of Dubuque - Housing & Community Development Department
Please answer the following questions after viewing the Housing Choice Voucher Program's online briefing.
Name:*
Email Address:
Phone Number:
Please select the Caseworker's name in which you received your paperwork:*
You may file discrimination complaints:*
1. With HUD
2. With the City of Dubuque Human Rights Department
3. With HUD & the City of Dubuque Human Rights Department
4. None of the above
Family responsibilities include:*
1. Providing true & complete information
2. Taking care of the rental unit
3. Complying with the terms of the lease, your family obligations & the Tenant Certification policies
4. All of the above
Landlords can ask the Housing Authority for all of the following information except:*
1. Who is authorized to be in the household
2. Source and amount of income
3. Current & previous addresses listed in your file
4. Tenancy history (if documented)
Family changes that must be reported to your caseworker in writing are:*
1. Birth, adoption, or court awarded custody of a child
2. Any family member's absence from the unit for more than 2 weeks
3. Changes of income
4. All of the above
It is ok for others that don't live with you to use your address.*
1. True
2. False
The unit you receive assistance to pay for must be your only residence.*
1. True
2. False
You do not need to notify your caseworker when you plan to move.*
1. True
2. False
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Step Two

Tenant Certification and Family Obligations
TENANT CERTIFICATION/FAMILY OBLIGATIONS
Read the tenant certification/family obligations below. All household members 18 and over are required to sign on the back.
1. The family must report all income from all sources for the entire year on their annual reexamination forms. Remember income for all household members must be reported.
Decrease in Income: If you want your share of rent decreased you must report the change in writing by completing an Interim Change Report and submitting verification of all changes – the decrease and any increases since the last income change. If all required documentation is received after the 20^th of the month but prior to the last business day of the month, the change will be effective the 1^st of the following month but may require a retroactive payment to the Landlord.
1. Household composition:
  1. Adding Children: Birth, adoption, or court-awarded custody of a child must be reported within 30 days. Housing staff will send you the required forms and a list of required documents necessary to add the minor.
1. Adding an Adult: You must request written approval first from the Landlord before any adult is added to the household. Once Housing staff receives the written permission from the landlord stating first and last name of the person(s) they are approving, you will be sent the necessary paperwork to complete and a list of documents that must be provided. They cannot stay in the unit until final permission has been granted by Housing staff.
1. Removing a Household Member: You must submit written notice that the person no longer lives in the unit and provide documentation of where that person is now living within 30 days.
1. Absence from the unit:
  1. If any family member is absent from the unit for more than two (2) weeks but less than 30 days, you must provide written notice to your caseworker.
  2. Any absence for more than 30 consecutive days is only allowed for physician-approved medical reasons. However, the participant cannot be absent from the assisted unit for more than 180 consecutive calendar days.
1. You are allowed to have guests and visitors. Those who stay more than 15 days in a row or 30 days total within a 12 month period are not considered a guest/visitor and should be added to your household.
1. The assisted housing unit must be the only residence for all authorized household members.
1. You cannot use any other address for any purpose such as employment, benefits, driver’s license, etc.
1. No one else is allowed to use your address for any purpose such as mail, registering vehicles, court system, etc.
Use of the assisted unit’s address by any person other than those approved by the Housing staff may be used as evidence that the person is living in the unit as an unauthorized member resulting in the termination of the participant family.
1. Under no circumstances shall an assisted housing unit be used for places of furlough for anyone that is incarcerated or on leave from a halfway house.
9.The family must have all utility services that the family is responsible to pay in the family’s own name and pay their utilities. The gas, water, and electric must remain in service at all times.
1. Any relationship between the participant and the owner or their families must be disclosed to Housing staff. HUD has restrictions on renting from certain family members which may include in-laws and step-(parents, brother, sister, etc.).
1. You cannot move during the initial 12-month term (first year) of the lease.
1. The family must notify the landlord in writing and provide Housing staff with a copy before moving from the unit.
1. No family member shall engage in drug-related or violent criminal activity.
1. Family must not commit any serious or repeated violation of the lease.
1. Family must not damage the unit or premises (other than damage from ordinary wear and tear) or permit any guest to damage the unit or premises.
1. Family must not sublease or let the unit or assign the lease or transfer the unit.
1. School aged children must be enrolled in the Dubuque Community Public or Parochial Schools or must have an approved open enrollment, or an approved Home Schooling/E-Learning enrollment.
1. Additional State supported assistance including but not limited to SNAP, Medicare/Medicaid, FIP, etc, must be provided by Iowa. Residents who have moved to Iowa from another state must end benefits in previous State and apply for benefits in Iowa within 30 days of new admission.
1. No family member shall engage in any pattern of illegal drug use or alcohol abuse that interferes with the health, safety, or right to peaceful enjoyment by other neighbors in the dwelling unit or on the premises.
1. Deferred judgments shall constitute a guilty conviction.
1. All information provided must be true and complete.
1. No one shall misrepresent information by failing to report, omitting information, report incorrect or incomplete information. No one shall commit fraud.
I (We) understand my (our) family must follow the rules which are listed above in order to continue participation in the Section 8 Assisted Housing Program. Failure to abide by these rules shall be grounds for termination of assistance; however, exceptions may be granted on a case-by-case basis with written approval from your caseworker.
Signature of Head Household*
Date*
Other Household Adults
Date:
Other Household Adults
Date:
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Step Three

BRIEFING CERTIFICATION
Signature of Head of Household*
Date:*
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Step Four

Family Self Sufficiency Program*
Please select one:
1. YES! I am interested in participating in the FSS Program
1. No. I do not wish to participate at this time
Resident Advisory Board*
Please select one:
1. Yes, I'm interested in being notified of the quarterly meetings
1. No, I'm not interested
Dubuque Resources*
Please select one:
1. I'm familiar with the resources in Dubuque
1. I'm NOT familiar with the resources in Dubuque

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