The submission of an Intake Form does not constitute acceptance,
approval of minimum qualification criteria, or a guarantee of a program award. Any award is subject to funding availability. Submission of the Intake Form is only the first step and places your name on the waitlist. Additional documentation is required to be submitted and reviewed for eligibility. You will be contacted with information regarding the next steps. Please consult the Program
Guidelines for all Program requirements.
Program Guidelines are available on the website page for the Oyster Bay Emergency
Rental Assistance program at
https://www.lihp.org/TOBerapintake.html (English) and https://www.lihp.org/TOBerapintake-SP.html (Spanish)
VIOLATION OF FEDERAL LAW:
THE INFORMATION PROVIDED MUST BE TRUE AND CORRECT. THE INFORMATION PROVIDED IS SUBJECT TO VERIFICATION BY LIHP, THE TOWN, THE U.S. TREASURY, HUD AND/OR ANY AGENCY OF THE U.S. GOVERNMENT. BY SUBMITTING AN APPLICATION AND SUPPORTING DOCUMENTS, THE APPLICANT ACKNOWLEDGES AND UNDERSTANDS THAT TITLE 18 OF THE UNITED STATES CODE SECTION 1001: (1) MAKES IT A VIOLATION OF FEDERAL LAW FOR A PERSON TO KNOWINGLY AND WILLFULLY (A) FALSIFY, CONCEAL, OR COVER-UP A MATERIAL FACT; (B) MAKE ANY MATERIALLY FALSE, FICTITIOUS, OR FRAUDULENT STATEMENT OR REPRESENTATION; OR (C) MAKE OR USE ANY FALSE WRITING OR DOCUMENT KNOWING IT CONTAINS A MATERIALLY FALSE, FICTITIOUS OR FRAUDULENT STATEMENT OR REPRESENTATION, TO ANY BRANCH OF THE UNITED STATES GOVERNMENT; AND (2) REQUIRES A FINE, IMPRISONMENT FOR NOT MORE THAN FIVE (5) YEARS, OR BOTH, WHICH MAY BE RULED A FELONY, FOR ANY VIOLATION OF SUCH SECTION.
FAIR HOUSING AND NON-DISCRIMINATION:
is committed to furthering and promoting fair housing, equal opportunity, and
non-discrimination in compliance with all federal, state and local laws,
including, but not limited to, the Fair Housing Act, as amended by the Housing
for Older Americans Act, the Americans with Disabilities Act, the Civil Rights
Act, and the New York State Human Rights Law.
LIHP will have staff available to assist with the Application, and
answer questions about eligibility requirements. In furtherance of this policy, LIHP will not
discriminate on the basis of race, creed, color, national or ethnic origin,
sex, sexual orientation, gender identity, familial status, source of income,
religion, disability, veterans’ status, age, or any other basis prohibited by
LIMITED ENGLISH PROFICIENCY AND
and Program Guidelines are available in English and Spanish and will be made
available in other languages as requested.
LIHP will take reasonable steps to ensure that persons
with Limited English Proficiency (LEP) and persons, who need assistance or who
have a limited ability to speak, read, or write English, will have meaningful
access and an equal opportunity to participate in the Program. Interpreters, translators and other aids
needed to comply with this policy shall be provided as reasonably necessary.
The undersigned is applying to the Town
of Oyster Bay U.S. Treasury Rental Assistance Program (the “Program”). The Program is administered by the Long
Island Housing Partnership (LIHP) for the Town of Oyster Bay (the “Town”). To be considered for the Program and in
consideration of payments that may be received pursuant to the Program, the
undersigned agrees as follows:
1. LIHP and/or the Town is hereby authorized and permitted to disclose
and verify any and all information contained in my application and in other
documents submitted for the Program, to or with any third party, including, but
not limited to, the Town, the U.S. Treasury, any agency or representative of
the U.S. government, any representative or agency of New York State, my
landlord or property management company,
my utility or home energy companies, any member of my household, my
tenants, any member of the tenant
household, or any municipal agency or other entity providing rental or utility
assistance (a “Third Party”), as applicable, either during the process or as
part of the ongoing Program compliance. Without limiting the foregoing, LIHP
and/or the Town may share information regarding my application and Program
award, if applicable, with any other Third Party and are authorized to obtain
information on me from any such Third Party regarding my application with such
Third Party and my eligibility or award from such Third Party for rental or utility assistance.
undersigned authorizes any such Third
Party to provide to LIHP, the Town, the U.S. Treasury, any agency or representative of the U.S.
government, or any representative or agency of New York State, any and all information and documentation that
they may request, including but not limited to, information and documentation
on rent, utilities, payment history, employment history and income; bank,
money-market, and similar accounts balances, credit history, copies of income tax returns, and
application, status and award information regarding any rental or utilities
copy of this authorization may be accepted as an original.
By signing below, I agree to participate in the Town of Oyster Bay U.S. Treasury Emergency Rental Assistance Program and confirm that I have read the Program Guidelines and agree to all the terms and conditions contained therein.
agree, and it is your intent, to sign this record/document by inserting/typing
your name below and by electronically submitting this record/document.
You understand that by signing and submitting this record/document in this
fashion, you are affirming the truth of the statements contained therein and
that it is the legal equivalent of having placed your handwritten signature on
the submitted record/document and all parties may rely on same.