PROGRAM INTAKE FORM
TOWN OF OYSTER BAY U.S. TREASURY EMERGENCY RENTAL ASSISTANCE PROGRAM

For Town of Oyster Bay Residents Only (excluding the City of Glen Cove)

                                                            IMPORTANT NOTICE

 

FUNDING IS LIMITED. ALL AWARDS ARE SUBJECT TO THE AVAILABILITY OF FUNDS. 

 

A REQUEST FOR ASSISTANCE DOES NOT GUARANTEE AN AWARD OR THE PAYMENT OF THE AMOUNT REQUESTED.  A REQUEST FOR ASSISTANCE MAY BE AMENDED, ADJUSTED OR EVEN DENIED, WITHOUT NOTICE, BASED UPON AVAILABLE FUNDING.

Oyster Bay U.S. Treasury Emergency Rental Assistance Program

INTAKE FORM

ONLY 1 INTAKE FORM PER HOUSEHOLD MAY BE SUBMITTED!

Intake forms will be accepted beginning at 9:00 am on September 29, 2022.


Intake forms may only be submitted online.

No Mail-In, Fax or Drop-Off will be accepted

If you have any questions regarding the program or need any assistance, including language assistance, please call LIHP at (631) 435-4710 or email LIHP at OysterBayERAP@lihp.org with any questions. 
You may also  visit the LIHP website at
 https://www.lihp.org/TOBerapintake.html (for English) or https://www.lihp.org/TOBerapintake-SP.html (for Spanish) for more information or contact LIHP’s community partner, Vision Long Island, at the address below.  Please call for an appointment.

Vision Long Island

100 Duffy Avenue

Suite 513

Hicksville, NY 11801

(516) 654-6928

rental@visionlongisland.org

 




Landlord Information


AN ACCURATE EMAIL ADDRESS IS CRITICAL TO REVIEW.  IT IS VITAL THAT YOU CHECK THE EMAIL ADDRESS YOU PROVIDED TO ENSURE IT IS ACCURATE.  YOU CANNOT BE RANKED ON THE WAITLIST FOR REVIEW UNLESS AND UNTIL YOU HAVE PROVIDED LIHP WITH A VALID EMAIL ADDRESS.













AN ACCURATE EMAIL ADDRESS IS CRITICAL TO REVIEW.  IT IS VITAL THAT YOU CHECK THE EMAIL ADDRESS YOU PROVIDED TO ENSURE IT IS ACCURATE.  YOU CANNOT BE RANKED ON THE WAITLIST FOR REVIEW UNLESS AND UNTIL YOU HAVE PROVIDED LIHP WITH A VALID EMAIL ADDRESS.






Tenant Information
















Type of Assistance Requested


Please Note: The City of Glen Cove is not included in this Program

STOP HERE!
It appears you are not qualified for the program.
Please refer back to the Program Guidelines for details.

STOP HERE!
It appears you are not qualified for the program.
Please refer back to the Program Guidelines for details.

STOP HERE!
It appears you are not qualified for the program.
Please refer back to the Program Guidelines for details.

STOP HERE!
It appears you are not qualified for the program.
Please refer back to the Program Guidelines for details.


STOP HERE!
It appears you are not qualified for the program.
Please refer back to the Program Guidelines for details.


Income Limits

An income priority will be provided to households at or under 50% HUD AMI or who have been unemployed for more than 90 days prior to the application
***

YOU MUST ANSWER YES TO AT LEAST ONE OF THE FOLLOWING FOUR QUESTIONS TO BE ELIGIBLE FOR THIS PROGRAM





STOP HERE!
It appears you are not qualified for the program.
                                                 Please refer back to the Program Guidelines for details.                                                                                             

         STOP HERE!
It appears you are not qualified for the program.
                                                   Please refer back to the Program Guidelines for details.                                                                                                     

STOP HERE!
It appears you are not qualified for the program.
                                                 Please refer back to the Program Guidelines for details.                                                                                                      

STOP HERE!
It appears you are not qualified for the program.
                                                  Please refer back to the Program Guidelines for details.                                                                                                     

STOP HERE!
It appears you are not qualified for the program. 
                                                   Please refer back to the Program Guidelines for details.                                                                                                     

STOP HERE!
It appears you are not qualified for the program.
                                                     Please refer back to the Program Guidelines for details.                                                                                                     

DISCLAIMERS:

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:

LIHP 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 law.


LIMITED ENGLISH PROFICIENCY AND ACCOMMODATIONS:

Applications 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.

 


AUTHORIZATION AND CONSENT:

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. 

2. The 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 assistance.

3. A copy of this authorization may be accepted as an original.


PROGRAM GUIDELINES:

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.


ELECTRONIC SIGNATURE:

You 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.

How your heard about this program