Detroit Housing Network: Housing Service Intake Form

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Hello

Welcome to the Detroit Housing Network's Housing Service Intake Form. This intake form is used to access a wide variety of housing services provided by a network of housing agencies called the Detroit Housing Network.


Follow the instructions below to complete this intake form and a Member of the Detroit Housing Network will work with you to access the housing services you are interested in.


Intake Form Instructions​

  1. Choose the housing services that you are interested in. ​

    •      If you need support navigating your options, we recommend selecting one-on-one housing counseling on page four of the intake form.​

    •      If you are interested in registering for a group educational workshop, select group educational workshops on page two of this intake form. You will then register for the workshop you are interested in on page three.

    •     If the service you are interested in requires an application, a DHN Member will use the information you submit from this intake form to generate a service application. A DHN Member will then submit your service application to the service provider and work with you to navigate your next steps. After your service application has been submitted to the service provider, you will begin working with the service provider and communicating with them directly for further updates on your service application.


  2. Tell us about your home. ​

    •      You will be asked to upload several documents related to you and your home. Be prepared to upload documents such as your State issued ID, proof of income, utility statements, mortgage statement and others. ​

    •      If you are using a desktop computer, you will be able to upload documents in the following file formats: JPG, PNG or PDF. ​

    •     This intake form is mobile-friendly. If you are using a mobile device, you will be able to use your mobile device's camera to upload photos of your documents as you fill out the form. If you are less comfortable using technology, we recommend completing this intake form with your mobile device for ease of uploading documents.

  3. Submit your intake form and a Detroit Housing Network Member will reach out to you via email in two-to-three business days. ​

Frequently Asked Questions 

  1. What do I do if I need support completing this intake form?

    • 
       Reach out to the Detroit Housing Network Member that serves your neighborhood. A complete list of Detroit Housing Network Members can be found DetroitHousingNetwork.org. DHN Members are available over the phone and in-person, however, it is recommended that you call DHN Members before stopping by their location.

  2. I don't know if I've submitted this intake form before. Should I submit another one?

    •     No. Email the Detroit Housing Network at DHN@CHNHousingPartners.org to find out if you've submitted this intake form before. 

  3. I've already submitted my intake form and no one has contacted me. Who can I contact for an update on my intake form?

    •     If it has been more than three business days since you submitted your intake form, contact the Detroit Housing Network at DHN@CHNHousingPartners.org for an update on its status.


Continue onto the next page of the form.

Please contact the Detroit Housing Network before completing an intake form to determine if you need to complete another intake form: DHN@chnhousingpartners.org
Housing Programs and Other Services
Which services are you interested in? (Check all that apply)

Housing Counseling and Education

One-on-one housing counseling is often the first step for clients who need support navigating their housing goals. Our HUD-certified housing counselors meet one-on-one with clients to understand their situation and develop an action plan and budget that empower them to reach their housing goals.

Our group educational opportunities are classroom-like settings that allow​ clients to learn more about housing topics from a HUD-certified housing counselor. Our Members offer online and in-person workshops on variety of topics that empower clients to improve their current housing situation or access new housing opportunities.  ​ ​                                                                                                                                    

Housing Programs and Products

Home repair and maintenance services provide pathways for homeowners to invest in and repair their homes. Home repairs can decrease your energy bills, provide a healthier living environment and raise property values for you and the generations that follow. 



If the service you are interested in requires an application, a DHN Member will use the information you submit from this intake form to generate a service application. A DHN Member will then submit your service application to the service provider and work with you to navigate your next steps. The Detroit Housing Network acts as an intermediary between you and the organization that provides the service you are interested in. The Detroit Housing Network and its Members are not responsible for the approval, denial or other potential determination of your service application.

Register for a group educational workshop
Available Workshops for the next 30 days are displayed below

Group Education








Group Education








Group Education








Group Education








Group Education








Group Education








Applicant and Co-Applicant Details

Applicant Information
In this section, please enter your most up-to-date contact information and demographic information.

Detroit Housing Network (DHN) is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all personal information shared verbally and/or in writing will be managed within ethical and legal consideration. Additionally, we want you to understand how we use the personal information we collect. Please carefully review this notice as it describes our policy regarding the collection and disclosure of your nonpublic, personal information.
 
DHN's Privacy Policy

The Applicant (and Co-Applicant, if applicable) should be an adult member of your household that will be able to represent, provide information for, and make decisions on behalf of your household. 



Please enter in the format ##########.

Please enter in the format ##########.





Unit number or second address line



Enter date in MM/DD/YYYY format










Please enter in the format #########.










Co-Applicant Information



Please enter in the format ##########.



Enter date in MM/DD/YYYY format








Please enter in the format #########.






Required Documents


Home Repair Documents


If you have dependents or visiting children:


If you own your home:



If you are self-employed:



Household Information


Please enter additional members who reside in your household (i.e. children, dependents, other family members, etc.). Use the "Add Additional Household Member" link to add as many as you need. Please enter all household members including ALL CHILDREN. Do not include you or the co-applicant.

You do NOT need to re-enter your own information here.


Household Member Details



Enter date in MM/DD/YYYY format

Please enter in the format #########.




















Housing and Utilities


Property Tax Information
We are collecting information about your property taxes because we know many residents have been impacted by foreclosure. We may use this information to connect you to a property tax program.





Home Repair Information









Hold down Control key to select more than one.

Ownership Information


Rental Information



Please enter in the format ##########

Please enter in the format ##########










Utility Information
This information will help us to determine whether you may be eligible to receive assistance or enroll in utility related programs.












Financial Information: Please provide detail on Assets, Debts, and Income

Assets
Please enter all liquid Assets you have control over for all household members over the age of 18. Liquid assets are cash on hand or assets in any other form that can be converted to cash within 20 days (SSA.gov)

Asset types include: Bank Accounts - Savings and/or Checking, Investment Accounts, Retirement, Certificates of Deposit, Cash on Hand, Pre-paid Debit Cards, Health Savings Accounts, Life Insurance Cash Value

To add an additional asset, select "Add Another Asset" (blue link in the bottom right)


$
Debts

To add an additional Debt, select "Add Another Debt" (blue link in the bottom right)


$
Income

To add another income record, select "Add Another Income" (blue link in the bottom right)


$

COVID-19 Housing Stability Assessment





Acknowledgement and Completion

I/we certify that all provided information is correct to the best of my knowledge and have received a copy of DHN's Privacy Policy. I/we authorize DHN Housing Network to verify all information contained in this online form.

By typing my full name below, I hereby authorize DHN to release nonpublic personal information it obtains about me to any third parties necessary to provide me with the services I requested. I acknowledge that I have read and understand the above privacy practices. I understand I will receive a copy of all information submitted at the email address I provided on Page 2, "Applicant E-mail Address".

WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.
Home Repair 
Authorization to Release Information
The Applicant(s) gives permission to the Intake Center to release the City of Detroit Single Family Home Repair Programs Application and supporting documentation to the CITY/LISC Detroit/Lender for the purposes of: 1) Obtaining a credit report in my name; 2) Verifying my income, asset and employment information; 3) Verifying any and all other information necessary to establish the Applicant(s) eligibility to receive assistance through the City of Detroit Single Family Home Repair Programs. The Applicant(s) understand that the information obtained will remain confidential and will be used solely for the purpose of determining eligibility to receive home repair assistance.

Notice of Non-Discrimination

The City of Detroit does not discriminate on the basis of age, color, creed, handicap, national origin, race, sex or sexual orientation. Persons or groups with discrimination complaints may file those complaints with the City of Detroit Human Rights Department, 2 Woodward Avenue, Suite 1026, Detroit, Michigan, 48226.

PENALTY FOR FALSE OR FRAUDULENT STATEMENT

U.S.C. Title 18, Sec. 1001, provides: “Whosoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies or make any false, contain any false, fictitious or fraudulent statements or
representation, makes or uses any false writing response or document knowing the same to contain any false , fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both.” The undersigned certifies under penalty of law that all statements made in this intake/application form and supporting documents are true and accurate, correct and complete. If any of the information provided by the CLIENT(s) is untrue, inaccurate or incomplete, regardless of when this is discovered by the City, the City may, in its sole discretion, immediately terminate the CLIENT(s)’s participation in the Loan Program without liability.

Right now or any time in the past 12 months, I, an immediate family member, or business associate has been employee, agent, consultant, elected, or appointed official of the City of Detroit.