CHN Housing Partners Lead Safe Non-Profit Incentive Application

Page 1 - Welcome

Welcome to CHN Housing Partners Online Application for Lead Safe Non-Profit Incentives 


Who is eligible to receive non-profit incentives?
Non-Profit Affordable Housing Providers who have received either their lead certificate or lead exemption from the City of Cleveland Department of Building and Housing, are eligible to apply for an incentive. 
  • Residential property must be built before 1978 and located in the City of Cleveland
  • Owner must be current on all property taxes or have a payment plan in place
  • Owner must have current rental registration issued by the City of Cleveland Department of Building and Housing

Incentive Amounts
  • $750 per lead certificate
  • $1,000 per lead exemption           

You will be asked to provide copies of the following via upload at the end of this application: 

  1. Completed W-9
  2. Proof of 501(c)3 status
  3. Current City of Cleveland Rental Registration for property
  4. Proof of current tax balance / proof of current payment plan
  5. Lead Certification letter or lead exemption letter

For your convenience, CHN Housing Partners allows the use of e-signatures with this online form. You will be prompted to enter your name at the end of this form prior to submitting to give consent. If you have questions or need further assistance, please call our hotline at 844-614-LEAD (5323)
.
Online Application Guidelines
To apply for programs with CHN Housing Partners, you must complete an application with us, along with providing documents to verify the information submitted. Each participant in this program is required to provide their annual income level and establish eligibility for this program and to verify race/ethnicity for data collection purposes only. We have split this into the following sections:

  1. Non-profit information
  2. Property or Unit information
  3. Upload documents

You may encounter a slow system or downtime due to a high volume of traffic on the site. Please use the "Save my progress and resume later" feature located at the top of the form OFTEN to avoid losing any information. (This form is powered by FormAssembly.)



Click Next Page to Continue


Page 2 - Applicant and Property Owner Details


Applicant Property Owner Details


In this section, please enter your most up to date contact information.

CHN Housing Partners (CHN) 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.
 
CHN's Privacy Policy
PLEASE PREPARE FOR UPLOAD: Completed & Signed IRS form W-9
Property Owner Information













Need help? Call out hotline at 844-614-LEAD (5323)


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.


Page 3 - Unit Details


Unit Details


We will be asking more specific questions about your subject property here.

You must submit one application for each unit.
Unit Details











Need help? Call our hotline at 844-614-LEAD (5323)

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.

Page 4 - File Upload


Upload Documents


Please use this page to upload documents that support your application. You can attach electronically downloaded documents, use a scanner, or take pictures or screenshots of your documents with your phone.

You can upload multiple files per section by using the "Add another ..." link. There is a limitation of 20 files per form. If you have more than 20 files to upload, please email them to Lead@chnhousingpartners.org

Gather the required documents:
  1. Completed W-9
  2. Proof of 501(c)3 status
  3. Current City of Cleveland Rental Registration for property
  4. Proof of current tax balance / proof of current payment plan
  5. Lead Certification letter or lead exemption letter

Complete applications with all required supporting documents will be processed faster - please upload as much as you are able to and ensure you have documents for each section!  








Need help? Call out hotline at 844-614-LEAD (5323)

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.

Page 5 - Acknowledgement


Acknowledgement & Submit

Lead Services Program

Terms of Service


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

I attest and acknowledge that our non-profit has not received any funding from the Lead Safe Home Fund (Lead Safe Resource Center or CHN Housing Partners Lead Services) to make this property / unit lead safe.

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.