Tenant-Based Rental Assistance Program
Application Instructions

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IMPORTANT:   Incomplete and Unsubmitted applications will be automatically deleted after 30 days of inactivity.

ALL APPLICATIONS MUST INCLUDE THE FOLLOWING:

• COMPLETED & SIGNED Housing Application
• Copy of CURRENT & SIGNED Diagnosis (or ISP or IFSP – if app is submitted via IDD or Early Intervention Supports or Service Coordination):    
  • Diagnosis MUST BE SIGNED BY a Doctor or Licensed Therapist
• Professional release ("ROI") to “SAM, Inc. Housing” 
  • An ROI is NOT REQUIRED if Application is submitted via SAM, INC. Case Management 
• Documentation/Verification of INCOME(s) – for ALL members of the household listed on the Application 
  • SAM Housing Programs REQUIRE AT LEAST ONE SOURCE OF VALID INCOME PER APPLICANT/HOUSEHOLD REQUESTING ASSISTANCE 
  • ALL DOCUMENTATION/VERIFICATION OF INCOME MUST BE CURRENT 
  • ALL MEMBERS LISTED ON THE APPLICATION THAT HAVE INCOME MUST INCLUDE DOCUMENATION OF THAT INCOME 
  • Documentationof eligible income would include, for example:  SS Award Letters, State Supplement/Benefit documentation, Pay Stubs, IRS Tax Documents (MUST BE FOR MOST RECENT REPORTING YEAR), etc. 
  • Documentation of Earned Income (Employment) MUST INCLUDE AT LEAST THREE (3) RECENT AND CURRENT PAY-STUBS 
  • Child Support and/or Food Stamp (SNAP) assistance CANNOT BE INCLUDED as eligible income 
  • Hand-written, “informal” statements / “under-the-table income” and similar such sources which would not be acceptable for tax purposes CANNOT BE INCLUDED as eligible income 
• A DETAILED narrative describing/detailing the Priority Group under which the application is being submitted
  • NARRATIVE MUST BE WRITTEN IN ENGLISH or AN ENGLISH TRANSLATION MUST BE INCLUDED (could be as an attachment) 
• ANY & ALL DOCUMENTATION/VERIFICATION as required, to support the Priority Group under which application is being submitted.  Examples would include (but not be limited to):  
  • Copies of Eviction/Court notices 
  • Copies of Placarded/Coding Violations 
  • Utility statements/shut-off notices 
  • Copies of Housing Authority eligibility documentation 
  • Copies of other notices from landlords/property managers/etc 
  • Any other documentation which verifies and supports the application 
  • If unsure whether a particular document is needed - ERR on the side of MORE is better than less
  • Attach anything which is believed/understood to support the Priority Group under which the application is being submitted 
• 2 signatures are required on the Application - both can be signed directly on the application 
  • Case manager/Treatment Provider submitting Application
  • Applicant (or responsible adult)

ELIGIBILITY REQUIREMENTS FOR OMHSAS / HEALTHCHOICES HOUSING PLAN APPLICATIONS: 

1).  Applicant must be 18 years of age or over

2).  Applicant must have CCBH Medical Assistance coverage

3).  Applicant must have a diagnosis of a current and qualifying Mental Health Disorder, Substance Use Disorder, or co-occurring Mental Health/Substance Use Disorder 

• ANY diagnosable Mental Health Disorder that has resulted in functional impairment will be eligible to apply for assistance through the OMHSAS Housing Plan.  
• The ONLY ineligible Mental Health diagnoses will be those:   
  • that are secondary to Traumatic Brain Injury 
  • A diagnosis of Organic Brain Syndrome
  • V-Code (deferred/unspecified MH diagnosis) diagnoses 

4).  Source(s) of eligible income within the household 

ELIGIBILITY REQUIREMENTS FOR PHARE HOUSING PROGRAMS APPLICATIONS: 

1).  Individual – Adult or Child - receiving MH, D&A, IDD or EI case management or outpatient services 

2).  Diagnosis of a qualifying Mental Health Disorder, Substance Use Disorder, or co-occurring Mental Health/Substance Use Disorder OR participation with IDD Supports Coordination OR participation with Early Intervention Service Coordination  

3).  Source(s) of eligible income within the household 

PRIORITY GROUPS:

1).  SHELTER: At a recognized shelter facility, such as Hope Rescue Mission, Opportunity House, Safe Berks or any other official emergency shelter facility/location

2). STATE HOSPITAL: being discharged from a Psychiatric State Hospital facility (Wernersville, Norristown, etc.)

3).  GROUP HOME, CRR, TRANSITIONAL LIVING:  Includes places such as Wernersville CCC, Threshold CRR, Easy Does It, YMCA programs, Family Promise, Project Transition, etc. 

4). PARTICIPANT IN A BERKS COUNTY-BASED ASSERTIVE COMMUNITY TREATMENT TEAM (ACT) 

5).  YOUTH, AGED 18 OR OVER, TRANSITIONING FROM CYS, JPO PLACEMENT SETTING TO INDEPENDENT LIVING:  one who has left after completing a program of treatment or one who has left on their own without completing treatment

6). BOARDING HOME / ROOMING HOUSE/PERSONAL CARE BOARDING HOME: currently residing in a property operated as a Boarding Home, Rooming House or Personal Care Boarding Home 

7). HOTEL/MOTEL: currently and temporarily residing in a property operated as a hotel or motel – as an alternative to homelessness.  

8). HOMELESS:  living in a place “not meant for human habitation” – examples would be on the street, living in a car, under a bridge, in an abandoned building, on a park bench (this does not include “couch-hopping” with friends and/or family) 

9).  REQUEST FOR UTILITY ASSISTANCE:  in the event LIHEAP and all other resources have already been exhausted 

10). EVICTION DUE TO NON-PAYMENT OF RENT: this is specifically defined as currently paying 50% or more of the total household income toward rent and utilities and facing eviction for non-payment of rent.  In addition to the required attachments for all applications listed on page 1 of this Instruction Sheet, ALL applications applied for under this Priority Group must also include the following:

• A copy of the current and signed lease 
• Documentation of utility costs paid over and above the rent within the past 3 months 
  • Utilities include only electric, gas, oil and/or water
  • the 3 most recent bills/invoices must be attached to the application 
  • A copy of the current, legal and validated Eviction Notice and/or current Order of Possession and/or notice to vacate 

11). AN EVICTION THAT IS NOT THE RESULT OF NON-PAYMENT OF RENT: (examples include):  

• A placarded building
  • a copy (or photo) of the placard must be attached
•  A bank or financial foreclosure on the owner of the building (not tenants)  
• documentation indicating sale or foreclosure must be attached
• A  sheriff/tax sale on the owner of the building (not tenants)
  •  notice of the current sale must be attached
• Sale of the Building to a new owner 
  • Documentation must be included 
• A fire or natural disaster
  • include pictures or copy of fire report as attachment(s)
• A Non-renewal of Lease 
• A copy of the current and signed lease IS REQUIRED FOR THIS PRIORITY GROUP 

12).  ACCEPTANCE INTO SECTION 8 (HOUSING CHOICE VOUCHER)/PUBLIC HOUSING/OTHER SUBSIDIZED HOUSING & REQUESTING ASSISTANCE WITH SECURITY DEPOSIT and UTLITY HOOK-UP 

13).  CURRENTLY IN PERMANENTLY SUBSIDIZED HOUSING (SECTION 8, PUBLIC OR PRIVATE) & FACING IMPENDING EVICTION  

14).  FLEEING DOMESTIC VIOLENCE/DOMESTIC VIOLENCE VICTIM  

15).  UNSTABLE/UNSAFE LIVING SITUATION   

16).  OTHER (MUST BE FULLY DESCRIBED IN NARRATIVE)  

17).  Application submitted SOLEY and ONLY for RUDDEN FAMILY FOUNDATION (RFF) DELIVERY CHARGE ASSISTANCE 

• Separate and additional RFF Application REQUIRED 
• Contact SAM Housing for a copy of the RFF Application
  
  

SUBMISSION OF APPLICATIONS:

PLEASE DO NOT submit ANY application UNTIL IT IS FULLY COMPLETED, WITH ALL REQUIRED SIGNATURES, DOCUMENTATION AND ATTACHMENTS.  Incomplete applications will result in delays and/or possible denial of assistance.  Applications which are incomplete will not be able to be given consideration for assistance eligibility or qualification/need and will be automatically deleted after 30 days.