Seymour Owner-Occupied Rehabilitation Program

Online Application

The City of Seymour is considering applying for the Office of Community and Rural Affairs (OCRA) Owner-Occupied Rehabilitation Program, funded by the Department of Housing and Urban Development's Community Development Block Grant Program. We would like to gauge public interest and determine the needs of our residents. Your responses will help us understand the community's needs and support our application. Thank you for your participation!

Hard copies of this preliminary application are available at Seymour City Hall located at 301-309 N Chesnut Street, Seymour, IN 47274 Monday-Friday 8:00 am - 4:30 pm.

A public hearing will be held Monday, August 12th at 5:00 p.m. at the Jackson County Public Library (303 W Second St., Seymour, IN 47274) in Meeting Room A.

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* 1. Please leave your contact information. As part of the city's application to the Community Development Block Grant Program, this information will help the city create a list of potential applicants that will be contact if the city receives funding.

Name

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

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* 2. What is your date of birth?

Date

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* 3. What is your race or ethnicity? This information is required by HUD for statistical purposes only.

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Another race

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* 4. What is your gender? This information is required by HUD for statistical reporting purposes only.

Female

Male

Other (specify)

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* 5. Do you own your home?

Yes

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* 6. If you own your home, do you pay for home insurance?

Yes

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* 7. If you own your home, did you pay your most recent property taxes on-time?

Yes

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* 8. If you own your home, do you have an active mortgage?

Yes

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* 9. What year was your home built?

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* 10. Is your home on a permanent foundation?

Yes

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* 11. What is your occupation?

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* 12. Please provide us with the following information regarding your place of employment.

Company Name

Address

City/Town

State/Province

ZIP/Postal Code

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* 13. What is your Gross Monthly Salary/Wages (before deductions and taxes)?

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* 14. What is your Net Monthly Salary/Wages (take home pay per month)?

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* 15. How many people currently live in your household?

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* 16. Please provide us with the name(s) of everyone currently living in your home, not including yourself.

Person 1

Person 2

Person 3

Person 4

Person 5

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* 17. Please provide us with the date(s) of birth for everyone currently living in your home, not including yourself.

Person 1

Date

Person 2

Date

Person 3

Date

Person 4

Date

Person 5

Date

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* 18. Please list the total monthly income(s) for each person currently living in your home, not including yourself.

Person 1

Person 2

Person 3

Person 4

Person 5

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* 19. Do you have any other sources of income that were not addressed in the previous questions?

Yes

Other (please specify)

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* 20. Does your annual household income fall BELOW any of the following HUD Income Limits for Jackson County?

$47,150

$53,900

$60,650

$67,350

$72,350

$78,150

$83,550

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* 21. Do you own any other real estate?

Yes

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* 22. Which of the following home repairs does your household need?

Roof repair or replacement

ADA accessibility modifications up to the threshold of the home

Heating and cooling replacement

Selecting lighting features and electrical upgrades

Water heater replacement

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* 23. Do you or anyone in your household belong to any of the following groups? Please check all that apply.

Individuals with disabilities

Elderly (65+ years old)

Veterans

Single parent head of household

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* 24. Do you have any specific concerns or needs regarding your home that you would like addressed?

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* 25. Do you support the City of Seymour's application to OCRA's Owner-Occupied Rehabilitation Grant Program?

Yes