Franklin Owner-Occupied Rehabilitation Application

Homeowner Application

The purpose of this application is to collect the information needed to determine your eligibility for participation in the OOR program. The information you provide will help ensure that assistance is directed to those who need it most and that all program requirements are met.

To avoid delays in processing your application and to ensure your eligibility, it is essential that you provide complete and accurate information. Any missing or incomplete responses may result in processing delays or disqualification. All submitted information will be verified during an income verification process.

When you have completed your survey, please press DONE so that your responses will be properly saved.

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* 1. Please provide the following contact information

Applicant Name *

Co-Applicant Name

Home Address *

City *

County *

Email Address *

Cell Phone Number *

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* 2. Do you own your home?

Yes

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* 3. Is your home on a permanent foundation?

Yes

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* 4. Do you live within city limits?

Yes

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* 5. Is the address you provided your primary residence?

Yes

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* 6. Do you have a mortgage for the address you provided?

Yes

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* 7. Do you have home insurance?

Yes

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* 8. Are your property taxes up to date?

Yes

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* 9. Is your home located in a floodplain?

Yes

Don't Know

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* 10. What types of home repairs are you requesting financial assistance for?

Roof Repair or Replacement

Heating and Cooling Replacement

Water Heater Replacement

ADA Modifications to the threshold of the home

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* 11. Enter any comments you have about the urgency of your repair request.

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* 12. What is your primary source of income?

Employment (full-time or part-time)

Social Security

Disability Benefits

Retirement Income

Unemployment

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* 13. What is your total annual household income before taxes?

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* 14. How many people live in your home?

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* 15. How many people over the age of 18 live in your home?

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* 16. Please provide the NAMES of everyone living in your home, including yourself.

Person 1

Person 2

Person 3

Person 4

Person 5

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* 17. Please provide the DATES OF BIRTH of everyone living in your home, including yourself.

Person 1

Person 2

Person 3

Person 4

Person 5

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* 18. Please provide the MONTHLY SALARY/WAGES of everyone living in your home, including yourself.

Person 1

Person 2

Person 3

Person 4

Person 5

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* 19. Does anyone in your household belong to the following groups:

Individuals with Disability

Elderly (62+ years or older)

Veterans

Single Parent Head of Household

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* 20. What is your race/ethnicity?

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

By submitting this application, I pledge the following:

· I certify that all information provided in this document is true and accurate to the best of my knowledge.

· I acknowledge that providing incomplete or inaccurate information may result in delays or disqualification from the program.

· I authorize the City of Franklin and its representatives to verify any information contained herein.

· I understand that if I receive assistance, I must comply with all program requirements, including future income verifications and home inspections.

· I understand that I must allow a licensed home inspector to conduct both an initial and final inspection of my home while I am present.

· I acknowledge that I do not have the option to select the contractor assigned to perform the work on my home.

· I understand that radon testing and mitigation are required for this program and will be provided at no cost to the homeowner.