4350.3 REV-1

OWNER’S NOTICE #1

Dear Applicant:

Section 214 of the Housing and Community Development Act of 1980, as amended, prohibits the Secretary of HUD from making financial assistance available to persons other than U.S. citizens or nationals, or certain categories of eligible noncitizens, in the following HUD programs:

  1. a. Section 8 Housing Assistance Payments programs;
  2. b. Section 236 of the National Housing Act including Rental Assistance Payment (RAP); and
  3. c. Section 101/Rent Supplement Program.

You have applied, or are applying for, assistance under one of these programs; therefore, you are required to declare U.S. Citizenship or submit evidence of eligible immigration status for each of your family members for whom you are seeking housing assistance. You must do the following:

  1. 1. Complete a Family Summary Sheet, using the attached blank format to list all family members who will reside in the assisted unit.
  2. 2. Each family member listed on the Family Summary Sheet must complete a Citizenship Declaration. If there are 10 people listed on the Family Summary Sheet, you should have 10 completed copies of the Citizenship Declaration. The Citizenship Declaration has easyto-follow instructions and explains what, if any other forms and/or evidence must be submitted with each Citizenship Declaration.
  3. 3. Submit the Family Summary Sheet, the Citizenship Declarations, and any other forms and/or evidence to the name and address listed below when you submit your application.
  4. Clark Terrace, 1156 South Clark Drive,
  5. Los Angeles, CA 90035

This Section 214 review will be completed in conjunction with the verification of other aspects of eligibility for assistance. If you have any questions or difficulty in completing the attached items or determining the type of documentation required, please contact us at the number listed in your paperwork. We will be happy to assist you. Also, if you are unable to provide the required documentation by the date shown above, you should immediately contact this office and request an extension, using the block provided on the Citizenship Declaration Format. Failure to provide this information or establish eligible status may result in your not being considered for housing assistance.

If this Section 214 review results in a determination of ineligibility, you will have an opportunity to appeal the decision. Also, if the final determination concludes that only certain members of your family are eligible for assistance, your family may be eligible for proration of assistance. That means that when assistance is available, a reduced amount may be provided for your family based on the number of members who are eligible.

If assistance becomes available and the other aspects of your eligibility review show that you are eligible for housing assistance, that assistance may be provided to you if at least one member of your household has submitted the required documentation. Following verification of the documentation submitted by all family members, assistance may be adjusted depending on the immigration status verified. You will be contacted as soon as we have further information regarding your eligibility for assistance.




Exhibit 3-3

HUD Occupancy Handbook

4350.3 REV-1

Citizenship Declaration

INSTRUCTIONS: Complete this Declaration for each member of the household listed on the Family Summary Sheet


ADMISSION NUMBERif applicable (this is an 11-digit number found on DHS Form I-94, Departure Record)

NATIONALITY (Enter the foreign nation or country to which you owe legal allegiance. This is normally but not always the country of birth.)

SAVE VERIFICATION NO.

(to be entered by owner if and when received)


INSTRUCTIONS: Complete the Declaration below by printing or by typing the person's first name, middle initial and last name in the space provided. Then review the blocks shown below and complete either block number 1, 2, or 3:


DECLARATION
I,hereby declare, under penalty of perjury, that I am

(print or type first name, middle initial, last name):


Sign and date below and return to the name and address specified in the attached notification letter. If this block is checked on behalf of a child, the adult who will reside in the assisted unit and who is responsible for the child should sign and date below.




2. A noncitizen with eligible immigration status as evidenced by one of the documents listed below:

HUD Occupancy Handbook