Applications and Forms
Please click on any of the following retirement home applications or forms below. All of the retirement home applications and forms can be viewed online or printed at your convenience.
Enterprise Income Verification
What is Enterprise Income Verification?
EIV is a web-based computer system containing employment and income information on individuals participating in HUD’s rental assistance programs. This information assists HUD in making sure “the right benefits go to the right persons”.
What income information is in EIV and where does it come from?
The Social Security Administration:
- Social Security (SS) benefits
- Supplemental Security Income (SSI) benefits
- Dual Entitlement SS benefits
The Department of Health and Human Services (HSS) National Directory of New Hires (NDNH):
- Unemployment compensation
- New Hire (W-4)
What is the information in EIV used for?
The EIV system provides the owner and/or manager of the property where you live with your income information and employment history. This information is used to meet HUD’s requirement to independently verify your employment and/or income when you recertify for continued rental assistance. Getting the information from the EIV system is more accurate and less time consuming and costly to the owner or manager than contacting your income source directly for verification.
Property owners and managers are able to use the EIV system to determine if you:
- Correctly reported your income.
They will also be able to determine if you:
- Used a false social security number.
- Failed to report or under reported the income of a spouse or other household member.
- Receive rental assistance at another property.
Is my consent required to get information about me from EIV?
Yes. When you sign form HUD-9887, Notice and Consent for the Release of Information, and form HUD-9887-A, Applicant’s/Tenant’s Consent to the Release of Information, you are giving your consent for HUD and the property owner or manager to obtain information about you to verify your employment and/or income and determine your eligibility for HUD rental assistance. Your failure to sign the consent forms may result in the denial of assistance or termination of assisted housing benefits.
Who has access to the EIV information?
Only you and those parties listed on the consent form HUD-9887 that you must sign have access to the information in EIV pertaining to you.
What are my responsibilities?
As a tenant in a HUD assisted property, you must certify that information provided on an application for housing assistance and the form used to certify and re-certify your assistance (form HUD-50059) is accurate and honest. This is also described in the Tenants Rights & Responsibilities brochure that your property owner or manager is required to give to you every year.
Penalties for providing false information
Providing false information is fraud. Penalties for those who commit fraud could include eviction, repayment of overpaid assistance received, fines up to $10,000, imprisonment for up to 5 years, prohibition from receiving any future rental assistance and/or state and local government penalties.
Protect yourself, follow HUD reporting requirements
When completing applications and recertifications, you must include all sources of income you or any member of your household receives. Some sources include:
- Income from wages
- Welfare payments
- Unemployment benefits
- Social Security (SS) or Supplemental Security
Income (SSI) benefits
- Veteran benefits
- Pensions, retirement, etc.
- Income from assets
• Monies received on behalf of a child such as:
- Child support
- AFDC payments
- Social security for children, etc.
If you have any questions on whether money received should be counted as income, ask your property owner or manager.
When changes occur in your household income or family composition, immediately contact your property owner or manager to determine if this will affect your rental assistance.
Your property owner or manager is required to provide you with a copy of the fact sheet “How Your Rent Is Determined” which includes a listing of what is included or excluded from income.
What if I disagree with the EIV information?
If you do not agree with the employment and/or income information in EIV, you must tell your property owner or manager. Your property owner or manager will contact the income source directly to obtain verification of the employment and/or income you disagree with. Once the property owner or manager receives the information from the income source, you will be notified in writing of the results.
What if I did not report income previously and it is now being reported in EIV?
If the EIV report discloses income from a prior period that you did not report, you have two options: 1) you can agree with the EIV report if it is correct, or 2) you can dispute the report if you believe it is incorrect. The property owner or manager will then conduct a written third party verification with the reporting source of income. If the source confirms this income is accurate, you will be required to repay any overpaid rental assistance as far back as five (5) years and you may be subject to penalties if it is determined that you deliberately tried to conceal your income.
What if the information in EIV is not about me?
EIV has the capability to uncover cases of potential identity theft; someone could be using your social security number. If this is discovered, you must notify the Social Security Administration by calling them toll-free at 1-800-772-1213. Further information on identity theft is available on the Social Security Administration website at: www.ssa.gov/pubs/10064.html.
Who do I contact if my income or rental assistance is not being calculated correctly?
First, contact your property owner or manager for an explanation.
If you need further assistance, you may contact the contract administrator for the property you live in; and if it is not resolved to your satisfaction, you may contact HUD. For help locating the HUD office nearest you, which can also provide you contact information for the contract administrator, please call the Multifamily Housing Clearinghouse at: 1-800-685-8470.
Where can I obtain more information on EIV and the income verification process?
Your property owner or manager can provide you with additional information on EIV and the income verification process. They can also refer you to the appropriate contract administrator or your local HUD office for additional information.
If you have access to a computer, you can read more about EIV and the income verification process on HUD’s Multifamily EIV homepage at: www.hud.gov/offi ces/hsg/mfh/rhiip/eiv/eivhome.cfm
Flat Rate Application
Knights of Pythias Retirement Center
Tenants may have common household pets in their units. KOPRC does not discriminate against applicants or tenants based on their ownership of a pet.
Assistance animals are exempt from the pet rules and pet deposit. However, tenant must comply with state and local health and safety laws and must be responsible for the care and maintenance of the animal. Assistance animals must be under control by the responsible person and appropriately restrained while in/on common areas. Proof of proper inoculations must be provided to the owner prior to the animal’s arrival and updated annually.
Management retains the right to verify the applicant or resident has a disability and there is a disability-related need for the requested accommodation of an assistance animal. Documentation of the disability and the need for the animal may be required by an appropriated third party.
Type of Pets Allowed: Dog, cat, fish, birds, turtles, small household animals.
Limitations on Pets
- Dogs must weigh under 40 pounds and stand under 20 inches at the top of the shoulders. Maximum number – One (1). Minimum age – three months. Must be housebroken.
- Cats must be a domesticated variety – size within reason. Maximum number – One (1). Minimum age – three months. Must be litter box trained.
- Fish-Tanks shall not exceed 10 gallons in size.
- Birds – Limit of one, not to exceed 12 inches. Wings must be clipped.
- Small “rodents” (Hamsters, Gerbils, Mice, and Guinea Pigs) or “lagomorphs” (rabbits) –
Limited to one type, two in number. Must be caged.
- Turtles-Limit oft wo, caged.
- Absolutely no birds of prey, reptiles, monkeys, rats, dangerous or poisonous fish or other
exotic or undomesticated animals of any type will be permitted.
- Pet Application/Registration Form, approval for housing a pet, completion of a pet policy & rules and payment, or arrangement for payment, of the refundable pet deposit is due when the pet is brought to the unit. Application/Registration Form must be completed prior to the pet living on the premises and must be updated annually. Pet owners are responsible for providing management with required documents in a timely manner.
- Applicant must certify their ability to control, clean, and care for the pet.
- Applicant must provide the name, address, and phone number of a person who agrees to take the pet from the building in case of absence (over 24 hours) of the pet owner for any reason. This information will be verified by the management. Additionally, this information must be updated annually to management during the recertification process for Section 8 residents. Market residents will be contacted by the office to update this information during their anniversary month.
- Management will need to personally see and evaluate a pet for temperament, behavior, quietness, response to owner, etc. Home visits may be required. Evaluation is to verify that the pet does comply with the selection criteria, that it appears to be in good health and well cared for and that it is well behaved and under the control of the owner. Overly aggressive, rambunctious or unfriendly animals will not be accepted.
- Applicant is responsible for the proper disposal of pet waste as outlined in the pet rules. Failure to comply may result in a $5 penalty charge per occurrence.
- If, after reviewing application information, the management determines that a resident intends to own or keep a common household pet in the dwelling unit and the pet constitutes a serious threat to the health and safety of others, management will refuse to register the pet.
Refundable Pet Deposits
Payment of a refundable pet deposit is due no later than the time the pet is brought to the unit. Pet deposit for dogs and cats is $300 per unit. This deposit is over and above the security deposit amount required by the Department of Housing and Urban Development for apartments. A monthly payment plan is available requiring a down payment of $50.00 followed by regular monthly payments of $10.00 each month until paid in full. The refundable pet deposit is required for dogs and cats only.
Within fourteen days after the termination of the rental agreement and vacation of the premises the landlord shall give a full and specific statement of the basis for retaining any of the deposit together with the payment of any refund due to the tenant under the terms and conditions of the rental agreement. Additionally, should the pet no longer live in the unit, upon request by the tenant and after an inspection by management, an accounting of any charges due will be given along with a refund of the remaining balance on hand, within fourteen days.
General Information for Pet Owners
- All pet owners wishing to take up residency in this community and those now residing here will adhere strictly to the rules and regulations of Knights of Pythias Retirement Center, the State of Washington ownership laws, and other laws as they may apply and be adopted in the future.
- Pet owners will be responsible for the financial and physical caring of their pets, damage incurred by their pets or legal claims, actions, suits, judgments, and demands brought about in connection with their pet.
- Any exceptions or unusual requests to the pet rules and regulations will be the final decision of the administrator.
- Resident must agree to abide by all applicable Pet Rules and Regulations.
- Resident has completed a Pet Application & Registration form and has been granted permission by Landlord to keep the pet(s) specified below under the following terms and conditions:
- Pets may not be kept, bred, or used for any commercial purpose. All pets must be spayed or neutered.
- Your apartment and this community will be kept in a safe, clean, healthy and sanitary condition at all times. All health and safety codes must be met and followed.
- All pets are encouraged to wear I.D. tags bearing the name of the owner and apartment number. Any unsupervised pet found in the common areas without an I.D. tag will result in the animal being turned over to the animal shelter.
- All animals must be under the control of a responsible person.
- All pets must be under leash control or crated at all times when outside the owner’s apartment.
- No pet will be allowed to use balcony areas as a relief or exercise area.
- No pet will be left alone unattended outside on the balcony or patio at any time.
- Precautions will be taken at all times by the pet owner to protect the interior of the apartment and common areas of our community.
- Persons who walk pets are responsible to clean up all waste. Place waste in a plastic bag, and dispose of it in the designated area. Do not dispose of waste, including kitty litter, fish tank gravel, pet pads, etc., down the trash chutes or down the commode. Dispose of it in the garbage can in the first floor hallway by the back elevator or in the outside dumpster.
- Resident agrees to keep his pet under control at all times so that pets do not jump on, frighten, or annoy others by excessive barking or other aggressive behavior.
- For sanitary reasons, absolutely no pets are allowed in the dining room or dining room lounge area at any time. This policy does not include assistance animals.
- Pets that disturb the peace and quiet of the neighbors through noise (barking, whining, etc.), smell, animal waste, and biting, scratching, or any other nuisance must be immediately removed from the community.
- If it is determined that the pet is abandoned, management will make every attempt to contact the responsible party first, but if those efforts fail, the pet will be removed to the local animal shelter.
- Absolutely no used dog waste bags will be permitted in the building. Please dispose of pet waste in the containers provided outside.
- The pet agreement addendum authorizes the owner and/or public officials’ entry to your apartment for the purpose of removing a pet that has been left unattended or whose health is in danger because of poor care, neglect, or abuse.
- It is the sole responsibility of the pet owner to make arrangements for their pet’s care while away from the community at any time (on vacation, during hospital stays, etc.) Your pet caregiver may not stay in your apartment during your absence. Our staff cannot be the caretaker of your pet.
- Upon move-out, if any evidence of fleas is detected, the unit will be flea bombed at the expense of the resident. If necessary, multiple treatments will be done.
- Resident agrees to provide adequate care, nutrition, exercise and medical attention for pets, including proper immunization.
- Resident also acknowledges that other residents may have chemical sensitivities or allergies or are easily frightened by such animals. Use common sense and respect the rights of others.
- Birds will not be allowed to fly free in the apartments, hallways, or common spaces or courtyards.
- In case of death, a family member must claim the pet within a thirty-six (36) hour period.
Violations of the Rules and Regulations
- All complaints will be promptly investigated.
- An inspection may be performed in order to determine if a violation has occurred.
- Upon discovery of any violation of the rules and regulations, any damage created by
the pet will be noted, cost of repairs determined and the pet owner notified.
- Resident will receive a ten (10) days notice to comply with their lease provisions in order to properly accomplish repairs to the satisfaction of the management, with a re- inspection at the end of the ten days.
- If repair has been properly accomplished, notice will be filed in resident folder.
- At the end of the ten (10) days, if the repair has not been accomplished, pet owner will be notified that he is in violation of his lease and will instigate proper repairs within ten (10) days or his lease can be terminated with this community.
- Re-inspection will take place at the end of the second ten (10) day period. If repairs have not been properly completed to the satisfaction of the management, pet owner will be served with proper paperwork that his lease will be terminated.
- Pet owners will be given the option of having the repairs corrected themselves or having the maintenance staff of this community complete the repairs at owner’s expense. The charges will be actual cost.
- If the maintenance staff does the repairs, all bills will be due and payable within 30 days from the date of the invoice. Non-payment of bills will be in violation of lease.
- In rare cases when an animal goes completely out of control and physically attacks or attempts to attack another person or animal on the premises, material or substantial non-compliance with the pet rules and regulations has occurred. Pet must be removed from premise immediately.
Registering with Management
Registration documentation will be updated annually and will be kept in the resident file. Management will notify you when it is time to complete this process and inform you of what is required.
All visiting pets must be cleared with management.
￼Knights of Pythias Retirement Center does not discriminate against applicants, residents or employees on the basis of race, color, creed, religion, sex, national origin, familial status, disability or socio-economic class.
Knights of Pythias Retirement Center does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs and activities. The person named below has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development’s regulations implementing Section 504 (24 CFR Part 8 dated June 2, 1988): Compliance Manager, KOPRC, 3409 Main St, Vancouver, WA 98663, 360-696-4375.
(Policy Revised 8/2016)
Subsidized Application Packet
Tenant Selection Plan
The Knights of Pythias Active Retirement Center offers both private pay apartments and subsidized apartments. The applications and forms address both types of housing options.
If you have any questions about any of the applications and forms please contact us.
Fax forms to: 360-694-6263