Forms

Rental Assistance Forms

Local Information Sheet Effective 5/1/26 and Payment Standards Effective 1/1/2026 (New Fees 5/1/2026)

Utility Allowance Effective 1/1/2026

HCV-Landlord-Handbook New PWC with Direct Deposit 4-22-24

Statement of Tenants Rights and Responsibilities

Briefing Package

Housing Choice Voucher Program Brochure ​R-1 Statement of Family Obligation and Grounds for Denial 4.15.2024
L-1 HUD Fraud Form 1141 English 12-2005 ​​R-2 PHA Plan Chapter 5 Briefings and Voucher Issuance 01-2023
L-1a HUD Fraud Form 1141 Spanish 2-8-2024 ​R-3 Voucher OMB 2577-0169 Expires 7-31-22
L-2 HUD Form A Good Place to Live ​R-4 What You Should Know About EIV HUD July 2009
​L-3 Protect Your Family From Lead In Your Home (English) March 2021
R-5 PHA Plan Chapter 10 Moving with Continued Assistance and Portability 01-2023
L-3a Protect Your Family From Lead In Your Home (Spanish) March 2021 R-6 Port Out Request Form 2-28-18 Fillable
​L-4 HAP Contract OMB 2577-0169 Expires 4-30-2026 ​R-7 Virginia Housing Search Information
L-5 Complete Guide to Landlord - Tenant Rights

R-8 Request for Tenancy Approval HUD 2577-0169 (English) Exp 7-31-22

R-9 Home Search Log

L-6 HUD Resident Rights and Responsibilities HUD ​​R-10 PHA Plan Chapter 8 Housing Quality Standards and Rent Reasonableness 01-2023
L-7a HUD Form 5382 Certification of Domestic Violence 6-30-17

​R-11 Local Information Sheet Effective 4/1/25 and Payment Standards Effective 1/1/2026  revised 01/23/26 

R-12 PHA Plan Chapter 6 Income and Subsidy Determinations 01-2023
L-7b OHCD VAWA Lease Addendum 3-1-24 ​R-13 Utility Allowance Charts Effective 1-1-26
L-8 Fair Housing Equal Opportunity for All HUD (English) 1686 Published 2011 R-14 Map of PWC HCV with Poverty Areas 2021
L-9 Are You a Victim - Reporting Discrimination (English) HUD 2529-0011 Exp 12-31-23 ​R-15 Virginia Tenant Rights and Responsibilities Landlord Tenant Act As of July 2025 (English) 
​L-9a Are You a Victim - Reporting Discrimination (Spanish) HUD 2529-0011 Exp 12-31-23 ​R-15a Virginia Tenant Rights and Responsibilities Landlord Tenant Act of July 2025 (Spanish) 
L-10 PHA Plan Chapter 16 Program Administration Informal Hearing 01-2023  
​L-11 Community Resource List - ARPA Partners and Services ​
​L-12 Register as Vendor Direct Deposit and W-9 2004  

Recertification 

Affidavit of Understanding Applicant Tenant Unauthorized Persons Revised 4-9-18.pdf ​Applicant Tenant Certification Statement 4-6-18.pdf ​Authorization to Release Information and other forms 4-6-18.pdf
​Briefing Declaration - 2018 legal 4-6-18.pdf ​Earned Income Disallowance.pdf IVT Authorization to Release Information
​Recertification Verification Need Checklist 4-14-18.pdf School Attendance Verification 4-19-18.pdf ​Self Certification Do Not Received Child Support 6-11-18.pdf
​Self Certification of Child Support Payments Received 6-11-18.pdf ​Statement of Family Obligation and Grounds for Denial 4-9-18.pdf ​Tenant Information Form For Rental Assistance Benefits (TIF) 06-13-2024
​ ​  

Reasonable Accommodations

Vendor Registration and Direct Deposit

Register as Vendor, Direct Deposit and W-9 (2024) ​W-9 Request for Taxpayer ID Number and Certification 2024.pdf ​Change of Ownership/Management Packet

Income Verification

​Applicant Tenant Certification Statement 4-6-18.pdf ​Bank Verification 2-28-18.pdf ​EXHIBIT 6 Income.pdf
​FamilyDeclarationofAssetsunder$5000.pdf ​IVT Authorization to Release Information.pdf ​School Attendance Verification 4-19-18.pdf
​Self Certification Do Not Received Child Support 6-11-18.pdf ​Self Certification of Child Support Payments Received 6-11-18.pdf ​Self Employment Certification 6-11-18.pdf
​Statement of Family Obligation and Grounds for Denial 4-9-18.pdf ​Verification of Income Loss of Income 6-27-18.pdf ​Zero Income Certification.pdf
​Zero Income Checklist.pdf ​Zero Income Worksheet.pdf  

Other Forms

Change Form for Applicant and Participant 7-5-18.pdf ​FamilyDeclarationofAssetsunder$5000.pdf ​Home Search Log 7-5-18.pdf
​Informal Hearing Procedures for Participants.pdf ​Mutual Agreement to Terminate Lease and HAP Contract 7-5-18.pdf ​Owner Certification Form 6-18-18.pdf
​Port Out Request Form 2-28-18.pdf ​Rent Increase Request Form 2017.pdf ​Self Certification Do Not Received Child Support 6-11-18.pdf
​Self Certification of Child Support Payments Received 6-11-18.pdf ​Self Employment Certification 6-11-18.pdf ​Verification of Income Loss of Income 6-27-18.pdf
Waiting List Update Form