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APPLICATION FOR HOMEOWNER’S ASSISTANCE PROGRAMSThe Catawba Nation is pleased to offer various programs for homeowners. The following programsyou may be eligible for are 1) Healthy Homes Program 2) Homeowners Assistance Fund PilotProgram 3) Home Improvement Program or 4) ISWA Rehabilitation Program. Each program hasunique guidelines and income thresholds. For detailed information, please see below. All programsdepend on grant fund availability. Applying does not automatically qualify you for the program.Healthy Homes Program: This program is funded bythe American Rescue Plan Act and provided by theCatawba Nation’s Environmental Services Division. Thisprogram provides up to 15,000 for eligiblehomeowners to provide a Healthy Home assessment todetermine needed Home Repairs, Energy Conservation,Pest Management, etc. For further information pleasecontact Scott Hansen at scott.hansen@catawba.com orTiffany Witherington attiffany.witherington@catawba.com. Applicants withincome at or below the Federal Poverty Guidelinewill be prioritized.ISWA Rehabilitation Program: This program isfunded by HUD and provided by ISWA. This programprovides a 0% interest loan of up to 30,000 for homerepairs for eligible Homeowners, which may beforgivable for eligible Tribal Seniors. For furtherinformation please contact Rachel Sanders atrachel.sanders@catawba.com. To qualify, applicants’income cannot exceed HUD’s 80% Median Income limit.Revised: 2/15/2022Persons inHousehold12345678Persons inHousehold12345678Federal PovertyGuideline 0- 12,880 0- 17,420 0- 21,960 0- 26,500 0- 31,040 0- 35,580 0- 40,120 0- 44,660Income Limit 47,150 53,900 60,650 67,350 72,750 78,150 83,550 88,950
Home Improvement Program (HIP): This program isPersonsIncome Limitfunded by the American Rescue Plan Act and overseenSingle0.00 to 74,999.99by the Bureau of Indian Affairs. This program isHead of Household0.00 to 112,499.99managed by the Catawba Nation’s Land ManagementMarried Filing Jointly0.00 to 149.999.99Division. This program provides assistance with majorrepairs including HVAC replacement, roof replacement, window replacement, and additional insulationwhere energy efficiency needs to be addressed for eligible Homeowners. For further information pleasecontact Shana George-Perry at shana.george@catawba.com.Homeowners Assistance Fund (HAF) Pilot Program:This program is funded by the American Rescue PlanAct and provided by the Catawba Nation’s FamilyServices Department. This program provides assistancewith Mortgage Assistance, Utility Assistance, andInternet Assistance for eligible Homeowners. Forfurther information please contact Morgan Webster atmorgan.webster@catawba.com. To qualify, applicants’income must be at or below the following incomeguideline:Persons inHousehold12345678Income Limit 88,450 101,050 113,700 126,300 136,450 146,550 156,650 166,750
Applicant Personal and Contact InformationApplicant Full NameDate of BirthTribal Enrollment #Physical Address(Street, City. Zip)Mailing Address(Street, City. Zip)Phone NumberMarital Status(Check one)NameEmail AddressAre you or your Married Yesspouse a veteran? Single No Widowed Other (explain)Household Member Information:(Please list all persons living in household on a permanent basis)Date of BirthLast 4 digits ofTribalAnnual orIncome SourceSSNEnrollment #Monthly Income(if applicable)(if applicable)(if applicable)
Description of Assistance RequestedIf you are requesting assistance with repairs, please describe the repairs you are requesting:Application Checklist Income Verification for All Household MembersExamples of Earned Income: Copy of 1040 tax returns W-2 Wage stubs Other income verificationExamples of Unearned Income: Social security Retirement Disability Unemployment benefits Child support Other unearned income No Income Verification, if applicable Verification of Tribal Membership for all Tribalhousehold membersPlease attach copy of Tribal ID Land Assignment/Plat Confirmation or deed to simpleproperty/plat Release of Information Form, attached All Other Required Supporting Documentation:See documentation requirements for specific programs in nextsectionCatawba’s Housing Assistance Programs & Supporting Documentation RequirementsPlease select all COVID-19 related programs you areapplying for: Healthy Home Program: Healthy Home Assessment,Home Repairs, Energy Conservation, Pest Management,Indoor Air Quality, Mold and Lead – Maximum Supportis up to 15,000 BIA-Housing Improvement Program (HIP) – homerepair program that provides assistance withweatherization ISWA Rehabilitation Program - home repairprogram that provides a 0% interest loan for up to 30,000 for eligible low-moderate income TribalMembers. Loan may be forgivable for eligible Tribalseniors.Please attach the following supporting documentationassociated with the program(s) you are applying for:Medical documents for respiratory illness prioritization, ifapplicable. If eligible for this program, the Tribe willcoordinate with you in scheduling a home assessment inorder to obtain a quote for repairs/services.If you are interested and eligible for this program, a CINrepresentative will contact you to collect any additionalinformation or documentation to proceed with theprogram.If you are interested and eligible for this program, an ISWArepresentative will contact you to collect any additionalinformation or documentation to proceed with theprogram.
Copy of Mortgage bill (within last 30 days)Mortgage Company:Account #:Mailing Address:City/State/Zip: Copy of Utility bill(s) (within last 30 days)Utility Provider:Account #:Mailing Address:City/Zip/State: Homeowner Assistance Fund (HAF) PilotProgram – mortgage assistance, utilityassistance for Homeowner’s, and assistance withinternet costs.Utility Provider:Account #:Mailing Address:City/Zip/State:Utility Provider:Account #:Mailing Address:City/Zip/State:Utility Provider:Account #:Mailing Address:City/Zip/State: Copy of Internet bill (within last 30 days)Internet Provider:Account #:Mailing Address:City/Zip/State:
Confirmation of Financial NeedBy submitting this application, I hereby certify that I have suffered from a financial hardship due to theCOVID-19 public emergency. I certify that all information provided in this application is accurate.Have one or more individuals in your household experienced any of the following financialhardship due, directly or indirectly, to the COVID-19 pandemic? (check all that apply) A reduction in household Income Loss of Employment/Temporary Layoff/or Furlough Reduction in hours/pay Unable to work or experiencing financial hardship due to no child care/school Underlying medical condition requiring staying home to prevent exposure Loss of self-employment/business income Over the age of 50 and enduring increased costs because of the COVID-19 pandemic. Disabled and enduring increased costs because of the COVID-19 pandemic Incurred significant costs (hospital bills, medication costs, etc.) Other financial hardship; list:I acknowledge that although the Tribe intents the most favorable tax treatment available under theGeneral Welfare Exclusion Act established under the Internal Revenue Code Section 139E. The Tribewill not be responsible for payment of any tax penalties, interest, or other costs incurred by recipientsin connection with their receipt of emergency financial assistance under the program. I acknowledgethat the Tribe does not provide tax, legal, or accounting advice, and that I am solely responsible forobtaining advice regarding my personal tax obligations with respect to any financial assistance that Ireceive.Printed Name:Signature:Date:How to Submit this ApplicationSubmit by Mail: Attn: Morgan Webster996 Avenue of the NationsRock Hill, SC 29730Submit by email: homeowners@catawba.comMake an Appointment to drop off in person: 803-366-4792, ask for COVID-19 Programs staff
For Official Use OnlyDate received by the Tribe:Tribal enrollment verified? YesSupporting Documentation provided: No YesDate Verified: NoIncome Eligible:Information Sent to Program Manager(s): Healthy Homes Program Yes No Homeowner’s Assistance Fund Program Yes No Home Improvement Program Yes No ISWA Rehab ProgramDenied Program(s) and why: Yes NoApproval/Denial Letter sent: Yes NoDate Mailed:
Release of InformationHealthy Home, HAF, HIP ARPA, and ISWA RehabilitationApplicant Personal and Contact InformationApplicant Full NameDate of BirthTribal Enrollment #Physical Address(Street, City. Zip)Phone NumberSocial Security #I hereby authorize use or disclosure of protected Housing Repair Application and associated documentation asdescribed below.1. The following specific business is authorized to use or disclose information:Catawba Indian Nation 996 Avenue of the Nations, Rock Hill, SC 29730 and/or ISWA Development Corporation,2919 Sturgis Rd., Rock Hill, SC2. The following facility may receive disclosure of information:Catawba Indian Nation and/or ISWA Development CorporationFacility Name996 Avenue of the Nations and 2919 Sturgis Rd.AddressRock Hill, SC 29730City, State, Zip Code3. The specific information that should be disclosed is:The entire contents of any documents related to requesting home repair assistance. I understand that theinformation used or disclosed may be subject to re-disclosure by the facility receiving it and would then no longerbe protected by federal privacy regulations.4. I may revoke this authorization by notifying Catawba Indian Nation or ISWA Development Corporation staff inwriting of my desire to revoke it. However, I understand that any action already taken in reliance on thisauthorization cannot be reversed, and my revocation will not affect those actions.5. Purpose/use of the information is for:To create and continued a relationship with the Catawba Indian Nation and ISWA Development Corporationconcerning my rights and obligations with respect to a housing repair assistance.6. This authorization expires on December 31, 2024, OR upon occurrence of the following event that relates to me orto the purpose of the intended use or disclosure of information about me:Upon the sale of the home, my death, or conveyance to a successor.SignatureSignature of Individual*(The person about whom the information relates)OR, if applicable –Signature of Guardian orPersonal Representative of Patient’s EstateDate of Individual’s SignatureDate of Guardian’s/Personal Description of Authority to ActRepresentative’s Signaturefor the Individual
Homeowners Assistance Fund (HAF) Pilot Program: This program is funded by the American Rescue Plan Act and provided by the Catawba Nation's Family Services Department. This program provides assistance with Mortgage Assistance, Utility Assistance, and Internet Assistance for eligible Homeowners. For
