Hawaii County Emergency Rental Assistance Application

 

The Hawaii County Emergency Rental Assistance Program (ERAP) is funded through a federal grant from the County of Hawaii. The program is led by Hawaii Community Lending and administered by nonprofit partners: HOPE Services Hawaii, Hawaii First Federal Credit Union, Neighborhood Place of Puna, Habitat for Humanity Hawaii Island, The Salvation Army, and Hawaii County Economic Opportunity Council. ERAP provides rent or utility payments from March 2020 through December 2021 to applicants who have been impacted directly by COVID-19 not to exceed 12 months of total assistance. Your household is only eligible to receive ERAP assistance from 1 nonprofit provider. 

Rent and utility payments are only eligible for primary residences in the County of Hawaii. Applicants must earn at or below 80% area median income and verify proof of hardship due to COVID-19 for each month they receive assistance. Priority will be given to households with annual incomes less than 50% area median income with one or more members that have been unemployed for at least 90 days. Payments for approved applicants will be made directly to the landlord, property manager, or utility company. Approved applicants will also have access to financial counseling and housing stability services. Please complete this application and submit with required documents listed below to be considered for an ERAP grant. 

 

 

 

Please complete the application and submit with required documents to be considered for a grant: 

Proof of Resident and Age for Applicant

• Copy of photo ID 

 

Income Documents for ALL household members (provide all that apply)

• All pages and schedules for 2020 Federal Tax Form 

 

OR

• 30 days most recent pay stubs

• 1 month most recent business bank statements (if self-employed)

• Unemployment or Pandemic Unemployment Assistance (PUA) benefit letter

• Public benefit statement

• Other income documentation (i.e. child support or alimony letter, pension/retirement earning statement, etc) 

 

Housing (provide 1 of the following)

• Copy of complete, current, and signed rental lease/contract

Bank statements or cancelled checks verifying payment of monthly rent (if no signed lease)

Bank statements or cancelled checks verifying payment of utilities for the residential unit (if no signed lease) 

 

Proof of Hardship (provide 1 of the following)

• Unemployment or PUA approval letter

• Written attestation (request from nonprofit) 

 

If requesting assistance for previous months

• Past due rent notice with amount owed

• Eviction notice with amount owed

• Past due utility notice 

The items marked with (*) are required fields.

Personal Information
Are you a Resident of Hawaii Island? There are penalties for willfully and knowingly giving false information on an application for Federal-State funds. Penalties for falsifying information may include immediate repayment of all Federal-State funds received and/or prosecution under the law. Residents of other islands may request assistance from Catholic Charities Hawaii or Council for Native Hawaiian Advancement. *
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Select Your Ethnicity *
Your Head of Household is *
Tell Us Your Current Employment Status *
Select Your Race (please select only 1 primary race) *
 
Are you an eligible beneficiary or active lessee of Hawaiian Home Lands? *
List YOURSELF AND ALL ADULT household members over age 18 below. Include their first and last name, date of birth, monthly and annual income, income type, and whether they are a senior (over age 62) and/or disabled. *
 First NameLast NameDate of BirthMonthly IncomeAnnual IncomeIncome Type Wages, alimony, child support, public assistance, unemployment, family assistanceSenior? Yes/NoDisabled? Yes/No
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Have any household members been unemployed for more than 90 days? *

Property manager or landlord’s mailing address.

Utility company’s mailing address.

Do you provide the nonprofit partner approval to contact the requested payee(s)? *
Authorization to Release Information. Multiple organizations are providing housing stability services and to help you gain access to assistance quicker some information collected in this application maybe shared with the Hawaii Housing Finance and Development Corporation, County of Hawaii, Hawaii Community Lending, Hawaii First Federal Credit Union, Neighborhood Place of Puna, Habitat for Humanity Hawaii Island, HOPE Services Hawaii, The Salvation Army, Hawaii County Economic Opportunity Council, Catholic Charities Hawaii, Council for Native Hawaiian Advancement, Kuikahi Mediation Center, West Hawaii Mediation Center, Hawaiian Community Assets, and other STREAK partners. Do you consent for our organization to share this information with these entities? *
Households who previously received assistance through other COVID-19 federal, state, or local funded programs for the requested period are not eligible. Applicants may need to provide information of financial resources received for the same purpose. Have you received assistance through other COVID-19 federal, state, or local funded programs for the requested period? *
Do you approve the nonprofit to contact your landlord, property manager, and/or utility company to issue payment for the assistance? *
Do you approve the nonprofit or County of Hawaii to provide future communications by email on available coronavirus related financial assistance and programs? *

APPLICANT STATEMENT. “I certify, on behalf of all household members, that the information included in this application is correct, complete, true and accurate to the best of my knowledge.  I am aware there are penalties for willfully and knowingly giving false information on an application for Federal, State or Local funds. Penalties for falsifying information may include immediate repayment of all Federal, State or Local funds received and/or prosecution under the law. I understand the information on this form is subject to verification. I attest one or more members of our household have experienced a reduction in household income, incurred significant costs, or experienced other financial hardship due, directly or indirectly, to the COVID-19 outbreak. I further attest our household has not received other government assistance for the requested period.”

Applicant Signature
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If this application has been completed and/or is being submitted by the landlord or property manager, please have the appropriate representative sign below and have the tenant sign above.
Landlord Signature
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If this application has been completed over the phone, please have the applicant provide verbal confirmation in place of their signature, write “Completed over the phone – received verbal confirmation” in the Applicant Signature section above, and nonprofit staff member should sign and date below.

Nonprofit Staff Signature (if application completed by phone)
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