APPLICANT CERTIFICATION AND ACKNOWLEDGEMENT
1. GIVING TRUE AND COMPLETE INFORMATION.
I certify all the information provided on this application is accurate and complete to the best of my knowledge. I have reviewed all applicable NCIHA forms and certify the information shown is correct.
2. REPORTING CHANGES IN INCOME OR HOUSEHOLD COMPOSITION
I understand I am required to report changes in income and any changes in the household size when a person moves in or out of the unit. I understand the rules regarding guests/visitors, and when I must report anyone who is stying with me.
3. REPORTING ON PRIOR HOUSING ASSISTANCE
I certify I have disclosed where and when I received any previous federal housing assistance and whether or not any money is owed. I certify that for this previous assistance I did not commit any fraud, knowingly misrepresent any information, or vacate the unit in violation of the lease.
4. NO DUPLICATE RESIDENCES OR ASSISTANCE
I certify the house or apartment will be my principle residence, and I will not obtain duplicate federal housing assistance while I am in this current program.
5. NO OWNERSHIP INTEREST IN ANOTHER HOME WHICH I COULD USE AS A RESIDENCE
I certify I do not own any interest in a house, condominium, cooperative, or building which I could use as a residence, and that I am currently in need of decent, safe, and sanitary housing. If I acquire an ownership interest in a residence while I am renting a house or apartment from NCIHA, I agree to notify NCIHA immediately. Further, I understand NCIHA may terminate my lease based on my ownership interest in a residence. I agree to vacate the house or apartment I am renting from NCIHA immediately if NCIHA terminates my lease because I have acquired an interest in a residence.
6. COOPERATION
I know I am required to cooperate in the supplying of all information needed to determine my eligibility, level of benefits, or verify my true circumstances. Cooperation includes attending pre-scheduled meetings and completing and signing needed forms. I understand failure, or refusal to do so, may result in delays, termination of assistance, or eviction.
7. CRIMINAL AND ADMINISTRATIVE ACTION FOR FALSE INFORMATION
I understand that knowingly supplying false, incomplete, or inaccurate information is punishable under federal or state criminal law. I understand that knowingly supplying false, incomplete, or inaccurate information is grounds for termination of housing assistance and/or termination of tenancy.
8. TRIBAL MEMBERSHIP
I certify that I, or a member of my household, is a current member of one of the NCIHA consortium tribes. If applying for on-site housing or Tribe specific assistance, I certify that I, or a member of my household, is a current member of the applicable Tribe.
9. NO OUTSTANDING DEBTS
I certify I do not have any outstanding debts with NCIHA or my Tribe. Any outstanding debts must be resolved before I am eligible for assistance with NCIHA.