EMERGENCY RENTAL ASSISTANCE PROGRAM

The Emergency Rental Assistance Program (ERAP) assists eligible Seminole Nation tribal households and
other tribal households that are unable to pay rent and utilities (electric, water, gas, propane, sewer, trash
removal) due to the COVID-19 pandemic. ERAP can assist eligible households with rental arrearages, utility
arrearages, current rental payments and current utility payments. Telecommunication services (telephone, cable,
Internet) delivered to the rental dwelling ARE NOT considered to be utilities. This program is only available to
rental households and does not apply to households with a mortgage or who currently own their home.

This program is limited to one tribal member per household.

Payments will be made directly to the landlord or utility company.

Program Requirements

1 or more individuals within the household who has qualified for unemployment benefits or experienced a reduction in household income, incurred significant costs, or experienced other financial hardship due, directly, or indirectly, to the COVID–19 outbreak.
1 or more individuals within the household can demonstrate a risk of experiencing homelessness or housing instability.
Household income is at or below 80% of area median income.

Required Documents

Copy of Tribal Membership Card for Head of Household or Spouse (if applicable)
Copy of State Driver’s License or ID
Copy of Social Security Card (all household members)

Landlord/Utility Form

Tax Identification Number required (for landlord)
Utility Bills (copy)
Bill must be in tribal member or spouse’s name
Account number must be on bill

Copy of Lease
Income Verification (please submit one of the following for all household members receiving income):
2021 Tax Returns
60 Days Check Stubs
Proof of Unemployment (90 days unemployment will receive priority)

EMERGENCY RENTAL ASSISTANCE Application Housing Authority of the Seminole Nation

First Name *

Last Name *

Date of Birth *

Address *

Address 2

City *

State/Province *

Zip/Postal Code *

County *

Phone *

Email Address

What is the primary applicant's race? *

Caucasian	Black or African American	Native American
Other

Preferred way to contact *

Phone

Email

Any

Assistance Needed (Select all that apply) *

Rent

Utilities

Security Deposit (New move in)

Utility Deposit (New account)

Utility type

Electric

Water

Gas\Propane

Trash

Utility Type *

Account number *

Utility Type

Account Number

Utility Type

Account Number

Utility Type

Account Number

Utility Type

Account Number

Upload Documents *

Household Composition

Complete the information below for each member who will be living with you

Name *

SSN *

Bithday *

Sex *

Relationship *

Name

SSN

Birthday

Sex

Relationship

Name

SSN

Birthday

Sex

Relationship

Name

SSN

Birthday

Sex

Relationship

Name

SSN

Birthday

Sex

Relationship

By signing below, I hereby certify that:

The above information is true and accurate, and if requested by the Seminole Nation of
Oklahoma, can provide documentation in support of my attestation of need. I also
understand that if any of the above information supplied is found to be false, I can be
required to return any support payments received.

I 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 am at risk of experiencing homelessness, housing instability or currently reside in
unsafe or unhealthy living conditions.

I am NOT receiving any other form of Federal assistance to pay my rent or utility
payment.

I am obligated to pay rent and utilities on a residential dwelling that I do not own or have
a mortgage interest in.

PLEASE NOTE: Once you have been approved/denied for assistance, you will receive a
letter in the mail. Please also be aware that you are still required to make payments to
the Landlord/Utility Company.

You are responsible for any unpaid balances.
Payments may take up to 30 days to credit your account. *

I Agree

Print Name *

DATE * +

Check this box and type your name below for signature. *

I agree

Type Signature *