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Consolidated Homeless Grant Verification of Household Eligibility and Income Recertification FormDepartment of Commerce Effective Date July 2019Complete only the applicable sections you need for each
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To fill out the form for homeless or risk of:
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Gather all necessary personal information, such as name, contact information, and identification details.
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Start with providing basic details about the person's current living situation and why they are at risk or homeless.
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Proceed with filling out information about any dependents or family members who are also affected.
05
Provide details about any income sources, employment history, or public assistance the person may have.
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Include any relevant medical or mental health conditions that contribute to the homelessness or risk.
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Include any information about previous housing or attempts to secure housing.
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List any current or ongoing support services the person may be receiving.
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Finally, review the form for accuracy and completeness before submitting it to the appropriate organization.

Who needs homeless or risk of?

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Homeless or risk of individuals in need of assistance include:
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- Those without permanent shelter, living on the streets, or in emergency shelters.
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- Individuals at risk of losing their housing due to eviction, foreclosure, or other financial issues.
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- People experiencing domestic violence or unsafe living conditions.
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- Those facing mental health or substance abuse issues that contribute to their homelessness or risk of homelessness.
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- Families with children who lack stable housing.
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- Veterans who are homeless or at risk of becoming homeless.
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- People with medical conditions or disabilities who cannot secure appropriate housing.
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- Youth who have run away or been abandoned without a safe place to stay.
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- Those affected by natural disasters or other emergencies that have caused displacement.
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Homeless or risk of refers to the situation where individuals or families lack a permanent, stable residence or are at immediate danger of losing their existing housing.
Individuals and families who are experiencing homelessness or are at risk of becoming homeless, as well as service providers who assist these populations, may be required to file for various assistance programs.
To fill out homeless or risk of documentation, provide accurate personal information, details about the current living situation, reasons for homelessness or risk of, and any relevant supporting documents to verify the situation.
The purpose of homeless or risk of documentation is to assess eligibility for housing assistance programs, connect individuals and families to resources, and ultimately help them secure stable housing.
Information that must be reported includes personal identification details, current address (if applicable), description of housing situation, reasons for homelessness or risk, and any other pertinent demographic information.
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