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NJ I Choose Home Housing Intake Form 2016-2025 free printable template

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HOUSING INTAKE FORM (**ONLY submit for ICH NJ/MFP eligible individuals) Date: Meets MFP Eligibility?: Yes No Name: Social Security # / / Address: DOB: Age: Veteran: Y/N Phone #: Intake Worker/Title:
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How to fill out NJ I Choose Home Housing Intake Form

01
Start by downloading the NJ I Choose Home Housing Intake Form from the official website.
02
Fill in your personal details, including your name, address, and contact information.
03
Indicate your household composition by listing all members living in your household.
04
Provide information regarding your income sources and amounts for each household member.
05
Include details about any assets, such as bank accounts, properties, or investments.
06
Specify your housing preferences, including type of housing and location if applicable.
07
Complete any additional sections regarding your health care needs and services required.
08
Review all provided information for accuracy and completeness.
09
Sign and date the form to certify that the information is correct.
10
Submit the completed form to the appropriate local agency as instructed.

Who needs NJ I Choose Home Housing Intake Form?

01
Individuals or families seeking support for housing assistance in New Jersey.
02
Those eligible for programs under the NJ I Choose Home initiative.
03
Persons with disabilities or those in need of supportive housing options.
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The NJ I Choose Home Housing Intake Form is a document used to assess eligibility for home-based services under New Jersey's I Choose Home program, supporting individuals to live independently in their communities.
Individuals who are seeking home-based services through the NJ I Choose Home program, including those transitioning from institutional settings or requiring support to live independently, are required to file the form.
To fill out the NJ I Choose Home Housing Intake Form, applicants must provide personal details, current living situation information, health and support needs, and any additional documentation that demonstrates eligibility for the program.
The purpose of the NJ I Choose Home Housing Intake Form is to gather necessary information to determine an individual's eligibility for receiving home-based services and supports, ensuring they can live independently and safely.
The information that must be reported on the NJ I Choose Home Housing Intake Form includes personal identification details, income and financial information, medical and health history, living arrangement details, and any specific support required for independent living.
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MFP HCV SSA TANF ICHNJ SSI MFPeligible 1st SSDI DOB resided subsidized Eligibility excluding Medicare Medicaid Earnings accessible INTAKE Documentation

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