Planning and Community Development
ALL INFORMATION WILL BE KEPT CONFIDENTIAL
Dear Seneca County Resident, The Seneca County Department of Planning and Community Development is applying for funding from the 2011 New York State Community Development Block Grant (CDBG) program to help lower income homeowners make emergency repairs and safety improvements to their home. These housing rehabilitation funds come from several sources, all of which originate from your federal income tax dollars from previous years. They have already been obligated toward repair programs; it is now just a matter of deciding which communities will receive them. This is a highly competitive grant – some three hundred New York State communities will apply this year, but only a quarter of them will win funds in early Fall 2011. But if we are awarded, Seneca County will be able to provide up to 40 eligible and interested Seneca County homeowners with financial assistance grants to make critical safety repairs to their homes. The vast majority of these funds go to helping seniors and families with young children be able to live in safe, decent, sanitary, and affordable homes. Below is a Housing Conditions Survey and also serves as a pre-application for housing repair assistance should Seneca County be successful in winning these grant funds. Your participation in this grant is critical. If you are not interested in grant assistance, or don’t think you will be eligible, please still consider completing this survey. Your information will be kept confidential and will not be shared except in the aggregate tallies which will help make the case for these funds to come to Seneca County, and in this way you’ll help others in the county gain access to grant funds for vital repairs to their homes. If you have any questions, please feel free to contact Peter Brown, Seneca County Grant Management Specialist, at 315-539-1726 during regular business hours, Monday through Friday.
If you need assistance with filling out this form, please call Mr. Peter Brown in the Seneca County Department of Planning and Community Development Office at 315-539-1726
1. Are you willing to apply for State/Federal grant monies if it is determined that your eligible for home repair/improvement grants?
2. If you are interested in applying for grant funds, will you permit Seneca County and its agents refer this survey to other housing agencies, such as Bishop Sheen, Seneca Housing, or Seneca County Weatherization?
3. By writing my initials at the line, I agree to give to the County of Seneca and its agents the unrestricted right to use, for any lawful purpose, any photograph taken of my property by the County or its agents, and to use the said photographs in connection therewith for the purpose of applying for any grants it so chooses. I release and discharge the County of Interlaken and its agents from any and all claims or causes of action arising from the use of such photographs including without limitations claims for libel or invasion of privacy. I have read this release and understand its contents. This release is binding upon me and my heirs.
4. I certify that the following information, to the best of my knowledge, is true and correct. I understand that any false statements made knowingly may disqualify me from participating in grant programs. I certify that I am 18 years of age or older. I understand that this information will be reviewed and used to determine whether or not I am eligible to participate in grant programs, as appropriate. Please initial the following box with your initials.
Most housing repair programs require that the household meets an income eligibility threshold. Please find the appropriate box below for the number of person in your household who are 18 years of age or over. This must include income from wages, interest earned, dividends received, social security, pension, child support or other sources. However, income from dependent minors, and full time students (18 years of age or older) who are not heads of households or spouses, does not need to be included in the total household income figures.
Our annual Household income is:Please check only one box from the following
My Household has:
2. What is the age of your head(s) of household (If two different, please select the oldest)? 24 or less 25-40 41-59 Age 60 and older
3. Is the head of the household male or female, or do you have a shared head of household (male & female)? Shared (Male & Female) Female Male
4. Do any children under the age of seven live there? No Yes If yes, how many?
5. Is the head of the household a "minority" person? No Yes, please check one:
1. What type of home do you live in? Single Family House Multi- Family House Mobile/Manuf. Home Apartment Building Other (Specify)
2. Approximately how much do you spend each month on: Rent: Mortgage: Property Taxes: Utilities:
3. Approximately how old is your home?
Please check all major repairs or improvements which need to be made to your home:
Please list the type of major repairs needed in your home, with No. 1 being the most needed:
1. 2. 3. 4. 5. 6. 7.
Mr. Peter Brown Seneca County Department of Planning and Community Development 1 DiPronio Drive Waterloo, NY 13165
