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 Ė 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 donít 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 youíll help others in the county gain access to grant funds for vital repairs to
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
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
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)
4. Do any children under the age of seven live there?
If yes, how many?
5. Is the head of the household a "minority" person?
Yes, please check one:
1. What type of home do you live in?
Single Family House
Multi- Family House
2. Approximately how much do you spend each month on:
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:
Mr. Peter Brown
Seneca County Department of Planning
and Community Development
1 DiPronio Drive
Waterloo, NY 13165