Homelessness Prevention Forms
Eligible participants for Pasadena’s ESG Homelessness Prevention (HP) program are those that are at-risk of homelessness (as defined by HUD) or meet HUD’s category 2, 3, or 4 definition for homelessness and have a total household income below 30 percent of the median family income for the area, as determined by HUD.
Eligibility Determinations
To verify eligibility upon entry, programs should complete the relevant Certification of HP Eligibility form (there are separate forms for those At-Risk of Homelessness and those who are Homeless under HUD Categories 2, 3, or 4) as well as an ESG Income Eligibility Worksheet. To provide continued support, programs must verify continued eligibility every three months using the Homelessness Prevention Re-Evaluation of Eligibility form and an ESG Income Eligibility Worksheet.
All eligibility forms should be accompanied by supporting documentation. To assist in this process, the Pasadena Partnership has created forms for documenting client’s housing status and income (see below). Together with the eligibility certifications, these documents must be maintained in the client’s file.
Documentation of Housing Status
Pasadena Partnership’s housing status verification forms include:
Documentation of Income
Pasadena Partnership’s housing status verification forms include:
Rental Assistance Forms
Pasadena Partnership’s rental assistance forms include:
Required for all ESG Rental Assistance. Provides guidelines for ensuring rent is reasonable in relation to rents for comparable units.
Download FormRequired for CoC and ESG Rental Assistance. Includes guidelines for calculating Fair Market Rent (FMR) and FY 2023 FMR for LA County.
Download FormExcel worksheet that calculates the utility allowance for a household based on unit type, number of bedrooms, and who is paying for the utility.
Download FormShould be conducted by program staff upon initial occupancy and then on an annual basis for the term of ESG assistance.
Download FormSummarizes the lead-based paint requirements and provides guidance for carrying out each step.
Download FormProvides ESG grantees with an overview of documents that can be used to verify compliance with the Lead-Based Paint requirements.
Download FormGuides grantees through the lead-based paint inspection process to ensure compliance with the rule.
Download FormCertification form verifying visual assessment was conducted by ESG staff.
Download FormCertification form that program staff can use to have property owners certify that all paint stabilization activities have been completed.
Download FormSummarizes the requirements of the HUD Housing Quality Standards (HQS) Inspection process.
Download FormShould be conducted by program staff upon initial unit occupancy.
Download FormShould be conducted by program staff on an annual basis for the term of CoC assistance.
Download Form