TRIBAL CITIZEN PORTAL

Homeowner Assistance Fund (HAF) Application

Nansemond Indian Nation
Homeowner Assistance Fund (HAF) Application

1001 Pembroke Lane | Suffolk, Virginia 23434 | (757) 255-9317

Homeowner Assistance Fund Application

Applicant Information (Head of Household)

First
Middle
Last
Mailing Address:
Mailing Address:
City
State/Province
Zip/Postal
Physical Address:
Physical Address:
City
State/Province
Zip/Postal
What type of assistance are you applying for:

General Information

Are you or a member of your household a member of the Nansemond Indian Nation?
If yes, submit proof of membership with this application.

Maximum file size: 5MB

Is the home you are applying for assistance for your primary residence?
Are you a homeowner of a dwelling currently used as your primary residence?
If yes, attach proof of homeownership such as a mortgage or deed.

Maximum file size: 5MB

 

Do you receive any of the following assistance?

SNAP (Supplemental Nutrition Assistance Program)
SSI (Supplemental Security Income)
TANF (Temporary Assistance for Needy Families)
Medicaid
LIHEAP (Low Income Home Energy Assistance)

Household Information

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Income Verification

Applicant must attach and submit a written attestation as to household income with supporting documentation. Supporting documentation includes paystubs, IRS Form W2, IRS Form 1099, wage statements, tax filings, or deposit statements demonstrating regular income.

Applicants must demonstrate household income at or below established thresholds: 150% of the Area Median Income (AMI) for household size OR 100% of median income for the United States for household size, whichever threshold is greater.

Maximum file size: 5MB

Applicant must attach and submit a wage statement, interest statement, unemployment compensation statement, or a copy of IRS Form 1040 as filed for the household for 2024/2025 for ALL HOUSEHOLD MEMBERS.

Applicant must submit sufficient confirmation of the household’s monthly income at the time of the application for at least the three months before submission for ALL HOUSEHOLD MEMBERS.

Mortgage Payment Assistance

Mortgage Payment Assistance helps homeowners avoid foreclosure and stay current on mortgage payments by addressing financial hardships caused by the COVID-19 pandemic. The applicant must provide a mortgage statement showing the balance due and payment status, along with the head of the household's name and primary residence information listed on this application.

Mortgage Information – please provide the name and contact information of the bank or company holding your mortgage.

Maximum file size: 50MB

Current Mortgage Status:
Months
Is your home currently in foreclosure?

Utilities Assistance

Utilities Assistance helps homeowners with delinquent utility bills such as electricity, water, sewer, home heating fuel, and internet.

Utility Information – please provide the name and contact information of the entity owed for utilities.

Utilities

What is the current status?
Is the service disconnected?
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Property Tax Assistance

Property Tax Assistance helps homeowners with delinquent property taxes, preventing tax foreclosure. The applicant must provide a property tax notice or bill showing the amount owed and the payment due date.

Property Tax Information – please provide the name and contact information of the entity owed property taxes.

Maximum file size: 50MB

Current Property Tax Status:
Months
Is your property currently in foreclosure?

Weatherization and Home Repair Assistance

Weatherization and Home Repair Assistance helps homeowners maintain the habitability of their primary residence, including essential repairs and maintenance. This includes repairs for structural damage, plumbing, electrical, weatherization, mold or contaminant remediation, and pest control. The applicant must provide three written quotes from licensed contractors or vendors who will provide the services. Payments will be made directly to the service provider and not to the homeowner.

 

Please provide the total cost of performing the necessary repairs, maintenance, or weatherization of the home. Applicants must provide three quotes and attach supporting documentation from the licensed contractor or vendor providing the services. The selected vendor must submit an IRS Form W-9 to the Tribe to receive payment. All payments are made directly to the service provider, not the homeowner.

Maximum file size: 5MB

Hardship Attestation (Required)

To be eligible to receive funding under the Nansemond Indian Nation Homeowner Assistance Fund (HAF) Program, the applicant must provide a signed and dated Attestation of Financial Hardship.

I hereby attest that I have experienced a financial hardship after January 21, 2020, and that I meet the eligibility criteria for the Nansemond Indian Nation’s Homeowners Financial Assistance (HAF) Program.

I have experienced the following financial hardship(s). Check all that apply:

 

I understand that providing false information may result in my disqualification from the program, legal action, and recovery of funding provided to me. By signing below, I confirm that all information provided is accurate and complete to the best of my knowledge and I have not knowingly or willfully provided false information.