Examen previo REU v2 - Loudoun Cares

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Examen previo REU v2

Pre-Screening Questionnaire

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Please note: Your name must be on the primary lease agreement in order to complete this pre-screen. The Rent Assistance & Eviction Prevention Programs do not cover sub-leasing arrangements. Please contact our ConnectLine if you have questions.

Do you live in Loudoun County?(Obligatorio)

There are seven (7) towns in Loudon County:

‣ Town of Hamilton
‣ Town of Hillsboro
‣ Town of Leesburg
‣ Town of Lovettsville
‣ Town of Middleburg
‣ Town of Purcellville
‣ Town of Round Hill

Loudoun Cares provides assistance for Loudoun County residents only. Not sure if you live in Loudoun County? Hover over question mark above for a list of applicable towns.
Please contact your local Department of Family Services about any assistance they may be able to offer.

‣ Fairfax County, VA: (703) 324-7500
‣ Clarke County, VA: (540) 955-3700
‣ Fauquier County, VA: (540) 422-8400
‣ Prince William County, VA: (703) 792-7500
‣ Frederick County, MD: (301) 600-1200

Yes, I live in Loudoun County.

Do you rent or own your home?(Obligatorio)

Rent

Own

Currently Unhoused

What kind of assistance do you need?(Obligatorio)

Select all that apply.

Rental Assistance or Eviction Prevention

Utility Assistance

Other (i.e., car repair, diapers, food, medical, etc.)

What is your current primary rental concern?(Obligatorio)

I am in the eviction process and have a court date.

I have a 5-Day or 30-Day Pay or Quit Notice.

I have been struggling to pay my rent for months.

What kind of assistance do you need?(Obligatorio)

Select all that apply.
Please note that we do not offer mortgage assistance at this time.

Utility Assistance

Other (i.e., car repair, diapers, food, medical, etc.)

Please note: To be eligible for funding, you must meet the following requirements:

You must be experiencing a housing cost burden (rent is more than 30% of household income).

Your household income (before taxes) must be 80% or below the Area Median Income (AMI).

Your household must have experienced economic hardship due to COVID-19 (more details follow).

Household Information

The following information help us determine the types and sources of assistance for which you may qualify.

How many people live in your household?(Obligatorio)

This includes all people, regardless of age or relation, that currently live in your home.

Is your household income (before taxes) less than or equal to $86,700/year ($7,225/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $99,050/year ($8,254/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $111,450/year ($9,288/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $123,800/year ($10,317/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $133,750/year ($11,146/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $143,650/year ($11,971/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $153,550/year ($12,796/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $163,450/year ($13,621/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $173,320/year ($14,443/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $183,224/year ($15,269/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $43,350/year ($3,613/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $49,550/year ($4,129/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $55,750/year ($4,646/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $61,900/year ($5,158/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $66,900/year ($5,575/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $71,850/year ($5,988/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $76,800/year ($6,400/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $81,750/year ($6,813/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $86,660/year ($7,222/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Is your household income (before taxes) less than or equal to $91,612/year ($7,634/month)?(Obligatorio)

This includes all sources of income (including job income/wages, pension, social security, disability, child support, and alimony) for all members of the household over the age of 18.

Yes

No

Do you currently receive any government assistance?(Obligatorio)

Types of government assistance may include:

‣ SNAP (Food Stamps)
‣ Free and Reduced School Lunch
‣ TANF (Temporary Assistance for Needy Families)
‣ Section 8/Housing Choice Vouchers
‣ WIC Coupons (Women, Infants, and Children Supplemental Nutrition Program)
‣ Head Start Program
‣ CCDF Voucher (Childcare and Development Program)
‣ LITC (Low Income Tax Credit)
‣ Medicaid
‣ Medicaid CHIP Child Health Insurance
‣ Medicare Part D
‣ SSI (Social Security Insurance)

This helps us qualify you for certain programs.
For examples of types of government assistance, please hover over the question mark for more information.

Yes

No

Additional Information

Is your need for help related to economic factors of COVID-19?(Obligatorio)

Examples of COVID-related economic hardship include:

‣ Job loss of household member due to business being affected
‣ Reduced hours of household member as a result of business being affected
‣ Place of employment closed due to business being affected
‣ More than a 10% increase in rent between 2021 and 2023
‣ More than a 20% increase in utilities between 2021 and 2023
‣ Increased household expenses (childcare, medical bills, food, etc.)
‣ Health issues as a result of COVID-19 factors
‣ Mental health issues as a result of COVID-19 factors
‣ Unstable employment

Other hardship factors may apply

For examples of economic factors of COVID-19, please hover over the question mark for more information.

Yes

No

Unsure

Contact Information

Name(Obligatorio)

Nombre Apellidos

Phone(Obligatorio)

Email(Obligatorio)

Address(Obligatorio)

Dirección Dirección 2 Ciudad Provincia Código Postal

What is the best time to reach you?(Obligatorio)

Select all that apply

Business hours (9:00 am – 5:00 pm)

After 5:00 pm

Weekends

Any time is good

Consent(Obligatorio)

I certify that the information I have provided is true and complete to the best of my knowledge.

By typing my name below, I acknowledge and authorize Loudoun Cares to share the information provided with the agencies, partners, and personnel necessary to process my request for assistance.(Obligatorio)

Comments

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Examen previo REU v2

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