Application For Appeal Of The Disability Rent Increase Exemption Determination Form (Page 2 of 5) in pdf

Application For Appeal Of The Disability Rent Increase Exemption Determination Form Page 2

Application for Appeal of the DRIE Determination

Page 2

SECTION C - GROUND(S) FOR APPEAL

If you are an applicant to whom Finance has denied the DRIE benefit, answer question #17. If

you are an owner appealing Financeʼs approval of DRIE benefit, answer question #18. Check the

reason for your appeal in question #17 or #18 and complete question #19. See instructions for

suggested forms of documentation to support your appeal.

17. Appeal by DRIE Applicant:

I live in an apartment eligible under the law.

2. a.

I am named on the lease or rent order;

I am not named on the lease or rent order but am the tenant of record; or

I am the disabled spouse or registered domestic partner of the tenant of record.

3. a.

I receive Federal Supplemental Security Income;

I receive Federal Social Security Disability Insurance;

I receive US Department of Veterans Affairs pension or compensation; or

I currently receive disability-related Medicaid (and have received either SSI or SSDI in the past.)

I meet the DRIE income eligibility requirement.

I pay more than one-third of my householdʼs aggregate disposable income for rent.

18. Appeal by Property Owner:

The DRIE applicant:

Does NOT live in an apartment eligible under the law.

Is not named on the lease or rent order and is not the tenant of record, the

disabled spouse or registered domestic partner of either.

19. Explain the basis of your appeal (checked in question #17 or #18). If necessary, attach additional sheet(s):

____________________________________________________________________________

20. List all documents that you are enclosing with your application to support your appeal:

(We recommend that you submit copies only and retain your original documents.)

a. __________________________________________________________________________

b. __________________________________________________________________________

c. __________________________________________________________________________

Application For Appeal Of The Disability Rent Increase Exemption Determination Form Page 2