Nyc Housing Development Corporation Application For Apartment (Page 3 of 8) in pdf

Nyc Housing Development Corporation Application For Apartment Page 3

A. Name & Address (Required)

First, Middle Initial,

& Last Name, Suffix:

Current Address Line

City:

State:

Zip Code:

Cell Phone:

Home Phone:

Work Phone:

Email:

How long have you lived at this address?

Years,

Months

Please select one of the following, email or paper mail as your preferred method of communication for ALL future

correspondence regarding this application. If your preferred mailing address is different than the one listed above, please

indicate the preferred mailing address in the space provided:

Email:

Paper Mail

(specify if mailing address is different than above):

B. Household Information (Required)

PRIVACY ACT NOTIFICATION - The Federal Privacy Act of 1974, as amended, requires agencies requesting Social Security Numbers

to disclose (a) whether compliance with the request is voluntary or mandatory, (b) why the information is requested; and (c) how it will be

used. Providing Social Security Numbers and/or Taxpayer Identification Numbers on this application is voluntary. Social Security Numbers

and Taxpayer Identification Numbers which are voluntarily disclosed on this application will be used only to establish an organized and

specific method of identifying applicants who are seeking affordable housing within the City of New York, will be kept in a secure location,

and will not be used or disclosed for any other purpose. Failure to provide a Social Security Number or Taxpayer Identification Number on

this application will not result in an applicant’s disqualification at this time. If your application is selected for further processing, the

building’s landlord will have the right to require this information at that time in order to perform a credit check.

How many persons, including yourself, will live in the unit for which you are applying? ________

Plover Apartments Application Page 3 of 8

Nyc Housing Development Corporation Application For Apartment Page 3