Nyc Housing Development Corporation Application For Apartment Page 4
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8List ALL OF THE PEOPLE who will live in the unit for which you are applying, starting with yourself (Head of
Household), and provide the following information. Please indicate if the household member has a disability. If yes, would
you describe the disability as a mobility impairment (MI), visual impairment (VI), or hearing impairment (HI):
Disabled?
First, Mid. Initial, & Last Name,
SSN/TIN
Relationship to
Birth
Sex
Occupatio
Suffix
(Optional
Applicant
Date
n
(MM/DD/Y
MI
VI
HI
)
Y)
Head of Household
Are you or a member of your household a Veteran of the U.S. Armed Forces?
Yes
No
*Please see Definition of Eligibility below.
If you checked either mobility, visual, or hearing impairment, do you or a member of your household require a special accommodation?
Yes – please specify the accommodation required:
No
Definition of veteran from 38 U.S.C. 101(2):
*
The term “veteran” means a person who served in the active military, naval, or air service, and who was discharged
or released there from under conditions other than dishonorable.
C. Income (Required)
Question 1
Are you or a member of your household an employee of the City of New York,
Yes
the New York City Housing Development Corporation, the New York City
Economic Development Corporation, the New York City Housing Authority, or
No
the New York City Health and Hospitals Corporation?
If “yes,” please specify the agency or entity at which you or a member of your
household is employed.
Question 2
If you answered “yes” to Question 1 above, have you personally had any role or
Yes
involvement in any process, decision, or approval regarding the housing
development that is the subject of this application?
No
Note: If you answered “yes” to Question 1 above, you may be required to submit a statement from your employer that your
application does not create a conflict of interest. If you answered “yes” to Question 2 above, you will be required to submit a
statement from your employer that your application does not create a conflict of interest. Such statement would not be required
until later in the application process, after you have been selected through the lottery, when you will also be required to provide
other documents to verify income and eligibility.
Plover Apartments Application Page 4 of 8
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