Medical Services Division - Mfp

MONEY FOLLOWS THE PERSON RENTAL APPLICATION

DEPARTMENT OF HUMAN SERVICES

MEDICAL SERVICES DIVISION - MFP

SFN 774 (1-2012)

CONSUMER INFORMATION:

Name: / Date of Proposed Transition:
Transition Coordinator (TC)/ DD Program Manager (DDPM): / TC/DDPM Telephone Number:

PUBLIC HOUSING AUTHORITY INFORMATION:

Name of Public Housing Authority: / Date of Application of Housing Choice Voucher:
Date Placed on Waiting List for Housing Choice Voucher: / Expected Fee for Housing Inspection: / Date of Housing Inspection:
Monthly Income: / Total Apartment Rental Cost: / Proposed Renter Share: / Proposed Voucher Share:

FOR INTERNAL USE ONLY:

Date Application Received:
Proof of Application/Waiting List Status for HCV:
Date Approved by MFP Program Administrator:
Amount of Rent to be Paid by the MFP Rental Assistance:
Date Placed on MFP RGA Program Waiting List:
Starting Date of Assistance / Ending Date of Assistance

APPLICATION PROCESS:

·  Requests for the MFP Rental Gap Assistance program will be made by the participant’s MFP Transition Coordinators/DD Program Manager and submitted for approval to the MFP Program Administrator.
·  The Transition Coordinator/DD Program Manager will complete the MFP Rental Gap Assistance Program application document and provide written evidence from sources of local rental assistance agency that the applicant has applied for a Housing Choice Voucher or other rental assistance, has been found to be eligible for the assistance, and that the applicant has been placed on a waiting list.
·  MFP Rental Gap Assistance program applicants are responsible for finding their own qualified unit
·  The property owner and/or landlord will establish the lease, enforce its provisions and collect the MFP participant’s monthly rent.
·  The ND MFP Rental Gap Assistance Program pays the Transition Coordination or HCBS Provider Agency the difference between the market rent price and the amount of rent paid by the MFP participant/tenant.The Transition Coordinator/HCBS Waiver provider will make the MFP Rental Gap Assistance Program payment to the property owner/landlord on behalf of the MFP participant.
·  The property owner and/or landlord is responsible for the maintenance and upkeep of the facility.
·  Properties eligible for Rental Assistance must be located within the state of North Dakota.
·  The MFP Program Administrator will establish a wait list if needed based on time of application and time of transition to the community.

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