Baltimore Regional Housing Partnership

Only fill out this form if you are on the wait list and need to report a change. Use this form to report all changes EXCEPT a change of address. See CHANGE OF ADDRESS FORM.

Head of Household Information.

Fill in the required information for you, the Head of Household.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Cell Phone*

Email*

Date of Birth*

Last four of your Social Security #*

What change are you reporting?*

Select All
Updating Eligibility Status
Remove Member from my Application
Add Member to my Application
Change in Other Information

Update Eligibility Status*

I live in Housing Authority of Baltimore City (HABC) family public housing
I lived in HABC family public housing between January 31, 1995, and present
I was displaced from closed or torn down HABC family public housing
I am on the HABC family public housing or Housing Choice Voucher wait list
I live in Baltimore City. BRHP will check if you live in an eligible area

Check an answer for each.

Fill in the information for the household member whom you want to remove.

Name*

First Last

Effective Date*

New Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Last 4 of Social Security #*

Date of Birth*

Fill in or check the required information for each household member you are requesting to add.

Name*

First Last

Social Security #*

Date of Birth*

Sex*

Male
Female
Other

Relationship to Head of Household*

Name

First Last

Social Security #

Date of Birth

Sex

Male
Female
Other

Relationship to Head of Household

Change in Other Information

Check an answer for each.

Current Public Housing Resident with a prior application for Housing Choice Voucher or pending transfer request?

Urgent Need to Relocate Reason

If yes, check all that apply*

Documented health condition of a family member
Need for housing closer to place of employment, education or training
Other

Please use this space to write in OTHER

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If yes, check all that apply*

Head of Household is employed
Head of Household is willing to participate in a job-training program
Head of Household is age 62 or older, or is a person with disabilities

Required Signature

I hereby certify under the penalty of perjury that the declarations I have made in this document are true and complete. I understand and acknowledge that any knowing or willful misrepresentations of the declarations (including submission of falsified supporting documentation to support my declarations) contained in this document may result in civil liability and/or criminal penalties, including but not limited to fine or imprisonment, or both under the provision of Title 18 of the United States Code (USC) Section 1001.

Signature of Head of Household

Date

Untitled

Waitlist Update Form

Waitlist Update

Head of Household Information.

Urgent Need to Relocate Reason

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Required Signature

Waitlist Update Form

Waitlist Update

Head of Household Information.

Urgent Need to Relocate Reason

Section Break

Required Signature

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