QNbr	Question	Your Response
1	Was the applicant referred by a CoC- partner agency- victim-service provider- or approved provider?	Yes	No
2	Is the applicant applying without the required qualifying referral?	Yes	No
3	Is the applicant homeless- at imminent risk of homelessness- or in unstable/unsafe housing as defined by HUD?	Yes	No
4	Is the applicant fleeing or attempting to flee domestic/dating violence- sexual assault- stalking- or trafficking?	Yes	No
5	Does at least one qualifying population category apply to the household?	Yes	No
6	Is the applicant a U.S. citizen- national- or non-citizen with eligible immigration status?	Yes	No
7	Will the applicant provide documentation of citizenship or eligible immigration status for all household members claiming assistance?	Yes	No
8	Are all (or the relevant) household members ineligible non-citizens with no qualifying immigration status?	Yes	No
9	Can the applicant provide a valid SSN or ITIN (or documentation of exemption) for the required household members?	Yes	No
10	Is the applicant at least 18 years of age- an emancipated minor- or the head of household?	Yes	No
11	Is the household's gross income at or below the program's applicable AMI/income limit?	Yes	No
12	Does the household income exceed the program's income limit?	Yes	No
13	Can the applicant document and disclose all sources of household income?	Yes	No
14	Can the applicant document and disclose all household assets?	Yes	No
15	Will the applicant agree to periodic income/eligibility (and student-status) recertification?	Yes	No
16	Does the applicant have unreported or undisclosed income sources?	Yes	No
17	Can the applicant document all household members and provide proof of relationship (birth certificates- IDs- custody documents)?	Yes	No
18	Are all household members who will occupy the unit listed on the application?	Yes	No
19	Are there undisclosed individuals living in the household who are not listed on the application?	Yes	No
20	Is any household member subject to a lifetime sex-offender registration requirement?	Yes	No
21	Has any household member been convicted of manufacturing/producing methamphetamine on assisted-housing premises?	Yes	No
22	Will the applicant consent to a criminal background check?	Yes	No
23	Has the applicant been evicted from assisted housing for drug-related criminal activity within the lookback period?	Yes	No
24	Is any household member currently engaged in illegal drug use (threatening other residents)?	Yes	No
25	Does the applicant owe an unpaid debt to a PHA- HUD program- or prior housing provider?	Yes	No
26	Has any household member committed fraud- bribery- or other corrupt acts in connection with a federal housing/assistance program?	Yes	No
27	Is the applicant willing to participate in coordinated entry and vulnerability assessment?	Yes	No
28	Does the applicant need- and is willing to engage in- case management and supportive services?	Yes	No
29	Will the applicant actively search for and occupy an eligible unit within the program's timeframe?	Yes	No
30	Will the unit pass- and will the applicant allow- the required housing-quality inspections (HQS/NSPIRE)?	Yes	No
31	Will the rent be reasonable and within the program's payment standard?	Yes	No
32	Will the applicant sign a qualifying lease (and HAP contract where applicable)?	Yes	No
33	Will the assisted unit/home be the applicant's primary residence?	Yes	No
34	Does the applicant intend to sublet- transfer- or use the unit for non-residential or commercial purposes?	Yes	No
35	Will the applicant pay the required tenant share of rent and any required security/utility deposits?	Yes	No
36	Will the applicant comply with the lease terms- house rules- family obligations- and program requirements (including residential-only use)?	Yes	No
37	Will the applicant promptly report changes in household income- composition- or status?	Yes	No
38	Does the applicant understand their rights under the Violence Against Women Act (VAWA)?	Yes	No
39	Does the applicant understand their fair-housing rights and protected-class status?	Yes	No
40	Do full-time student household members meet a qualifying student exception?	Yes	No
41	Is the household composed entirely of full-time students who do NOT meet any qualifying exception?	Yes	No
42	Does the application comply with the program's jurisdiction- allocation- and portability requirements?	Yes	No
43	Is the applicant receiving duplicative federal/state rental assistance for the same housing?	Yes	No
44	Will the applicant certify (under penalty of perjury where applicable) that all information provided is true- complete- and accurate?	Yes	No
45	Will the applicant consent to third-party verification and release of information for all submitted eligibility data?	Yes	No
46	Has the applicant provided false- misleading- or incomplete information on this or a prior application?	Yes	No
47	Can the applicant provide valid government-issued photo identification (or accepted ID documents)?	Yes	No
48	Is the property located within an eligible rural area/census tract?	Yes	No
49	Can the applicant provide verifiable employment/income history?	Yes	No
50	Does the applicant have stable- sufficient income to meet mortgage obligations?	Yes	No
51	Does the applicant meet the minimum credit-score requirement (or alternative credit guidelines)?	Yes	No
52	Is the applicant's debt-to-income (DTI) ratio within program limits?	Yes	No
53	Can the applicant provide recent federal tax returns (or IRS verification of non-filing)?	Yes	No
54	Can the applicant provide recent bank statements for all accounts?	Yes	No
55	Can the applicant provide recent pay stubs?	Yes	No
56	Will the applicant complete a HUD-approved homebuyer education/financial-literacy course?	Yes	No
57	Will the applicant occupy the home within the required timeframe after closing?	Yes	No
58	Will the applicant maintain and occupy the property in compliance with program/affordability requirements?	Yes	No
59	Does the property meet (or will it meet after rehab) minimum habitability and safety standards?	Yes	No
60	Is the applicant in active bankruptcy proceedings (or recent disqualifying bankruptcy)?	Yes	No
61	Has the applicant had a foreclosure- deed-in-lieu- or short sale within the lookback (or active proceedings)?	Yes	No
62	Is the applicant currently delinquent on any federal debt (taxes- student loans- child support)?	Yes	No
63	Does the applicant own other residential property suitable for occupancy?	Yes	No
64	Has the applicant been convicted of a disqualifying felony (e.g.- fraud- financial- or other) within the lookback period?	Yes	No
65	Is the applicant debarred- suspended- or excluded from receiving federal funds/benefits?	Yes	No
66	Has the applicant reached the maximum allowable amount/duration of assistance?	Yes	No
67	Does the applicant intend to use the property as a rental- vacation home- or investment property?	Yes	No
68	Does the applicant have unresolved judgments- liens- or garnishments exceeding the program threshold?	Yes	No
69	Is the applicant currently incarcerated (with no qualifying release date)?	Yes	No
70	Is the applicant a current resident of- or located within- the jurisdiction or service area administering the program?	Yes	No
71	Does the applicant (or a household member) have a documented qualifying disability/condition with verification?	Yes	No
72	Has the applicant completed- or is willing to complete- the required application packet?	Yes	No
73	Has the applicant been terminated from a housing/assistance program for cause within the lookback period?	Yes	No
74	Does the applicant have an active felony warrant- probation violation- or is fleeing prosecution?	Yes	No
75	Is the applicant unwilling to engage in required services- case management- lease terms- or program rules?	Yes	No
76	Is the applicant already permanently/stably housed without need for assistance?	Yes	No
77	Has the applicant refused to provide required documentation or sign required forms?	Yes	No
78	Is the applicant a non-resident (outside the service area) with no intent to relocate?	Yes	No
79	Did the applicant (or their family member) perform qualifying U.S. military service?	Yes	No
80	Was the applicant discharged under conditions other than dishonorable?	Yes	No
81	Is the applicant eligible for VA healthcare services?	Yes	No
82	Is the applicant willing to undergo VA clinical assessment and case management?	Yes	No
83	Can the applicant provide a DD-214 or equivalent proof of military service?	Yes	No
84	Was the applicant's only service non-qualifying (e.g.- training-only Reserve/Guard without federal activation)?	Yes	No
85	Was the applicant discharged dishonorably from military service?	Yes	No
86	Is the applicant ineligible for VA healthcare benefits?	Yes	No
87	Is the disability of long-continued and indefinite duration (12+ months)?	Yes	No
88	Does the disability substantially impede the applicant's ability to live independently or perform daily activities?	Yes	No
89	Would more suitable housing improve the applicant's ability to live independently?	Yes	No
90	Is the applicant willing to sign the required HUD consent- release-of-information- and certification forms (e.g.- 9886/9887)?	Yes	No
91	Is the applicant capable of living independently with or without supportive services?	Yes	No
92	Is the head of household- co-head- or spouse the person with the qualifying disability?	Yes	No
93	Does any household member's pattern of alcohol abuse threaten other residents?	Yes	No
94	Is the applicant seeking disability housing without a qualifying disabled head of household?	Yes	No
95	Is the applicant unable or unwilling to live independently or meet essential lease obligations even with reasonable accommodation?	Yes	No
96	Does the applicant pose a direct threat to the health and safety of other residents or property?	Yes	No
97	Is the assistance sought for a property that is not the applicant's primary residence?	Yes	No
98	Is the applicant a full-time student dependent of income-ineligible parents who does not meet a student exception?	Yes	No
99	Is the applicant the named tenant/lessee residing in the unit for which assistance is sought?	Yes	No
100	Is the rental unit owned by an immediate family member- or is the applicant related to/part of the owner's household?	Yes	No
101	Has a household member qualified for unemployment benefits or been unemployed within the lookback?	Yes	No
102	Has the household experienced a COVID-19-related financial hardship?	Yes	No
103	Can the applicant demonstrate a risk of homelessness or housing instability?	Yes	No
104	Does the applicant owe unpaid rent/utilities or have past-due- eviction- or shut-off notices?	Yes	No
105	Is the applicant currently living in unsafe or unhealthy housing conditions?	Yes	No
106	Has the applicant already received assistance (or a third-party payment) covering the same expenses/time period?	Yes	No
107	Is the requested assistance for an eligible (current or prospective) rent expense?	Yes	No
108	Is the applicant requesting assistance for eligible utility- energy- or internet costs?	Yes	No
109	Is the applicant requesting assistance for an ineligible expense (e.g.- telephone or cable TV)?	Yes	No
110	Is the unit an ineligible type (e.g.- hotel/motel/short-term rental)?	Yes	No
111	Can the applicant provide a lease- mortgage statement- or other proof of rental obligation?	Yes	No
112	Is the landlord willing to participate and accept direct payment (with contact/payment info provided)?	Yes	No
113	Does the applicant agree that assistance will be used solely for eligible expenses?	Yes	No
114	Does the applicant understand that assistance is subject to the availability of funds and is not guaranteed?	Yes	No
115	Does the applicant qualify under a local or state-designated preference category?	Yes	No
116	Is the applicant willing to attend a mandatory program briefing if selected?	Yes	No
117	Has any household member been convicted of a violent crime against persons or property within the lookback period?	Yes	No
118	Has any household member engaged in drug-related criminal activity within the program's lookback period?	Yes	No
119	Does the applicant have an unresolved history of lease violations- evictions- property damage- or housing-related debt?	Yes	No
120	Has any household member committed violence against another household member (VAWA perpetrator restriction)?	Yes	No
121	Is at least one household member 62 or older and a primary occupant of the unit?	Yes	No
122	Will the applicant consent to a credit and/or rental-history verification?	Yes	No
123	Can the applicant provide references from previous landlords?	Yes	No
124	Is the household composed solely of members under the required elderly age- with no qualifying elderly member?	Yes	No
125	Does the applicant require a level of medical/nursing care that exceeds what the program can support?	Yes	No
126	Has the applicant disposed of assets for less than fair market value within the lookback period?	Yes	No
127	Does the applicant understand the program's rent-calculation and continued-occupancy rules?	Yes	No
128	Does the applicant receive other rental assistance that may be combined (affecting rent calculation- not eligibility)?	Yes	No
129	Has the applicant applied for- or is willing to apply for- all mainstream benefits they may be entitled to?	Yes	No
130	Does the applicant meet the chronic-homelessness threshold (long-term or repeated episodes)?	Yes	No
131	Was the applicant recently discharged from an institution without stable housing?	Yes	No
132	Do the applicant's assets exceed the program's asset limit?	Yes	No
133	Does the applicant have a history of arson convictions that pose a risk to other residents?	Yes	No
134	Has the applicant been banned or barred from the housing agency's properties or from federally assisted housing?	Yes	No
135	Is the applicant under the program's required minimum age?	Yes	No
136	Does the applicant have stable income sufficient for housing stability without the program?	Yes	No
137	Did the applicant voluntarily terminate employment within the lookback without a valid recognized reason?	Yes	No
138	Does the applicant have an active substance-use disorder requiring immediate inpatient treatment?	Yes	No
139	Is the applicant a dependent of another household member already enrolled in the program?	Yes	No
140	Does the applicant have reliable transportation/access to program activities?	Yes	No
141	Is the applicant legally authorized to work/participate where required?	Yes	No
142	Is the applicant able to commit to the required program duration?	Yes	No
143	Are there active legal actions (e.g.- protective orders- civil actions) that would interfere with program participation?	Yes	No
144	Can the applicant provide third-party verification of their homeless history?	Yes	No
145	Can the applicant document prior residence (or absence thereof) for the required period?	Yes	No
146	Is the applicant residing in an institutional setting beyond program limits with no prior qualifying homeless episode?	Yes	No
147	Can the applicant provide proof of residency?	Yes	No
148	Does the applicant own the property for which rental assistance is being sought?	Yes	No
149	Will the household comply with the program's occupancy standards?	Yes	No
150	Is the applicant a first-time homebuyer?	Yes	No
151	Does the purchase price fall within the program's maximum purchase-price limits?	Yes	No
152	Is the applicant the unremarried surviving spouse of a qualifying veteran?	Yes	No
153	Does the applicant have- or can obtain- a valid VA Certificate of Eligibility (COE)?	Yes	No
154	Does the applicant have an existing (VA or non-VA) mortgage on the property?	Yes	No
155	Is the applicant refinancing to obtain a lower rate or switch from ARM to fixed-rate?	Yes	No
156	Are the applicant's payments on the existing loan current (within allowed late tolerances)?	Yes	No
157	Is the applicant attempting to take cash out of the home's equity through this refinance?	Yes	No
158	Does the applicant meet VA/lender credit and income requirements?	Yes	No
159	Is the applicant a Native American veteran (or a veteran married to a Native American)?	Yes	No
160	Will the property be located on Federal Trust Land?	Yes	No
161	Does the applicant's tribal government have a Memorandum of Understanding (MOU) with the VA?	Yes	No
162	Is the applicant purchasing land that is NOT located on Federal Trust Land?	Yes	No
163	Does the applicant have a qualifying service-connected disability?	Yes	No
164	Does the applicant meet one of the specific severe-disability criteria required for the adaptive-housing grant?	Yes	No
165	Will the grant be used to build- buy- or adapt a home to accommodate the applicant's disability?	Yes	No
166	Will the applicant hold title to the home being adapted or purchased?	Yes	No
167	Is the applicant's disability NOT service-connected?	Yes	No
168	Is the applicant currently eligible for an SAH or SHA grant?	Yes	No
169	Is the applicant temporarily living in a home owned by a family member?	Yes	No
170	Does the applicant own the home where the temporary adaptations are needed (disqualifying for TRA)?	Yes	No
171	Did the applicant receive a Specially Adapted Housing (SAH) grant?	Yes	No
172	Is the applicant under age 70?	Yes	No
173	Is the applicant age 70 or older at the time of application?	Yes	No