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These programs do not discriminate on the basis of race, color, national origin, gender or gender identity, age, religion, familial status, sexual orientation or disability. These programs are funded through the United States Department of Housing and Urban Development (HUD) Community Development Block Grant (CDBG), HOME, and MassHousing funds. Updated 6.1.21 DOMINICK PANGALLO MAYOR TOM DANIEL, AICP DIRECTOR CITY OF SALEM, MASSACHUSETTS DEPARTMENT OF PLANNING AND COMMUNITY DEVELOPMENT 98 WASHINGTON STREET, 2ND FLOOR ♦ SALEM, MASSACHUSETTS 01970 TELE: [PHONE REDACTED] HOUSING REHABILITATION & DELEADING PROGRAMS APPLICATION CHECKLIST PLEASE MAIL OR DELIVER COMPLETE PACKET TO ADDRESS ABOVE. ALL APPLICANTS: ❑ Housing Rehabilitation & Deleading Programs Application for Assistance ❑ Income Documentation* – copies of the following that apply to any household member: Employed: Twelve (12) weeks of pay stubs for all working household members age 18 and over. Self-employed: Most recent federal tax return, including Schedule C and all attachments. Unemployed: Three most recent months of benefit claim checks. Social Security: Social Security letter from current year stating benefit amount (include any child benefits). Public Assistance: Recent Checks as well as a letter from the agency stating amount of assistance. Pension/Disability: Company letter from current year stating amount of benefits or direct deposit records. Child Support/Alimony Court Order or letter from non-custodial parent/ex-spouse stating payments. Rental Income: Three most recent months of rent receipts. Full-Time Adult Students: Letter from school stating current enrollment status for household members age 18 and over. ❑ Most Recent Federal Tax Return (Form 1040 with all schedules and attachments) ❑ Six most recent months of statements for all savings & checking accounts for each person ❑ Most recent quarterly statements for retirement accounts, CDs, stocks, and any other investments ❑ Property Deed ❑ Most recent mortgage statement with current loan amount ❑ Evidence of Homeowner’s Property Insurance (including Flood Insurance if property is in a Flood Zone) ❑ Lead Inspection Report(s), if available MULTI-FAMILY HOMES: (IF SEEKING REPAIRS TO RENTAL UNITS) ❑ Rental Agreement/Lease for each unit ❑ Tenant Application for each unit ❑ Tenant Household Income Documentation, same as above, for all residents in each unit *If you are an Investor-Owner (ie. not living in the property) applying to the Housing Rehabilitation Program only (not Get the Lead Out), you do not need to submit your household income documentation. Eligibility is based on tenant household income only. GET THE LEAD OUT APPLICANTS: ❑ Loan Application ❑ Last two years of Federal Tax Returns (Form 1040 with all schedules and attachments) ❑ Lead Blood Level Testing Results (applicable only if child under 6 who resides in the home has been tested) ❑ Optional – Child Lead Paint Prevention Program Certificate and abatement expense receipts if applicable *Program eligibility is determined by a projection of gross household income for the coming 12-month period.