Program Overview

Please provide the following information.

CALIFORNIA COVID-19
RENT RELIEF PROGRAM

If you received an email invitation to complete this application, please provide the 6-digit TENANT case
number provided in the invitation email. If you are initiating this application on behalf of tenants, skip this
section and move to Section A: Landlord Information.

Please provide your Tenant's first and last name:

Please provide your Tenant's phone number:

Please provide your Tenant's email address

OVERVIEW
The California COVID-19 Rent Relief program may be able to help the many Californians with unexpected
financial hardships created by COVID-19. The program is intended to help eligible households cover unpaid
rent and utilities, future payments for rent and utilities, and to provide funding for housing stabilization
services.

Simple 3-Step Application Process

1. Fill out the application to the best of your ability. It will help us to determine if your tenant will qualify
for assistance and make sure we send you the right amount of money.

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 2. The State of California will notify your tenant that the Rent Relief process is underway. Your tenant
must participate in the program to receive payment. We will begin to process your application only
after your tenant submits a corresponding application.

3. Once you are done your Case Manager will help you if more information is required. Please respond
to any requests for additional information so that your application is complete! You can indicate
whether you want to be contacted by email or phone in the application. If you do not respond we will
not be able to pay you directly.

Most people take about 30 minutes to complete this secure and private application. We will not share your
information without your permission.

What can I do to speed up the process?

• Let your tenant(s) know you have applied. Once you submit the landlord application, please contact
your tenant(s) and encourage them to follow the instructions provided in the invitation email (titled
“You Are Invited: CA COVID-19 Rent Relief Program” and sent from no-
reply@neighborlysoftware.com).
• Watch for emails and/or respond to calls from the California COVID-19 Rent Relief Program.
• Make sure you are uploading the right information. We accept photos, scans, electronic documents,
and text files to make it easier to upload your information.
• Provide good contact information for both you and your tenant(s) if possible. Providing your tenant’s
email address and phone number will help speed up the process.

What should I expect from the program?

• As a participating landlord, payment made on behalf of your tenant(s) will be made directly to you.
You will be notified via email when your payment is approved.
• Your information is private. No information regarding legal status will be provided to any other
government agency.
• You can request information on the status of your application by either logging into this application
portal, or by calling toll free 1-833-430-2122.

Please do not submit multiple applications as this may result in a lengthier delay in the application review
process. Do not submit an application for each tenant. The application you submit should encompass all
your rental properties and tenants.

Both you and your tenant(s) will be notified when payment is processed.

For an overview of the program, please visit our main page at www.housingiskey.com. You can also locate
additional information regarding eviction protections under eviction protection resources in the same website.

If you need assistance completing an application, our Call Center staff can complete the application with you
by phone by calling 1-833-430-2122. Call center hours are from 7:00 AM – 7:00 PM Pacific time Monday-
Sunday. Language assistance is available.

As part of the Program application, all landlords will be required to submit the following paperwork required
to perform the eligibility review: TAX FORM: Please provide an IRS W-9 Form.

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FALSE OR FRAUDULENT PAPERWORK OR STATEMENTS
Falsification of paperwork or any material falsehoods or omissions in the Application, including knowingly
seeking duplicative benefits, is subject to state and federal criminal penalties. You are particularly put on
notice that Title 18, Section 1001 of the United States Code states that a person shall be fined or imprisoned
for up to five (5) years for knowingly and willfully making any materially false or fraudulent statement or
representation to any U.S. Department or Agency.

REASONABLE ACCOMMODATION
If you or anyone in your household is a person with disabilities and requires a specific accommodation to
apply for this Program, please contact the program call center by phone at 1-833-430-2122.

If reasonable accommodations are required, the program will guide you to a local partner organization that
can assist you with your application.

FAIR HOUSING
HCD follows all federal and state requirements related to fair housing and discrimination. HCD also takes
steps to affirmatively further fair housing in California and to ensure that all of its programs are free of
discrimination. To learn more about fair housing and anti-discrimination, please visit https://www.dfeh.ca.gov.

TO REPORT FRAUD, WASTE, AND ABUSE:

All HCD employees and contractor employees have a responsibility to report fraud, waste, and abuse that
they suspect are occurring or have occurred. The public is invited to share such concerns. Any suspected
fraud in connection with California’s COVID-19 Rent Relief program should be reported to HCD for
immediate review. HCD reserves the right to decline funding or participation if it is determined that fraud has
occurred.

Report Fraud To:

California COVID-19 Rent Relief program: reportfraud@ca-rentrelief.com
U.S. Department of Treasury: Report fraud, waste, and abuse | U.S. Department of the Treasury Office of Inspector
General: Report Fraud, Waste, and Abuse | Office of Inspector General (treasury.gov)
For General Program Questions, Contact Us Here:
By phone: (833) 430-2122

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 A. Landlord Information

Please provide the following information.

PRIMARY LANDLORD

A.1. Landlord Name (as appears on W9)

A.2. Landlord Address (as appears on W9)

A.3. Landlord Telephone Number

A.4. Landlord Email

A.5. DUNS Number, if applicable

A.6. EIN, TIN or SSN for Payment Records (as appears on W9 or W8)

A.7. Did you provide an EIN, TIN, or SSN?

A.8. Please provide a completed and signed IRS W-9 FORM using the EIN/SSN you select above.
Your records will need to be uploaded into the online application. You can upload a picture, a scanned copy
of your document, an electronic document, or a screen shot of your document

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A.9. Please indicate your preferred method of payment (ACH or Check).

A.10. If you selected check, please provide the mailing address to receive the check. (NOTE: any
payment from the Program will be mailed to this address).

ALTERNATE LANDLORD CONTACT

A.11. Alternate Contact Name (you may choose to provide a Property Manager’s name)

A.12. Alternate Contact Telephone Number

A.13. Alternate Contact Email Address

A.14. Vacated Units: Are you requesting assistance for unpaid rents owed by any former tenants
who are no longer residing in the unit? Unpaid rents would need to be from the covered period.

Yes

No

If Yes: The former tenant must complete a tenant application to confirm eligibility. Payments for rents owed
by tenants who vacated the unit may only be payable to the landlord and must be used to cover rents owed
during the applicable period. Please identify the name(s) of former tenants for whom you are requesting
payment. Please note you will also need to upload complete tenant and unit information in the next step of
this application (under B. Tenant Information). Current contact information is critical in processing claims for
vacated units.

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Number of Vacated Units:

Former Tenant Name (please enter full tenant names separated by a semicolon ; ):

A.15. Subsidized Unit: Is the rental property a subsidized unit that requires tenant income
verification for eligibility? Subsidies include Housing Choice Vouchers, Low-Income Housing Tax
Credits, Tenant-Based Rental Assistance, Veteran Affairs Supportive Housing, or other income
restricted housing that required income verification and recertification for eligible tenants.

Yes

No

If yes, Please indicate the name of the tenant, the subsidy source, the applicable income limit (e.g. 30% AMI,
60% AMI, 80% AMI) for the unit, and the date of the last tenant recertification for each subsidized unit for
which you are requesting assistance.

Tenant Name Subsidy Income Limit Recertification Date

A.16. Eviction: Have you or do you intend to file for eviction against this tenant for nonpayment of
rents during COVID-19?

Yes

No

If yes, Please indicate the name of the tenant(s) below. For more information about eviction protections
under AB832, please see Eviction Protections information at housingiskey.com.

Number of Units that you are seeking eviction against:

Tenant Name (please enter full tenant name(s) separated by semicolon ; ):

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Documentation

Please provide one of the following documentations to substantiate proof of ownership for all rental properties
for which you are seeking assistance. Your records will need to be uploaded into the online application. You
can upload a picture, a scanned copy of your document, an electronic document, or a screen shot of your
document

Property deed

Property tax receipt/documentation

Current mortgage statement

Homeowner/property insurance

Other documentation allowed on a case-by-case basis

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 B. Tenant(s) Information

Please identify all of your tenants that you would like to participate in the California COVID-19 Emergency
Rental Assistance Program. Upon submission of this Landlord application, all the tenants listed below will
receive an email invitation to participate in the California COVID-19 Emergency Rental Assistance Program.

For EACH tenant, please provide the following:

• Rent statement or ledger documenting their arrears (by each month, including any rental assistance
previously paid directly to the landlord, if available).
• Provide Lease or Written Agreement
• If the rental property is a subsidized unit that requires tenant income verification for eligibility, please
upload tenant’s income and recertification documents.
• If you cannot get your tenant’s email address or if your tenant does not have an email address, we
encourage you to support your tenant in calling (833-687-0967) to make an appointment with an
application assistance professional for free application assistance.
To complete this portion of the application, for every tenant whom you do not have an email, use support@ca-
rentrelief.com as the tenant’s email address. This will initiate a support ticket to assist your case manager in
connecting your application with your tenant. Do not use your email address or include a false email, as that
will compromise your application and will cause a delay in the processing. of the application.
Email Address Address Phone Number

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Submit

By submitting this Application for California Department of Housing and Community Development
(“HCD”) California COVID-19 Rent Relief Program (the “Program”), I, as an authorized representative of
the Landlord, hereby certify that:

1. Binding Contract. I am hereby entering into a binding contract (“Agreement”) with the individual listed as
Tenant in this Application and HCD, but only to the extent that HCD determines, in its sole discretion, that
Tenant is eligible for the Program. This Agreement is not binding on HCD until HCD approves the financial
assistance under the Program. For the purposes of this Agreement the term “lease” refers to any formal or
informal rental agreement between a landlord and tenant.

2. Tenant and Unit Information.

a. The Tenant named in this Application is one of the persons that is currently occupying the Unit for whom
assistance is being requested and Tenant has occupied and will occupy the Unit for all periods for which
assistance is being requested. In the case of a self-evicted tenant, the Tenant named in this Application
is one of the persons that previously occupied the Unit for whom assistance is being requested and
Tenant occupied the Unit for all periods for which assistance is being requested.
b. Tenant and I entered into a residential lease for the housing unit specified within this Application (the
“Unit”).
c. The Unit is located at an address within the State of California.
d. I am the property owner of the Unit or have entered into a management/agency agreement that gives
me the authority to lease the Unit and participate in the Program. I will provide HCD with proof of
ownership or a Notice of Owner Management Agreement signed by the property owner.
e. The information provided in the Application regarding the terms of the lease with Tenant, the rent
amount, and any utility amounts are true and accurate. I will provide a copy of Tenant’s lease or written
agreement to HCD or, if there is no current written lease, I will provide documentation regarding the rent
owed by the Tenant.
f. Tenant’s completion of the application based on the contract rent does not constitute an admission or a
waiver of tenant’s right to contest the rental value based on habitability.

3. Assistance Payments. Tenant requires financial assistance to pay the rental arrears that have accumulated
and are owed under the lease, Tenant requires assistance to pay current or future rental payment(s), and/or
Tenant requires assistance to pay the arrearages that have accumulated for utility payments that are owed to
me or a Utility Provider. I agree to accept financial assistance on behalf of Tenant subject to the requirements
herein.

a. Payments made under the Program for late rent, utilities, and fees may only cover amounts that became
due after April 1, 2020 and may not cover any amounts incurred prior to that date. I am not requesting
assistance for any amount that became due prior to April 1, 2020.
b. I acknowledge that in no case am I entitled to a payment for a month that Tenant did not or does not
reside at the Unit. I shall return any such payment to HCD immediately.
c. I will accept payment from the Program via check for the benefit of Tenant, unless HCD approves
another form of payment in writing.
d. I shall not apply for or receive any private or federal assistance that is duplicative of the financial
assistance provided under the Program.
e. I shall repay any duplicate payment or overage to HCD immediately.

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 f. I shall apply payments to Tenant’s account(s) as directed by HCD.

4. Application of Payments. If Tenant is eligible for assistance under the Program, HCD shall provide me, as
Landlord, a breakdown of the amount(s) of assistance being provided in a form similar to the one below and I
shall apply the assistance provided accordingly. Such amount(s) of assistance, to be subsequently provided,
are hereby incorporated into this Agreement by this reference.

a. Late Rent Owed to Landlord.

The Amount of Rent owed by Tenant each month under the lease.
The Total Amount of Late Rent Owed being provided to Landlord on the Tenant’s behalf.

b. Current and/or Future Rent Payments.

The number of months of current and/or future rent payments (which may not exceed three months), the
amount of each payment, and the total amount Landlord will receive on Tenant’s behalf.

5. Limits on Assistance. Combining payments made under the Program, Tenant may not receive more than
fifteen (15) months of cumulative assistance. However, if, at the time of application, Tenant is fifteen (15)
months or more behind in rent or utility payments, then Tenant may receive up to eighteen (18) months of
cumulative assistance.

6. Recapture of Funds: If I receive any payment in excess of what is owed to me, I shall immediately return the
excess funds to HCD. I shall mail all refund payments to HCD at the following address:

Department of Housing & Community Development

ATTN: Accounts Receivable
2020 W. El Camino Avenue, Suite 300
Sacramento, CA 95833

The refund payment should be in the form of a check, cashier’s check, or money order made payable to the
California Department of Housing and Community Development. Payment must reference Tenant’s Name,
Landlord Case Number, and Tenant Case Number.

7. Landlord Obligations.
a. I shall not pursue eviction for any rent or fees due prior to April 1, 2020, but may use other means to
collect such arrearage.
b. I acknowledge that nothing in this certification waives my right to file an eviction based on a
nonmonetary default of Tenant.
c. I hereby waive, release, and discharge any claim for rent arrearage, late fees, or possession against
Tenant for nonpayment of rent for any month covered under the Program.
d. I agree to withdraw any such pending eviction action against Tenant and shall not initiate any future
actions for rent payments that are covered under this Agreement.
e. My activities conducted and records maintained pursuant to this Agreement are subject to monitoring
and evaluation by the State, the Comptroller of the Treasury, or their duly appointed representatives.
f. I acknowledge that all information collected, assembled, or maintained by the California COVID-19 Rent
Relief program pertaining to this certification, except personally identifying information and records made
confidential by law or court order, are subject to the California Public Records Act and must provide
citizens, public agencies, and other interested parties with reasonable access to all records pertaining to
this Contract subject to and in accordance with the California Public Records Act.

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 g. I shall maintain documentation for all payments received and activities conducted under this Agreement.
I shall maintain all books, records, and documents containing such documentation for a period of five (5)
full years from the date of the final payment I receive under this Agreement. I shall allow audit of such
documentation by the State, the Comptroller of the Treasury, or their duly appointed representatives at
any reasonable time upon reasonable notice. If applicable, financial statements must be prepared in
accordance with generally accepted accounting principles.

8. Judicial Enforcement. I, Tenant, or HCD may judicially enforce this Agreement.

9. Headings. The headings herein are inserted only for convenience of reference and in no way define, limit, or
describe the scope or intent of this Agreement, of any particular provision thereof, or the proper construction
thereof.

10. Severability. The invalidity of any clause, part, or provision of this Agreement will not affect the validity of
the remaining portions of this Agreement.

11. Governing Law. This Agreement is governed by the laws of the State of California and, where applicable,
laws of the United States of America.

 By submitting this Application, I certify that all information I provided to HCD is true, accurate, and
complete, and if requested, I shall provide further paperwork to support any representations.

 I further acknowledge that falsification of information or any material falsehoods or omissions in

the Application, including knowingly seeking duplicative benefits, is subject to state and federal
criminal penalties. I understand that I am particularly put on notice that Title 18, Section 1001 of the
United States Code states that a person shall be fined or imprisoned for up to five (5) years for
knowingly and willfully making any materially false or fraudulent statement or representation to any
U.S. Department or Agency.

 I certify that, by accepting payment under the Program, such payment will be payment in full of the
entire rental debt owed by the Tenant and the Tenant’s household to me for the specified time period.
Furthermore, I hereby release any and all claims for nonpayment of rental debt owed for the specified
time period, including a claim for unlawful detainer pursuant to paragraph (2) and (3) of Section 1161 of
the Code of Civil Procedure, against the Tenant and the Tenant’s household.

Signature

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