Landlord Screening (Project-Based Voucher)

Applicant Name:

PBV Development Name:

Applicant's Status:

Applicant did not make contact Applicant selected for tenancy Applicant determined to be suitable for possible future tenancy (All hfg BR Units have been leased or committed to another PBV family referred by HANO) Applicant refused housing Applicant denied tenancy for the following reason(s):

Poor Rental History Failed Criminal Background Screening Other (Explain below)

The owner certifies that the above captioned applicant was not offered tenancy by the owner of this property in accordance with the owner’s tenancy selection policy. The owner also certifies that any denial of tenancy does not violate fair housing laws, including but not limited to, Civil Rights Laws and the Violence Against Women Reauthorization Act (VAWA).

Name of Authorized Agent/Owner:

Title of Authorized Agent/Owner:

Please Sign Using Your Initials:

Landlords

Landlord Screening (Project-Based Voucher)