Creating Communities. Building Trust.
Project-Based Voucher (PBV)
Landlord Screening Determination Form
 
Please complete this form for each Project-Based Voucher applicant referred to you. Once completed, please click the Submit button below.
 
Applicant Name:  
PBV Development Name:  
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): (Check all that apply)
        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 and Title of Authorized Agent / Owner:  
Please sign using your Initials: