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TARGETING PROGRAM REFERRAL PACKET
How to Make a Referral to the Targeting Program
REFERRAL AGENCIES:
STEP 1: Assess the household’s potential for success in independent housing with access to the supports
and services determined necessary, appropriate and available.
STEP 2: Review property information using the Property Listing.
Explain the Targeting Program and review Targeting Program housing options within your service area.
Referral Agencies may only refer households to properties within the agency’s service area.
STEP 3: Determine if the household meets Targeting Program eligibility criteria.
Targeting Program eligibility criteria varies by property (see Property Listing for eligibility criteria).
Households must be eligible for and interested in living at the properties to which they are referred.
STEP 4: Complete the Targeting Program Referral forms.
Household Information is necessary for processing referrals. The Referral Agency Point or Back-up
person, identified on the agency’s Agreement to Participate, signs this form.
A separate Letter of Referral is needed for each property to which a household is applying as this form
will be forwarded to the property. The Referral Agency completes Section 1. The Referral Agency must
work with households to apply for Section 8 if the household is not already on the Section 8 waitlist. This
step is necessary prior to referral; however, Targeting Program eligibility is not impacted if waitlists are
closed or the household is ineligible for Section 8. To find contact information for the local Public Housing
Agency visit www.hud.gov/offices/pih/pha/contacts/states/nc.cfm. The head of household must sign
Section 2. DHHS completes Section 3.
STEP 5: Fax the Targeting Program Household Information form and Targeting Program Letter of Referral
to the appropriate DHHS Regional Housing Coordinator (see map on next page).
Referral forms must be reviewed and coordinated by the Referral Agency Point or Back-up person.
If a unit is available, the Regional Housing Coordinator will forward the Letter of Referral to the property
and notify the Referral Agency. If a unit is not available, the Regional Housing Coordinator will add the
household to the Targeted Unit waitlist. Completing the Targeting Program Referral Packet should not
be confused with completing a lease application at the property.
STEP 6: DHHS Regional Housing Coordinator will contact the referral agency when a unit is available.
If the referral agency confirms that the household is ready to apply, DHHS will forward the Letter of
Referral to the property and inform the referral agency that the Letter of Referral has been sent. The head
of household should contact property management, identifying him or herself as a Targeted Unit
household, and complete the lease application within 7 days.
STEP 7: Assist the household with the lease application depending on the household’s needs.
The Property Manager processes the application just as they would for a non referred person including
income verification and rental, credit and criminal background checks (fees may apply). The Property
Manager notifies the head of household and the Regional Housing Coordinator of the application decision
and the Regional Housing Coordinator notifies the Referral Agency.
STEP 8: If the lease application is approved, ensure that the household moves into the Targeted Unit.
The household needs to be prepared to pay a security deposit and utility deposits/fees and may need
assistance in understanding the lease when the Property Manager reviews it with him or her.
If the lease application is denied, contact the household to determine if they plan to appeal the
denial. Notify the Regional Housing Coordinator of their decision. Appeals, including Reasonable
Accommodation requests, must be submitted to Property Management within the time period specified in
the denial letter. Property Management will hold the application/unit open until the appeal process is
complete.
TARGETING PROGRAM
DHHS Regional Housing Coordinator Coverage Areas
Yadkin
Forsyth
Avery
Guilford
Currituck
Pasquotank
Perquimans
Nash
Edgecombe
Martin
Washington Tyrrell
Dare
Wilson
Rowan
Stanly
Rutherford
Union
Henderson
Lincoln
Gaston
Mecklenburg
Cleveland
Anson
Lee
Harnett
For statewide general information contact: Kay Johnson Martha Are Field Operations Manager Acting Regional Housing Manager 704‐619‐6716 919‐855‐4994 kay.r.johnson@dhhs.nc.gov martha.are@dhhs.nc.gov Hyde
Wayne
Moore
Lenoir
Region 3 Tonya Rathbone 704‐530‐9896 1‐888‐591‐4410 fax tonya.rathbone@dhhs.nc.gov Beaufort
Greene
Johnston
Craven
Pamlico
Cumberland
Hoke
Sampson
Scotland
Catawba
Montgomery
Pitt
Cabarrus
Richmond
Caldwell Alexander
Buncombe McDowell
Polk
Camden
Randolph
Burke
Transylvania
Vance
Wake
Davidson
Mitchell
Macon
Clay
Haywood
Cherokee
Jackson
Gates
Hertford
Franklin
Chatham
Iredell
Graham
Northampton
Halifax
Bertie
Davie
Madison Yancey
Swain
Durham
Wilkes
Alamance
Watauga
Surry
Warren
Chowan
Region 1 Russell Cate 919‐480‐9273 1‐888‐331‐8455 fax russell.cate@dhhs.nc.gov Stokes Rockingham
Orange
Caswell Person
Alleghany
Ashe
Granville
Region 4 Stacy Hurley 919‐401‐6850 1‐888‐510‐4487 fax stacy.hurley@dhhs.nc.gov
Region 2 Gillian Hampton 336‐982‐2392 1‐888‐570‐2290 fax gillian.hampton@dhhs.nc.gov Jones
Duplin
Onslow
Robeson
Carteret
Bladen
Pender
New
Hanover
Columbus
Brunswick
Region 5 Thea Craft 919‐855‐4985 1‐888‐426‐9964 fax thea.craft@dhhs.nc.gov TARGETING PROGRAM HOUSEHOLD INFORMATION
Information below is required for purposes of processing Targeted Unit referrals.
Referral Agency name:
Date:
Agency Point or Back-up person name:
Phone no:
Agency Point or Back-up person signature required:
Fax no:
1. Head of Household (name):
2. Date of Birth:
Last 4 digits of SSN: XXX – XX –
3. No. of household members (do not include live-in aides):
No. of live-in aides:
4. If household has 2 or more members, describe the relationship of each person to the head of household.
5. If household has medical reasons for an extra bedroom, please explain.
6. Head of household is a person with a disability... ……………………………...………...
Yes ….……
No
7. Head of household has income based on disability..….. …………………....…….….…
Yes …….…
No
a. Handicapped Unit (wider doors, grab bars) …………………………………………...
Yes ………
No
b. Fully Accessible Unit (curbless shower) .……………………………..………….….…
Yes ………
No
c. Visual/Audio Accessible Unit .…………………………………..…………………..…
Yes …...…
No
d. Ground floor unit if no elevator…..…………………………..………..…………………
Yes …...…
No
8. If question 7 answer is yes, list source of disability income (SSI, SSDI, VA, other):
9. Total monthly gross household income:
10. Indicate whether or not the household needs the following types of apartments:
Information below is optional and is collected for purposes of statewide data reporting.
11. Indicate the type of housing in which the household currently lives?
_____________
12. Indicate all types of housing where the household has lived in the past 12 months.
Own home or rental unit
ICF/MR
Home of family/friend
Adult Care Home/Assisted Living
Psychiatric facility
Nursing Home
Emergency room/Hospital
Group Home
Detox/Substance abuse tx facility
Jail/Prison
Shelter/street/car (Homeless)
Other (specify)
Last Updated 1.16.14
TARGETING PROGRAM LETTER OF REFERRAL
SECTION 1 (Completed by the Referral Agency.)
The head of household must sign a Letter of Referral for each property to which he/she wishes to apply. Referral
Agencies can only refer applicants to properties within the agency’s service area.
Referral of
to
.
Head of Household Name
Property Name (one only)
Please indicate that each of the following statements is accurate by initialing below.
1. _____ Household meets Targeted Unit eligibility criteria as specified on the Property Listing.
2. _____ Household is not comprised solely of full-time students. (If the household is comprised solely of
full-time students, contact DHHS for assistance.)
3. _____ I verified Section 8 status with
Local Section 8 Agency
. The household:
on
Date
is on the Section 8 waitlist.
is not eligible for Section 8.
cannot apply for Section 8 at this time, because the waitlist is closed.
(Application to Section 8 and status verification is required prior to referral, but status does not affect Targeting Program eligibility.)
SECTION 2 (Completed by the Referral Agency and the Head of Household.. Head of Household signature required.)
At lease application, I authorize the North Carolina Department of Health and Human Services (NC
DHHS) and property management to communicate regarding my application for the Targeted Unit.
If my application results in tenancy, I authorize NC DHHS and the Local Lead Agency assigned to this
property,
_______________________________________________________________________________________________________,
Name of Local Lead Agency
(Find the property’s Local Lead Agency on the Property Listing.)
to communicate with property management regarding issues related to my tenancy. Once I become a
tenant, I understand that I may withdraw this authorization at any time.
_____________________________________________
Head of Household Signature
____________________
Date
SECTION 3 (Completed by DHHS.)
DHHS Referral Verification
_________________________________________________
DHHS Staff Signature
Print Name
Last Updated 1.16.14
Date