Item 2 - Proposed Guidelines for the New Orange County Local Rent Supplement Program (OC-LRSP)

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6 d. Intake staff (or referral staff) observation that is confirmed by written verification of the condition from a professional licensed by the state to diagnose and treat the condition that is confirmed no later than fourteen (14) days of the application for assistance and accompanied with one of the types of evidence above; or other documentation approved by HUD. Victim of Domestic Violence The Local Rent Supplement Program applicants, who qualify under the definition of Victim of Domestic Violence, must provide the following documentation at the time of application to establish that they meet the required criteria: 1. The individual may satisfy the PHA’s request by providing any one of the following three forms of documentation [24 CFR 5.2007(b)]: a. A completed and signed HUD-approved certification form (HUD-50066, Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking), which must include the name of the perpetrator only if the name of the perpetrator is safe to provide and is known to the victim; b. A federal, state, tribal, territorial, or local police report, or court record, or an administrative record; or c. Documentation signed by a person who has assisted the victim in addressing domestic violence, dating violence, sexual assault, or stalking, or the effects of such abuse. This person may be an employee, agent, or volunteer of a victim service provider; an attorney; a mental health professional; or a medical professional. The person signing the documentation must attest under penalty of perjury to the person’s belief that the incidents in question are bona fide incidents of abuse. The victim must also sign the documentation. TENANT SELECTION Selection Criteria Families will be selected based on the following targeted population selection criteria and selection preference method. Within the preference category, families and individuals will be selected based on severity of needs. The OCHA system of preferences may select families either according to the date and time of application, or by a random selection process. When selecting families from the Waiting List OCHA is required to use targeted funding to assist only those families who meet the specified criteria, and OCHA is not permitted to skip down the waiting list to a family that it can afford to subsidize when there are not sufficient funds to subsidize the family at the top of the waiting list. Targeted Population: • Homeless Individuals • Homeless Families, including those families who may have children in child protective services 8