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13 <br /> 1 c. Copies of a disability check (e.g., <br /> 2 Social Security Disability Insurance <br /> 3 check or Veterans Disability <br /> 4 Compensation); Intake staff (or <br /> 5 referral staff) observation that is <br /> 6 confirmed by written verification of <br /> 7 the condition from a professional <br /> 8 licensed by the state to diagnose <br /> 9 and treat the condition that is <br /> 10 confirmed no later than fourteen (14) <br /> 11 days of the application for <br /> 12 assistance and accompanied with <br /> 13 one of the types of evidence above; <br /> 14 or other documentation approved by <br /> 15 HUD. <br /> 16 <br /> 17 Victim of Domestic Violence The Local Rent Supplement Program applicants, who <br /> 18 qualify under the definition of Victim of Domestic Violence, <br /> 19 must provide the following documentation at the time of <br /> 20 application to establish that they meet the required criteria: <br /> 21 1. The individual may satisfy the PHA's request by <br /> 22 providing any one of the following three forms of <br /> 23 documentation [24 CFR 5.2007(b)]: <br /> 24 a. A completed and signed HUD-approved <br /> 25 certification form (HUD-50066, <br /> 26 Certification of Domestic Violence, Dating <br /> 27 Violence, Sexual Assault, or Stalking), <br /> 28 which must include the name of the <br /> 29 perpetrator only if the name of the <br /> 30 perpetrator is safe to provide and is known <br /> 31 to the victim; <br /> 32 b. A federal, state, tribal, territorial, or local <br /> 33 police report, or court record, or an <br /> 34 administrative record; or <br /> 35 c. Documentation signed by a person who <br /> 36 has assisted the victim in addressing <br /> 37 domestic violence, dating violence, sexual <br /> 38 assault, or stalking, or the effects of <br /> 39 such abuse. This person may be an <br /> 40 employee, agent, or volunteer of a victim <br /> 41 service provider; an attorney; a mental <br /> 42 health professional; or a medical <br /> 43 professional. The person signing the <br /> 44 documentation must attest under penalty of <br /> 45 perjury to the person's belief that the <br /> 46 incidents in question are bona fide <br /> 47 incidents of abuse. The victim must also <br /> 48 sign the documentation. <br /> 49 <br /> 50 TENANT SELECTION Selection Criteria <br />