Housing Choice Voucher Program (Section 8)
Income Reduction Request

Fields marked with an * are required

SSN Last 4 Digits *
Name *
Phone Number *
Address *
Apartment Number
City *
Zip Code *
Type of household income that has decreased: *
I have not, nor will, apply for any other income program
I certify I have a loss of income and have not nor will apply for any income program. I understand if I choose to apply after this certification is signed, I must notify ACHA, in writing, within 48 hours of application. I further understand if I do not notify ACHA of income and it is discovered that I have received income, I will be held liable for any extra Housing Assistance Payment that was paid on my behalf.
I have applied for the following income program, including but not limited to Unemployment compensation:

By submitting this form, I certify that the information on this form is true and correct. I understand ACHA will need me to provide proof of my reduced income. Your HCVP counselor manager will be contacting you within 72 hours of receiving this form. Due to the high volume of requests, it may take up to 30 days to complete your new rent. Your landlord will be back paid.