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10.1a Ontario Renovates Pre-Screening Form

 

Community Housing                     Effective Date:  
Topic: Investment in Affordable Housing Program Replaces: 
Subject: Ontario Renovates Application Policy No. 10.1.a 

 

INVESTMENT IN AFFORDABLE HOUSING FOR ONTARIO (IAH)

ONTARIO RENOVATES APPLICATION FORM

Please complete the following information in FULL. 

Registered Property Owner’s Name: *
Registered Property Owner SIN #: *
All Owners Live at this address?*
Yes
No
If no, explain: Explain why not all owners live at this address
Spouse or Partner's Name:
Spouse or Partner's SIN #:
Property Address (where the work will be done) - # and Street Name: *
Town/City: *
Province: *
Postal Code: *
Mailing Address (if different):
Property Lot #: *
Concession: *
Township: *
Property Owner Home Telephone #: *
Property Owner Alternate Telephone #: *
Client Type:*
Senior
Family
Single
Special Needs
Other Household Member #1 Name:
Other Household Member #1 Age:
Relationship to Owner:
Other Household Member #2 Name:
Other Household Member #2 Age:
Relationship to Owner:
Other Household Member #3 Name:
Other Household Member #3 Age:
Relationship to Owner:
Other Household Member #4 Name:
Other Household Member #4 Age:
Relationship to Owner:
What is the age of your house?
What is the approximate value of your house?
What type of house do you live in?*
Single
Duplex
Mobile Home
Row House
Semi-detached
Other
If house type is Other, please specify
Insurance Payments up-to-date?*
Yes
No
Mortgage Payments up-to-date?*
Yes
No
Property tax up-to-date?  *
Yes
No
Have you received any other Government Assistance for your home?*(e.g. Residential Rehabilitative Assistance Program, Affordable Housing Program, Investment in Affordable Housing)  
Yes
No
If yes, specify: Specify which Government Assistance Program you received fund from
Date: Date on which you received funds from the Government Assistance Program specified (d/m/y).

Urgent Repairs to Dwelling

Briefly describe repairs and or modifications required:
Repairs to improve Accessibility to dwelling for persons with disabilities:
Repairs to dwelling, Safety-Related Features that support senior’s ability to age-in-place:

Loan Forgiveness

Funding for accessibility repairs made to a home, up to a maximum of $5,000, is in the form of a grant and does not require payment. 
 

Forgiveness of the loan portion will be earned by the homeowner at a rate of 10% per year for 10 years. 

To earn forgiveness, applicants must maintain continued ownership and occupancy of the dwelling and maintain replacement cost property insurance, as well as, adhere to all other terms and conditions of the program. If the homeowner sells or vacates the home, they are responsible for paying back any outstanding loan amount. 
 

PLEASE NOTE: Additional information may be requested, in order to confirm eligibility for assistance. 

Source of Income

To determine eligibility for assistance:

What is Your Total Household Income? *Total household income is the gross current year’s income (before deductions) of ALL household members. Note: For households with disabled members, the applicable deduction Canada Revenue Agency (CRA) tax credit for persons with disabilities may be deducted from gross income.

Yearly gross salary, wages, commissions, part-time earnings etc.

Homeowner (gross):
Spouse (gross):
Other Household Members (gross):

Child Tax Benefit (CTB)

Homeowner (CTB):
Spouse (CTB):
Other Household Members (CTB):

Employment Insurance Benefits, Social Assistance, Welfare, Workers Compensation

Homeowner (EI, etc.):
Spouse (EI, etc.):
Other Household Members (EI, etc.):

Old Age Pension, CPP, Private Pension, Veteran's Allowance, Disability Pension

Homeowner (OAP, CPP, etc.):
Spouse (OAP, CPP, etc.):
Other Household Members (OAP, CPP, etc.):

Bank Interest, investment and dividend income

Homeowner (Interest, etc.):
Spouse (Interest, etc.):
Other Household Members (Interest, etc.):

Alimony or child support payments

Homeowner (Alimony, etc.):
Spouse (Alimony, etc.):
Other Household Members (Alimony, etc.):

Self or seasonally employed

Homeowner (Self-employed):
Spouse (Self-employed):
Other Household Members (Self-employed):

Other income e.g. room and board (please specify)

Homeowner (Other):
Spouse (Other):
Other Household Members (Other):

Totals from above sources of income

Homeowner (Total) [a]:
Spouse (Total) [b]:
Other Household Members (Total) [c]:
Total Household Income [a+b+c]:

Financial Asset Value

To determine eligibility for assistance:

What are your household financial asset values? *Total household financial asset value is the gross asset value confirmed through current banking documentation of ALL household members. Although all accounts are requested, retirement accounts will be not be utilized for the determination of eligibility.

Chequing Accounts

Homeowner (Chequing):
Spouse (Chequing):
Other Household Members (Chequing):

Savings Accounts

Homeowner (Savings):
Spouse (Savings):
Other Household Members (Savings):

Guaranteed Investment Certificates (GIC)

Homeowner (GIC):
Spouse (GIC):
Other Household Members (GIC):

Tax Free Savings Accounts (TFSA)

Homeowner (TFSA):
Spouse (TFSA):
Other Household Members (TFSA):

Registered Retirement Savings Plan (RRSP)

Homeowner (RRSP):
Spouse (RRSP):
Other Household Members (RRSP):

Registered Retirement Income Funds (RRIF)

Homeowner (RRIF):
Spouse (RRIF):
Other Household Members (RRIF):

Registered Education Savings Plan (RESP)

Homeowner (RESP):
Spouse (RESP):
Other Household Members (RESP):

Other Financial Assets

Homeowner (Other):
Spouse (Other):
Other Household Members (Other):

Totals from above Assets

Homeowner (Total Assets) [d]:
Spouse (Total Assets) [e]:
Other Household Members (Total Assets) [f]:
Total Household Financial Assets [d+e+f]:

Declaration

Declaration Acceptance: *

I/We declare that all information given in the application is correct and is complete to the best of my/our knowledge and have read, understood and accept, the terms and conditions below.

Property Owner's Name. *
Date. *Date signed (d/m/y)
Spouse/Partner's Name.
Date. Date signed (d/m/y)

Declaration Terms and Conditions:

The application and supporting documents become the property of the Manitoulin-Sudbury District Services Board. Personal information contained on this form or in attachments is collected by the Manitoulin-Sudbury District Services Board pursuant to the Municipal Freedom of Information and Protection of Privacy Act, (R.S.O. 1990, c.M.56). This information will be used to determine eligibility for the Ontario Renovates Component. Personal information will be disclosed to the Manitoulin-Sudbury District Services Board, the Ministry of Municipal Affairs and Housing, and other municipal/provincial and federal departments and agencies that assist in the provision of affordable housing and to social agencies providing financial assistance to the applicant. Information provided by the household may be shared for the purposes of making decisions, verifying eligibility for assistance or reporting under the investment in Affordable Housing for Ontario program. The applicant consents to the verification, disclosure, and transfer or information given on this form and attachments by or to any of the above entities and will provide any required supporting material.

Pursuant to the Municipal Freedom of information and Protection of Privacy Act; I give my consent and authorization to the Manitoulin-Sudbury District Services Board to: 

  1. Make inquiries to verify the information given in this application and I authorize any person, corporation, or any social agency having knowledge of required information to release such information to the Manitoulin-Sudbury District Services Board. I agree to provide any supporting material required for my application. 
     
  2. Disclose the information given on this form to the Manitoulin-Sudbury District Services Board, the Ministry of Municipal Affairs and Housing and other municipal, provincial, and federal departments and agencies that assist in the provision of affordable housing and social services providing financial assistance to me and persons on this application. I understand that it is my responsibility to inform Manitoulin-Sudbury District Services Board of any changes in information within fifteen (15) days of the change (i.e, change of address, telephone number, family composition, type or amount of income) I agree to provide any supporting material or documents as required by the Manitoulin-Sudbury District Services Board, the Ministry of Municipal Affairs and Housing and other municipal, provincial, and federal departments and agencies.
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