HUD 52646 Voucher

Voucher
Housing Choice Voucher Program

OMB No. 2577-0169
(exp. 07/31/2007)

U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing

Public Reporting Burden for this collection of information is estimated to average 0.05 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
This collection of information is authorized under Section 8 of the U.S. Housing Act of l937 (42 U.S.C. 1437f). The information is used to authorize a family to look
for an eligible unit and specifies the size of the unit. The information also sets forth the family's obligations under the Housing Choice Voucher Program.
Please read entire document before completing form
Fill in all blanks below. Type or print clearly.

Voucher Number

1. Insert unit size in number of bedrooms. (This is the number of bedrooms for which the Family qualifies,
and is used in determining the amount of assistance to be paid on behalf of the Family to the owner.)

1. Unit Size

2. Date Voucher Issued (mm/dd/yyyy)
Insert actual date the Voucher is issued to the Family.

2. Issue Date (mm/dd/yyyy)

3. Date Voucher Expires (mm/dd/yyyy)
Insert date sixty days after date Voucher is issued. (See Section 6 of this form.)

3. Expiration Date (mm/dd/yyyy)

4. Date Extension Expires (if applicable)(mm/dd/yyyy)
(See Section 6. of this form)

4. Date Extension Expires (mm/dd/yyyy)

5. Name of Family Representative

6. Signature of Family Representative

Date Signed (mm/dd/yyyy)

9. Signature of PHA Official

Date Signed (mm/dd/yyyy)

7. Name of Public Housing Agency (PHA)

8. Name and Title of PHA Official

1. Housing Choice Voucher Program
A. The public housing agency (PHA) has determined that
the above named family (item 5) is eligible to participate
in the housing choice voucher program. Under this
program, the family chooses a decent, safe and sanitary
unit to live in. If the owner agrees to lease the unit to the
family under the housing choice voucher program, and
if the PHA approves the unit, the PHA will enter into a
housing assistance payments (HAP) contract with the
owner to make monthly payments to the owner to help
the family pay the rent.
B. The PHA determines the amount of the monthly housing
assistance payment to be paid to the owner. Generally,
the monthly housing assistance payment by the PHA is
the difference between the applicable payment standard
and 30 percent of monthly adjusted family income. In
determining the maximum initial housing assistance
payment for the family, the PHA will use the payment
standard in effect on the date the tenancy is approved by
the PHA. The family may choose to rent a unit for more
than the payment standard, but this choice does not
change the amount of the PHA’s assistance payment.
The actual amount of the PHA’s assistance payment will
be determined using the gross rent for the unit selected
by the family.
2. Voucher
A. When issuing this voucher the PHA expects that if the
family finds an approvable unit, the PHA will have the
money available to enter into a HAP contract with the
owner. However, the PHA is under no obligation to the
family, to any owner, or to any other person, to approve
a tenancy. The PHA does not have any liability to any
party by the issuance of this voucher.
Previous editions are obsolete

B. The voucher does not give the family any right to
participate in the PHA’s housing choice voucher program. The family becomes a participant in the PHA’s
housing choice voucher program when the HAP contract
between the PHA and the owner takes effect.
C. During the initial or any extended term of this voucher,
the PHA may require the family to report progress in
leasing a unit at such intervals and times as determined
by the PHA.
3. PHA Approval or Disapproval of Unit or Lease
A. When the family finds a suitable unit where the owner is
willing to participate in the program, the family must
give the PHA the request for tenancy approval (on the
form supplied by the PHA), signed by the owner and the
family, and a copy of the lease, including the HUDprescribed tenancy addendum. Note: Both documents
must be given to the PHA no later than the expiration
date stated in item 3 or 4 on top of page one of this
voucher.
B. The family must submit these documents in the manner that
is required by the PHA. PHA policy may prohibit the family
from submitting more than one request for tenancy approval at a time.
C. The lease must include, word-for-word, all provisions of
the tenancy addendum required by HUD and supplied by
the PHA. This is done by adding the HUD tenancy
addendum to the lease used by the owner. If there is a
difference between any provisions of the HUD tenancy
addendum and any provisions of the owner’s lease, the
provisions of the HUD tenancy addendum shall control.

Page 1 of 2

form HUD-52646 (7/2000)
ref. Handbook 7420.8

D. After receiving the request for tenancy approval and a
copy of the lease, the PHA will inspect the unit. The PHA
may not give approval for the family to lease the unit or
execute the HAP contract until the PHA has determined
that all the following program requirements are met: the
unit is eligible; the unit has been inspected by the PHA
and passes the housing quality standards (HQS); the rent is
reasonable; and the landlord and tenant have executed the
lease including the HUD-prescribed tenancy addendum.
E. If the PHA approves the unit, the PHA will notify the
family and the owner, and will furnish two copies of the
HAP contract to the owner.
1. The owner and the family must execute the lease.
2. The owner must sign both copies of the HAP contract and must furnish to the PHA a copy of the
executed lease and both copies of the executed HAP
contract.
3. The PHA will execute the HAP contract and return
an executed copy to the owner.
F. If the PHA determines that the unit or lease cannot be
approved for any reason, the PHA will notify the owner
and the family that:
1. The proposed unit or lease is disapproved for specified reasons, and
2. If the conditions requiring disapproval are remedied
to the satisfaction of the PHA on or before the date
specified by the PHA, the unit or lease will be
approved.
4. Obligations of the Family
A. When the family’s unit is approved and the HAP contract
is executed, the family must follow the rules listed below
in order to continue participating in the housing choice
voucher program.
B. The family must:
1. Supply any information that the PHA or HUD determines to be necessary including evidence of citizenship or eligible immigration status, and information
for use in a regularly scheduled reexamination or
interim reexamination of family income and composition.
2. Disclose and verify social security numbers and sign
and submit consent forms for obtaining information.
3. Supply any information requested by the PHA to
verify that the family is living in the unit or information related to family absence from the unit.
4. Promptly notify the PHA in writing when the family
is away from the unit for an extended period of time
in accordance with PHA policies.
5. Allow the PHA to inspect the unit at reasonable
times and after reasonable notice.
6. Notify the PHA and the owner in writing before
moving out of the unit or terminating the lease.
7. Use the assisted unit for residence by the family.
The unit must be the family’s only residence.
8. Promptly notify the PHA in writing of the birth,
adoption, or court-awarded custody of a child.
9. Request PHA written approval to add any other
family member as an occupant of the unit.

Previous editions are obsolete

10. Promptly notify the PHA in writing if any family
member no longer lives in the unit.
11. Give the PHA a copy of any owner eviction notice.
12. Pay utility bills and provide and maintain any appliances that the owner is not required to provide under
the lease.
C. Any information the family supplies must be true and
complete.
D. The family (including each family member) must not:
1. Own or have any interest in the unit (other than in a
cooperative, or the owner of a manufactured home
leasing a manufactured home space).
2. Commit any serious or repeated violation of the
lease.
3. Commit fraud, bribery or any other corrupt or criminal act in connection with the program.
4. Engage in drug-related criminal activity or violent
criminal activity or other criminal activity that threatens the health, safety or right to peaceful enjoyment
of other residents and persons residing in the immediate vicinity of the premises.
5. Sublease or let the unit or assign the lease or transfer
the unit.
6. Receive housing choice voucher program housing
assistance while receiving another housing subsidy,
for the same unit or a different unit under any other
Federal, State or local housing assistance program.
7. Damage the unit or premises (other than damage
from ordinary wear and tear) or permit any guest to
damage the unit or premises.
8. Receive housing choice voucher program housing
assistance while residing in a unit owned by a parent,
child, grandparent, grandchild, sister or brother of
any member of the family, unless the PHA has
determined (and has notified the owner and the
family of such determination) that approving rental
of the unit, notwithstanding such relationship, would
provide reasonable accommodation for a family
member who is a person with disabilities.
9. Engage in abuse of alcohol in a way that threatens
the health, safety or right to peaceful enjoyment of
the other residents and persons residing in the immediate vicinity of the premises.
5. Illegal Discrimination
If the family has reason to believe that, in its search for suitable
housing, it has been discriminated against on the basis of age,
race, color, religion, sex, disability, national origin, or familial
status, the family may file a housing discrimination complaint
with any HUD Field Office in person, by mail, or by telephone.
The PHA will give the family information on how to fill out
and file a complaint.
6. Expiration and Extension of Voucher
The voucher will expire on the date stated in item 3 on the top
of page one of this voucher unless the family requests an
extension in writing and the PHA grants a written extension of
the voucher in which case the voucher will expire on the date
stated in item 4. At its discretion, the PHA may grant a
family’s request for one or more extensions of the initial term.

Page 2 of 2

form HUD-52646 (7/2000)
ref. Handbook 7420.8