1. (a) A pre-approval request shall include the following information:

   1. (1) The applicant’s contact information:

      1. a. Full name;
      2. b. Mailing address, including street name and number or post office box number, city or town, state, and zip code; and
      3. c. Email address and daytime telephone number including area code;
   2. (2) The physical address where the remedy will be completed including street name and number, city or town, and zip code, if different from the mailing address provided in (1)b. above, including all unit numbers or additional addresses that will benefit from the remedy; and

   3. (3) The applicant’s income information including:

      1. a. Number of family members living in the household, not including tenants;
      2. b. Total annual family income, including all taxable and nontaxable income for all family members over the age of 18; and
      3. c. Other assets, excluding equity in the residence.

2. (b) The applicant shall provide to the department the following documentation to support the demonstration of income qualified eligibility as specified in Env-Dw 1503.03(a):

   1. (1) Most recent federal tax return(s);
   2. (2) Social security benefit statement(s);
   3. (3) W-2 form(s) from the previous tax year;
   4. (4) Annual pension, retirement statement(s), or both;
   5. (5) Indication of direct deposit of other benefit(s) or income(s); or
   6. (6) A copy of current paystubs covering the most recent one-month period for family members that are employed.

3. (c) The applicant shall provide to the department the following documentation to support proof of ownership of the residential property where the remedy will be completed:

   1. (1) Town or city issued property tax statement;
   2. (2) Town or city issued property tax card;
   3. (3) Deed or official record and a utility bill dated within two months; or
   4. (4) Mortgage statement.

Source. #14201, eff 2-26-25