City of Foster City Measure K Emergency Rent Relief Eligibility Screening Form
APPLICANT NAME
DATE OF APPLICATION
APPLICATION NUMBER
BMR PROPERTY
BMR UNIT #
VERIFIED SIZE OF UNIT
VERIFIED RENTAL RATE
RENT, UTILITIES, BOTH, DEPOSIT Amt Requested
CATEGORY Senior, disabled, veteran, minor(s)
APPROVED FOR DEMOGRAPHICS YES/NO
BASIS FOR NEED CHOOSE 1-9
OTHER: DESCRIBE
DOCUMENTATION PROVIDED YES/NO
APPROVED FOR NEED YES/NO
EXPLANATION
FINANCIAL ACCOUNTS BALANCE From Tenant statements
DOCUMENTATION PROVIDED YES/NO
APPROVED FOR ACCOUNT BALANCE YES/NO
HOUSEHOLD INCOME PER RECERT Last Recertification
DATE OF LAST RECERTIFICATION
MONTHLY INCOME
HOUSEHOLD SIZE Per lease
INCOME LIMIT FOR HH SIZE 50% AMI per HCD
UTILITY ALLOWANCE AMOUNT For Unit Size
INCOME <50% AMI APPROVED YES/NO
LEASE RECEIVED YES/NO/PENDING
DEPOSIT AMOUNT YES/NO/PENDING/N/A
IDENTIFICATION YES/NO/PENDING
UTILITY BILLS SUBMITTED Total bills submitted
LEDGER YES/NO/PENDING/N/A
ADDITIONAL DOCUMENTS REQ'D YES/NO/PENDING/N/A
APPROVED FOR DOCUMENTATION
VERIFICATION OF DOCUMENTS AND UTILITY BILLS SUBMITTED
TYPE OF REQUEST
HOUSEHOLD DEMOGRAPHICS
DEMONSTRATION OF NEED
ELIGIBILITY AND FUNDING AWARD
FOSTER CITY EMERGENCY RENT RELIEF PROGRAM FOR BMR TENANTS Must meet at least one demographic criteria. Documentation of veteran status is required. For disabilities, verification of the fact that the applicant is disabled. Do not ask or seek information about the nature of the disability. Age is verified by ID, Minor children are verified by the Income Certification.
APPLICANT INFORMATION
Must have a valid and verifiable need. Attach documentation. Examples include a letter or email from the employer, medical bills or documented evidence of medical issue or injury, paystubs, bank statements showing income reduction, or notarized affidavit.
Total balance must be less than $10,000. Checking, savings, stocks, digital wallet balance , etc. (but not 401K, IRA, Pension, Deferred Compensation).
Certified income/12; if job loss or income
reduction, use current income. If over 50% AMI
at recert, must verify reduction in income.
FINANCIAL ACCOUNT BALANCE <$10,000
INCOME VERIFICATION <50% AMI
Use HCD income limits and Utility Allowances for current year. City's income limits and UA take effect July 1 each year.
Must be based on current household size. Utility Allowance schedule is provided by the County and approved for each BMR property by the City. Recert must be less than 12 months old or income must be recertified. v.1 4/25
City of Foster City Measure K Emergency Rent Relief Eligibility Screening Form income plus assets
Rent plus
Utilities
Income x 3 months $ - Rent $ - Assets $ - Utilities + Exp.
Monthly income plus assets in bank x3
compared to rent $ - Is household at risk in next 3 months? YES Y/N
RENT -$
UTILITIES -$ Greater of UA or bills submitted TOTAL -$
AWARD AMOUNT -$ Max $3,000
NOTICE TO LANDLORD SENT YES/NO/PENDING
W9 RECEIVED YES/NO/PENDING
SDP COMPLETE YES/NO/PENDING
NOTICE SENT TO TENANT YES/NO/PENDING
Signature of Approver Title Date
Award Guidelines
Key for Basis of Need
See County Agreement, Resolution, and Board Memo for more information Income limits 50% AMI (Effective July 1, 2025 - June 30, 2026) 1 person: $68,550, 2 people: 74,350, 3 people: $88,150, 4 people: $97,900, 5 people: $105,750 Notes:
a) if the applicant applied for rent and utilities, the award amount is the rent plus the greater of utility allowance or utility bills submitted, with a maximum of $3,000; b) if the applicant applied for rent only, the award amount is one month of rent up to $3,000; c) if the applicant applied for a deposit, the award amount is the amount of the deposit as specified by the landlord, up to $3,000. Attach W9 and this form to SPD. Maximum award is $3,000 total per household.
AWARD APPROVAL
RISK OF DISPLACEMENT OR HOMELESSNESS
1-Job loss 2 - pay reduction, 3- medical, 4-disability, 5-caregiver, 6-job loss/job hunting, 7- job loss/training program, 8- can't afford deposit, 9-other (describe)
SDP COMPLETE
v.1 4/25