HUD-52578b PBV Statement of Family Responsibility

U.S. Department of Housing and Urban Development

Office of Public and Indian Housing

OMB Approval No. 2577–0169

Exp. (xx/xx/20xx)

Section 8 Project-Based Voucher Program
Statement of Family Responsibility
OMB Burden Statement: The public reporting burden for this collection of information is estimated
to average 0.25 hours, including the time for collecting, reviewing and reporting the data. The informat
ion is being collected as required by 24 CFR 983.252(b), under which the PHA must give the family a
packet that includes the family obligations under the program. Assurances of confidentiality are not
provided under this collection. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions to reduce this burden, to the Office of Public and
Indian Housing, US. Department of Housing and Urban Development, Washington, DC 20410. HUD
may not conduct and sponsor, and a person is not required to respond to, a collection of information
unless the collection displays a valid control number.
Privacy Notice: The Department of Housing and Urban Development (HUD) is authorized to collect
the information required on this form by Section 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f).
The information is used to certify the members of the family participating in the Section 8 projectbased voucher program and the family’s awareness of their family responsibilities under the program.
The Personally Identifiable Information (PII) data collected on this form are not stored or retrieved
within a system of record.

1.

Certification. The undersigned public housing agency (PHA) hereby certifies that
the family consisting of the following members:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

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__________________________________________________________________
__________________________________________________________________
is eligible to participate in the Section 8 project-based voucher program of this
PHA and is approved to occupy a unit at:
__________________________________________________________________
__________________________________________________________________
Under this program, the PHA makes housing assistance payments to owners for
units leased and occupied by participating families.
2.

Tenant Rent. The tenant rent is the portion of the monthly rent to owner paid by
the family, and is based on the family’s income, composition, and expenses. The
PHA determines the tenant rent in accordance with HUD requirements.

3.

Changes in Tenant Rent. A family’s tenant rent may change because of changes
in program requirements or changes in family income, composition, or expenses.
Any change in a family’s tenant rent will be effective on the date stated in a notice
by the PHA to the family and owner.

4.

PHA Housing Assistance Payment. The monthly housing assistance payment by
the PHA to the owner for a unit leased by a family is the rent to owner minus the
tenant rent (total tenant payment minus any applicable utility allowance). The
family is not responsible for payment of the portion of the rent to owner covered
by the housing assistance payment.

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5.

Family Right to Move.
(A)

The family may terminate its lease at any time after the first year of
occupancy. The family must give the owner advance written notice of
intent to vacate (with a copy to the PHA) in accordance with the lease. If
the family elects to terminate the lease in this manner, the PHA must offer
the family the opportunity for continued tenant-based rental assistance in
accordance with HUD requirements.

(B)

Before providing notice to terminate the lease under paragraph (A), the
family must first contact the PHA to request tenant-based rental assistance
if the family wishes to move with continued assistance. If tenant-based
rental assistance is not immediately available upon lease termination, the
PHA must give the family priority to receive the next available
opportunity for continued tenant-based rental assistance.

6.

Family Obligations.
(A)

Any family participating in the project-based voucher program of the
undersigned PHA must follow the rules listed below in order to continue
to receive housing assistance under the program. Any information the
family supplies must be true and complete.

(B)

Each family member must:
1.

Supply any information that the PHA or HUD determines to be
necessary for administration of the program.

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2.

Supply any information requested by the PHA or HUD for use in a
regularly scheduled reexamination or interim reexamination of
family income and composition.

3.

Disclose and verify social security numbers and sign and submit
consent forms for obtaining information.

4.

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.

5.

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.

6.

Allow the PHA to inspect the unit at reasonable times and after
reasonable notice.

7.

Notify the PHA and the owner in writing before moving out of the
unit or terminating the lease.

8.

Use the assisted unit for residence by eligible family members. The
unit must be the family’s only residence.

9.

Promptly notify the PHA in writing of the birth, adoption, or courtawarded custody of a child.

10.

Request PHA written approval to add any other family member as
an occupant of the unit.

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11.

Promptly notify the PHA in writing if any family member no
longer lives in the unit.

12.

Give the PHA a copy of any owner eviction notice.

13.

Pay utility bills and provide and maintain any appliances that the
owner is not required to provide under the lease.

14.

Submit evidence of citizenship or eligible immigration status if
they are seeking assistance. Families in which all members are
U.S. citizens or have eligible immigration status are eligible for
assistance. Mixed families, in which at least one member is a U.S.
citizen or has eligible immigration status and at least one member
does not contend eligible immigration status, are eligible for prorated assistance.

(C)

The family (including each family member) must not:
1.

Own or have any interest in the unit.

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.

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5.

Sublease or let the unit or assign the lease or transfer the unit.

6.

Receive project-based voucher 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 project-based voucher 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 of peaceful enjoyment of the other residents and
persons residing in the immediate vicinity of the premises.

7.

Termination of Assistance. The PHA may terminate housing assistance for any
grounds authorized in accordance with HUD requirements, including family
violation of any obligation under Section 6 of this Statement of Family
Responsibility.

8.

Illegal Discrimination. If the family has reason to believe that it has been
discriminated against on the basis of age, race, color, religion, sex

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(including sexual orientation and gender identity), disability, national
origin, or familial status, the family may file a housing discrimination
complaint with any HUD office in person, by mail, or by telephone. The PHA
will give the family information on how to fill out and file a complaint.
Eligibility for HUD’s programs must be made available without regard to actual
or perceived sexual orientation, gender identity, or marital status.
9.

Violence Against Women Act (VAWA). VAWA and HUD’s implementing
regulations provide housing protections for victims of domestic violence, dating
violence, sexual assault, and stalking. The PHA will provide the Notice of
Occupancy Rights and Certification Form and is responsible for having an
emergency transfer plan. The lease addendum also includes a description of
specific protections.

10.

HUD Requirements. HUD requirements for the Section 8 project-based voucher
program are issued by Headquarters as regulations, Federal Register notices, or
other binding directives. The Statement of Family Responsibility shall be
interpreted and implemented in accordance with HUD requirements.

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KEEP THIS DOCUMENT FOR YOUR RECORDS
Family
Name of Family Representative:
________________________________________________________________________
Address, Telephone Number:
________________________________________________________________________
________________________________________________________________________
Signature of Family Representative, Date:
________________________________________________________________________
________________________________________________________________________
Public Housing Agency
Name of PHA:
_______________________ ____________________________________________
Address, Telephone Number:
________________________________________________________________________
________________________________________________________________________
Signature of PHA Representative, Title, Date:
________________________________________________________________________
________________________________________________________________________

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