Letter to Landlord Requesting Rental Information

Letter to Landlord Requesting Rental Information

Alternative language for letter - (Final)

Letter to Landlord Requesting Rental Information

OMB: 0960-0454

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OIRA alternative language for 0960-0454 letter (draft)

[Name of Individaul] has recently applied for or currently receives Supplemental Security Income (SSI) with the Social Security Administration. Part of our requirements when evaluating an SSI application or existing SSI beneficiary is to assess the income sources for the individual, which can include “unearned” income such as a rental subsidy. If we determine the individual receives rental subsidy, we may change the individual’s SSI payment or determine they are no longer eligible for SSI payments. The above-named individual or their representative has identified you as the person they pay for their residence and has given us permission to request potentially relevant information from you.

This form is requesting information that will help inform us as to who is responsible for payment of rent at the listed residence. Your responses will help us understand whether the above individual is receiving a rental subsidy.

The information provided will be maintained as a part of the individual’s record with us. In addition, the information provided may be given out (such as to other Federal or state agencies) if required by Federal law without us seeking additional consent. Similarly, we may provide the information to a Federal or state agency that needs it to help decide whether the individual is eligible for other health or income assistance programs such as SSI State supplementary payments, food stamps, Medicaid, energy assistance, or unemployment insurance. Please contact the listed Social Security Office if you have additional questions about our information sharing policies.

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorGardiner, Kyle S. EOP/OMB
File Modified0000-00-00
File Created2024-10-28

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