Parkman Court Application Checklist

1. CDBG/Gregory DRive Repurposed Funds 2017
v-July2017
PARKMAN COURT APPLICATION CHECKLIST
The following supporting documentation must be sent as a referral packet:
□ Printed Community Housing Needs Form (dated within 30 days)
□ Attach these two items:
o CSB Authorization to release information for Christian Relief Services
o Information CRSVA should be aware of that may impact client’s housing
□ State issued photo identification
□ Copy of Social Security Card for all household members(if applicable)
□ Proof of all sources of income and/or assets.
□ Earned Income - submit paystubs for three months prior to application date.
□ SSI/SSDI - submit 1) Copy of award letter or 2) Bank statement showing direct deposit
from SSA.
□ Retirement/Pension - submit either 1) A copy of the check or letter or any source that
shows amount and frequency or 2) Bank statement that shows direct deposit.
□ TANF submit - either 1) TANF letter or 2) E-mail verification from DFS worker.
□ General Relief - Submit GR letter.
□ Alimony - Submit copy of court papers that show amount.
□ Child support - Submit either 1) Copy of court papers or 2) Copy of child support
enforcement letter or 3) Notarized letter from parent who is paying if informal
arrangement.
Income from self-employed business owner - Submit most recent year tax returns with all
schedule.
□ Income from rental property - Submit tax return that shows rental income.
□ Unemployment compensation - Submit 1) Check stub from unemployment office or 2)
Bank statement that shows direct deposit.
□ Interest, Dividends or Other income from assets, etc. - Submit either 1) Copy of check or
2) Letter or other document from the source that shows amount and frequency.
□ Workers Compensation - Submit either 1) Check stub from source or 2) Bank statement
that shows direct deposit.
□ Military pay/allowance/veterans benefits - Submit either 1) Check stub from source or 2)
Bank statement that shows direct deposit.
□ Retirement Accounts - Submit statement showing balance.
□
Once the client has been approved by the relevant service area’s team, include a note regarding the approval in
the referral packet. Next, send the entire packet via encrypted email to CSBhousinginfo@fairfaxcounty.gov and
include Parkman Court and the client’s Credible number in the subject line. Fax number is 703.653.9500.
Questions about this Project?
Community Svs. Board Services: Peggy Cook, Director CSB Residential Treatment Services 703.449.4104;
peggy.cook@fairfaxcounty.gov
Community Svs Board Housing: Connie Price, Housing Partnerships/CSB Residential and Facilities
Development | 703.383.8412: csbhousinginfo@fairfaxcounty.gov