Cityfheps landlord information form

landlord on behalf of the CityFHEPS tenant. HRA's payment standards are based on the Section 8 standard adopted by the New York City Housing Authority (NYCHA). These payment standards vary based on the number of bedrooms and whether all or some utilities are included. Make sure you know which utilities, if any, are included in the rent.

Cityfheps landlord information form. Landlord Utility Information Note to Landlord: FHEPS can only be used towards a residence within the five (5) boroughs of New York City. However, CityFHEPS can be used towards a residence anywhere in New York State. Please note that the rent and utility amounts provided on this form are only valid for potential FHEPS

• DSS-8f/DSS-8g (Apt/Room or SRO) Landlord Information Form • W-147N Security Voucher (if applicable) • Arrears documentation (landlord breakdown plus stipulation, decision or order - including court approval or order for legal and marshal fees, if applicable) • Landlord W9 (must match the deed) • Proof of ownership such as the deed

There are a few times when your landlord has the right to increase rent. If rent control policies do not protect your housing unit, your landlord is well within their legal rights ...DSS-8f or 8g ("Landlord Information Form") Signed by managing agent or other authorized representative? If checked, Proof of HPD Registration or Authorization W-147N Security Voucher DSS-8q Landlord Utility Information Check the rental type and associated forms included. Also check which landlord incentives apply, if any: Room RentalWhat help can landlords and families receive once they are participating in the program? HRA's Rental Assistance Call Center, reachable at 929-221-0043 can help both landlords and tenants with program information, aftercare referrals and payment inquiries. Additionally, families who have left shelter can receive ongoing support services.Meanwhile, 15 percent of all tenants told us their landlord threatened to evict them in the previous year, ... A CityFHEPS voucher for a 1-bedroom apartment to house this same family would cost a maximum of $2,387—and potentially much less—resulting in an annual total expense that is significantly lower than what the city is currently ...CityFHEPS paperwork glitches cut off rent supplement. Tenants utilizing the city's voucher program sued the Adams administration this week, claiming bureaucratic snafus are triggering rent ...

A: Form DSS-8B is used by the New York City government to maintain accurate tenant contact information for housing-related purposes. Form Details: Fill out the form in our online filing application. Download a fillable version of Form DSS-8B by clicking the link below or browse more documents and templates provided by the New York City ...Landlords can prevent failed inspections by providing access to all public areas of the building on the inspection date. Any failures in the public areas - including no access to the basement or boiler room - will result in a failure and/or violation and cause any apartment inspected on or after that day to fail the HQS Inspection until the failure and/or violation is validly certified or ...RRODHE - CONSTRUCTION SH.P.K. OTLLAK, Fshati Dushnik, lagjja Parangua nr.15 ,1557, 5000 Berat - AlbaniaLandlord Utility Information Note to Landlord: FHEPS can only be used towards a residence within the five (5) boroughs of New York City. However, CityFHEPS can be used towards a residence anywhere in New York State. Please note that the rent and utility amounts provided on this form are only valid for potential FHEPSCityFHEPS is a program that can help you find and pay for permanent housing if you are eligible. Eligible candidates include: Low-income families who live in shelters. Individual adults who live in shelters. Low-income families and adults who are at risk of becoming homeless. If you live in a shelter, you can get help finding out if you are ...DHS-10a (E) 01/23/2020 (page 4 of 6) LLF. 2. I understand that required notifications to DSS must be made in writing to: SOTA Program NYC Human Resources Administration 150 Greenwich Street, 36th Floor New York, NY 10007. I understand that if I have any questions, I may also call 718-557-1373.Go assist applicants button recipients by obtaining this information, the Department of Social Services provides a 'Landlord's Form' [LDSS-3668] that remains completed and signed by the landlord. Use of this form by this Department does not guarantee a lawsuit will be opened, obligate DSS to pay one rent, nor does it provide any safety against ...Download Printable Form Dss-7o In Pdf - The Latest Version Applicable For 2024. Fill Out The Application For Cityfheps (rooms Only) - New York City Online And Print It Out For Free. Form Dss-7o Is Often Used In New York City Department Of Social Services, New York City Legal Forms, Legal And United States Legal Forms.

CityFHEPS rent levels for apartments and SROs are indexed to the Section 8 standard adopted by the New York City Housing Authority (NYCHA). If you house a tenant with CityFHEPS, you will receive rent payments directly from DSS/HRA. What are the benefits of participating in CityFHEPS for landlords and brokers? Under CityFHEPS, you will receive:Under the current proposed rule, for a 2-family household in a 1 bedroom, their rent share of a $1,945 apartment would be $1,089, or 53.6% of their income. For a single family household in a 1 bedroom, that percentage is 72.5%, extremely difficult to cover the cost of living overall.CityFHEPS Documents. Important forms and documents with CityFHEPS applicants, your, housing, and other: Application Documents. Website Clearance Checklist; Apartment Review Checklist; Apartment Review Guidance; How Participant Deal Available in English, Spanish/Español, Chinese (Traditional)/ ...Landlord Utility Information Note to Landlord: FHEPS can only be used towards a residence within the five (5) boroughs of New York City. However, CityFHEPS can be used towards a residence anywhere in New York State. Please note that the rent and utility amounts provided on this form are only valid for potential FHEPSThe purpose of this policy bulletin is to inform staff of revisions to the CityFHEPS Landlord Information Form - Apartment Rentals (DSS-8f) and CityFHEPS Landlord Information Form - Room and SRO Rentals (DSS-8g). This policy bulletin also provides staff with the time frame on how long a landlord’s signature is valid for on certain forms and ...

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I Am Currently in Shelter. To help stop the spread of COVID-19, many HRA locations are consolidating until further notice. If your needs cannot be met by ACCESS HRA, call 311 or consult the HRA Locations page for more information.. If you are currently living in a Department of Homeless Services (DHS) or Human Resources Administration (HRA) …Broker’s Information Apartment Information Email the completed form to [email protected] or fax it to 1-646-500-6667. If you have questions, specific to how to Email the completed form to [email protected] or fax it to 212-487-7926. If you have questions, specific to how to complete this form, please contact …CityFHEPS Landlord Information Form Apartment Rentals. DSS-8f (E) 04/13/2023 (page 1 of 3) CityFHEPS is similar to Section 8 in that, subject to the availability of funding, it provides assistance, including. Learn more. DSS General Surveillance Management Center Users Manual. 8. Use a Different Username and Password for DSS: In the event that ...The Legal Aid Society sued Mayor Eric Adams and New York City to force the administration to expand a housing voucher program for people at risk of eviction or leaving the shelter system — a program that Adams tried unsuccessfully to kill.. The City Fighting Homelessness and Eviction Prevention Supplement (CityFHEPS) program helps New Yorkers at risk of homelessness get a voucher for an ...CityFHEPS Landlord Information Form – Room and SRO Rentals ((06/06/2019) CityFHEPS Packet Cover Sheet – Shelter (06/06/2019) CityFHEPS Packet Cover Sheet …

The City Council is seeking to join the lawsuit filed by low-income tenants against Mayor Eric Adams' administration last week over City Hall's refusal to implement a set of housing voucher ...The LTB has two types of forms: forms that allow you to save the information you enter, and forms that don't. Forms you can save: You will see this message at the top of these forms: N1, N2, N4, N5, N6, N7, N8, N9 and Certificate of Service. Forms you cannot save: You will see this message at the top of these forms.A side deal is when a landlord or broker asks you for additional up front or ongoing payments. • If a landlord or broker refuses CityFHEPS or asks you for a side deal, call the NYC Commission on Human Rights at 212-416-0197. • The HRA security voucher is considered payment of security.The CityFHEPS Landlord Requirements are set forth in Chapter 10 of Title 68 of the Rules of the City of New ... I am authorized to sign this landlord information form and the lease on behalf of the owner of the unit identified above and have attached proof of such authorization.CityFHEPS Frequently Asked Questions for Landlords and … DSS-8j (E) 05/03/2022 (page 1 of 4) CityFHEPS Frequently Asked Questions for Landlords and Brokers What is CityFHEPS?CityFHEPS is a rental assistance supplement program to help individuals and families find and keep an apartment, a room, or single room occupancy (SRO) unit.CityFHEPS consolidates seven subsidies into a single program ... The following is the most recent information we have about the people who live in your householdand are working : Name Hours Monthly Income . Is the above information correct? ☐Yes ☐ No If “No,” please complete the chart below and send us proof of the information. See . page 6. for more information. Status* Essential application and documents for CityFHEPS applicants, clientele, landlords, and others: Application Documents. Home Clearance Checklist; Apartment Review Checklist; Apartment Reviewing Guided; Program Student Agreement Available in English, Spanish/Español, China (Traditional)/ ...CityFHEPS from 30 to 14 hours per week. Create an option for CityFHEPS voucher-holders who choose to secure an apartment that rents above the CityFHEPS maximum to use a voucher by paying up to 40 percent of their income. Expand SSI eligibility for CityFHEPS families from only an adult in the household to any household member, such as a child.FHEPS. FHEPS is a rent supplement for families with children who receive Cash Assistance and have been evicted or are facing eviction, who lost their housing due to a domestic violence situation, or who have lost their housing because of health or safety issues. Formerly known as the Family Eviction Prevention Supplement (FEPS), the program has ...

Read the CityFHEPS Frequently Asked Questions for Landlords and Brokers; Learn how to register an apartment, room, or SRO to rent through CityFHEPS; Important CityFHEPS Forms and Documents * Nothing will change for clients already enrolled in LINC 6. Important Information. Renewal. If you failed to renew your CityFHEPS, you can still do so!

Landlords must give the family the following completed documents: 1. Signed lease or written agreement to rent the apartment to the family for at least one year 2. Completed Landlord Utility Information (DSS-8q) form 3. Request for security 4. Landlord’s . W-9 (needed to receive all payments) 5. Unit Hold Incentive Voucher (HRA …CityFHEPS Shelter Eligibility FAQ Group A Your household will belong to Group A if: 1. it meets one of the following requirements: a. Be a family living in DHS Shelter for the last 90 days with a gap no larger ... Complete information about eligibility is set forth in Chapter 10 of Title 68 of the Rules of the City of New York. Created Date:Instructions: Complete this form and submit this document along with the room rental packet. A. Landlord Information Landlord Name Phone B. Property Address Address Apartment # C. Current Room Allocation Room # Occupied? HRA Payment? If yes, Tenant Name and Cash Assistance (CA) Number if known Date Moved In Is the Tenant in room indicated The landlord submitting all applicable rental documents for HRA approval; and HRA confirming that it is not already making payments for this apartment or unit on behalf of anyone who is no longer residing there. This voucher is available to landlords renting apartments to CityFHEPS and HRA HOME • DSS-8f/DSS-8g (Apt/Room or SRO) Landlord Information Form • W-147N Security Voucher (if applicable) • Arrears documentation (landlord breakdown plus stipulation, decision or order - including court approval or order for legal and marshal fees, if applicable) • Landlord W9 (must match the deed) • Proof of ownership such as the deedLandlords have plenty of important duties to juggle when they’re working with tenants — and equally important concerns that come along with all the different management tasks they’...CityFHEPS RENEWAL REQUEST - New York City. DUE DATE: DSS-7e (E) 06/21/2020 (page 1 of 5) LLF Notice Date: Client Name: Case Number: Rental Assistance supplement Expiration Date: Rental Assistance RENEWAL Period CityFHEPS RENEWAL REQUEST INSTRUCTIONS: To continue getting a rental assistance supplement you must: Fill out and sign this RENEWAL form. Please answer all the questions.Admissibility for an CityFHEPS subsidy includes a range of requirements. Get answers to commonly asked questions about CityFHEPS. Currently in a Shelter. If you live in a shelter, the details will be discussed when she make with your case manager or housing specialist. At Risk are Becoming HomelessForms and Documents. Download important information and application forms for rental assistance programs. CityFHEPS Documents. FHEPS Documents.

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Using the information from the Registration form, DHS CAR must verify the block and lot and address on DOB's BIS and DOB NOW and proceed as follows: • If the building information matches, this step is a pass. • If the block and lot or address does not match, confirm the information with the shelter provider, landlord, or broker.CityFHEPS Documents. Important order and documents for CityFHEPS applicants, clients, landlords, and others: Application Documents. Website Clearance Checklist; Apartment Watch Checklist; Apartment Review Guidance; Program Participant AgreementThe CityFHEPS landlord information form is needed by landlords who wish to participate in the CityFHEPS program. 02 CityFHEPS is a New York City housing voucher program that helps eligible individuals and families find and maintain affordable housing.I filled out the change of landlord paperwork as well as request a minor increase in rent by $250 (still below market rate). After 6 months, the CityFHEPs and Homebase (the admin of the voucher allegedly) still has not paid their portion and the tenant and I have been been proactive in attempting to reach out to the related organizations but we ...For more information about our affordable marketing services kindly reach out to our professional team at [email protected], or by phone to Sam Rosenberg - 718-387-4448 - Ext 130. We stand behind your project from the planning stages to 100% TIMELY occupancy ready and eager to take on your new development!• The title "Landlord Statement of Understanding" was changed to "Landlord Information Form" and the CityFHEPS disclaimer was updated, if applicable, on the following forms: "CityFHEPS Approval Notice to Landlord" (DSS-8c); "CityFHEPS Landlord Information Form - Apartment Rentals" (DSS-8f); "CityFHEPS Landlord Information ...The reasons you may be eligible to receive CityFHEPS. It is important that you review the information on your Household Share letter to make sure it is right. If you are approved for CityFHEPS you will receive a letter from DSS with your final household share. If your information changed from when you received your Household ShareThe Texas State Law Library publishes legal choose guides to help both self-represented litigants/pro se litigators and attorneys/legal practitioners locate the authorized information they need.Form Details: Released on June 6, 2019; The latest edition provided by the New York City Department of Social Services; Easy to use and ready to print; Quick to customize; Compatible with most PDF-viewing applications; Fill out the form in our online filing application. Download a printable version of Form DSS-8H by clicking the link below or ..."Removing credit checks for CityFHEPS housing vouchers will make the voucher more flexible and easier to use, ensuring that 4,000 families will enter affordable homes more quickly every year. ... "We discontinued the practice of running credit reports for all applicants in 2021 because landlords who rent to families with rental subsidies ... ….

CityFHEPS is similar to Section 8 in that, subject to the availability of funding, it provides assistance, including rental assistance in specified amounts, to landlords and tenants who want to form a landlord-tenant relationship. Application for CityFHEPS (Rooms Only) This is a CityFHEPS application for the household below. We submit this application, along with the completed CityFHEPS packet cover sheet, on the household's behalf. If eligible, please approve and issue the appropriate Department of Social Services (DSS) checks and documents. (Turn Page) 1. Referral ...DSS-8f or 8g ("Landlord Information Form") Signed by managing agent or other authorized representative? If checked, Proof of HPD Registration or Authorization W-147N Security Voucher DSS-8q Landlord Utility Information Check the rental type and associated forms included. Also check which landlord incentives apply, if any: Room RentalCityFHEPS Documents. Important forms and documents for CityFHEPS applicants, my, landlords, and others: Petition Documents. Website Clearance Checklist; Apartment Review Checklist; Apartment Review Guidance; Program Participant Agreement Available in English, Spanish/Español, Chinese (Traditional)/ ...DSS-8f or 8g ("Landlord Information Form") Signed by managing agent or other authorized representative? If checked, Proof of HPD Registration or Authorization W-147N Security Voucher DSS-8q Landlord Utility Information Check the rental type and associated forms included. Also check which landlord incentives apply, if any: Room RentalMicrosoft InfoPath - W-137A (E) POS. W-137A (page 1 of 3) (LDSS-3815) 03/16/2020 LLF. Date: Case Name: Case Number: Caseload: Center: Worker Telephone No.: FH&C Telephone No.: Request for Emergency Assistance, Additional Allowances, or to Add a Person to the Cash Assistance Case (For Participants Only) Please fill out this form if you need ...Download Fillable Form Dss-8q In Pdf - The Latest Version Applicable For 2024. Fill Out The Landlord Utility Information - New York City Online And Print It Out For Free. Form Dss-8q Is Often Used In New York City Department Of Social Services, New York City Legal Forms, Legal And United States Legal Forms.To Fight Homelessness, House the Pepole Part 1: Reforming the CityFHEPS Voucher Program Is the Need of The Hour. At this moment of unprecedented need to keep people housed, the state government has, for all practical purposes, turned its back on renters by failing to create the Housing Access Voucher Program (Section 8 for New York State), pass Good Cause eviction protections, or expand Right ...Admissibility for an CityFHEPS subsidy includes a range of requirements. Get answers to commonly asked questions about CityFHEPS. Currently in a Shelter. If you live in a shelter, the details will be discussed when she make with your case manager or housing specialist. At Risk are Becoming HomelessPlease complete this Landlord Package in its entirety and return it to HRA with copies of all required documentation. If you need help completing this Landlord Package, please call (929) 221-0043 and, when prompted, select the Owner Services Unit. Proposed Lease: Please send an unsigned proposed lease to HRA with this completed Landlord Package ... Cityfheps landlord information form, Please return the completed form: By Mail: Office of Central Processing PO Box 02-9121 Brooklyn GPO Brooklyn, NY 11202-9914 By E-Mail: [email protected] . Author: NYC Created Date:, CityFHEPS Leasing Package Checklist New Apartment or Room Rental by Landlord A lease or rental agreement for at least one year Proof of Ownership Landlord's W9 or substitute W9 Form (DSS-8f or 8g) Room Rental Allocation Form (DSS-8d) (if applicable) Security Voucher (W-147N) Unit Hold Incentive (HRA-145), Landlords can prevent failed inspections by providing access to all public areas of the building on the inspection date. Any failures in the public areas - including no access to the basement or boiler room - will result in a failure and/or violation and cause any apartment inspected on or after that day to fail the HQS Inspection until the failure and/or violation is validly certified or ..., Application for CityFHEPS (Apartments and Single Room Occupancy Units) This is a CityFHEPS application for the household below. We submit this application, along with the completed CityFHEPS packet cover sheet, on the household's behalf. If eligible, please approve and issue the appropriate Department of Social Services (DSS) checks and ..., Related to cityfheps landlord forms SECTION 8 HOUSING: FAIR. SECTION 8 HOUSING: FAIR MARKET RENTS MHC/NASA Viewpoint Section 8 Housing Choice Voucher Program provides subsidized rents for qualifying lowincomeHUD. Fill Now. FORECLOSURE PREVENTION AND MITIGATION. U.S. DEPARTMENT OF HOUSING AND URBAN …, 3. Can CityFHEPS be used in other states? No, CityFHEPS can only be used within NYS. 4. Can CityFHEPS be used for room rentals outside of NYC? No, only apartments can be rented outside of NYC. 5. Are the maximum CityFHEPS rents the same outside of NYC? CityFHEPS rents outside of NYC are set to the local standard. Utility allowance rates are also, A: Form DSS-8B is used by the New York City government to maintain accurate tenant contact information for housing-related purposes. Form Details: Fill out the form in our online filing application. Download a fillable version of Form DSS-8B by clicking the link below or browse more documents and templates provided by the New York City ..., Rental Templates & Forms. To make your life easier as a landlord or tenant, we include a number of templates and forms on our website, such as lease agreements and lease termination letters. Just grab & go! Contract Agreements (15) …, CityFHEPS Leasing Package Checklist. New Apartment or Room Rental by Landlord. A lease or rental agreement for at least one year. Proof of Ownership. Landlord’s W9 or substitute W9. Landlord Information Form (DSS-8f or DSS-8g) Room Rental Allocation Form (DSS-8d) (if applicable) Security Voucher (W-147N), Finding a rental property that accepts DSS (Department of Social Security) can be a difficult task. With so many landlords and agencies not accepting DSS, it can be hard to find th..., New York City landlords must turn on heat systems beginning October 1st. The heating systems must be kept on though May 31st and meet minimum temperature requirements. During the d..., Human Resources Administration. Office of Constituent Services. 150 Greenwich St. 35th Floor. New York, NY 10007. Fax: 917-639-9241. Email: [email protected]. You do not need to give us proof of your condition at the time of the request. We may ask you to give us some medical or clinical documents later., Check the rental type and associated forms included. Also check which landlord incentives apply, if any: Room Rental? DSS-8d Room Allocation Form Apartment/SRO Rental? HRA-145 Unit Hold Incentive Voucher Landlord Bonus (availability based on zip code) CityFHEPS Rental Assistance Supplement 1 month OR 3 months (Turn Page) , For more information about our affordable marketing services kindly reach out to our professional team at [email protected], or by phone to Sam Rosenberg - 718-387-4448 - Ext 130. We stand behind your project from the planning stages to 100% TIMELY occupancy ready and eager to take on your new development!, Documents for Landlords and Brokers Change in Tenancy (DSS-85c) Change of Payee for CityFHEPS Payments Landlord Information Form - Apartment Rentals. Learn more. Read Free Rental Uments Read Pdf Free. free rental forms com simple rental application form 2022 pdf raise the rent cityfheps documents hra new york city 12 must., Important forms and documents for CityFHEPS applicants, clients, landlords, and others: How Documents. Website Clearance Checklist; Apartment Read Checklist; Apartments Review Guidance; Program Participant Agreement ... Room Rental Allocation Form (for spaces only) Rent Contact Information;, CityFHEPS Landlord Utility Information Form (Outside of New York City) Note to Landlord: There is a separate utility allowance schedule for Westchester County and for …, CityFHEPS Landlord Information Form Room and SRO Rentals. Preview. 9 hours ago CityFHEPS Landlord Information Form program and such tenant's landlord participating in the program. The CityFHEPS Landlord Requirements are set forth in Chapter 10 of Title 68 of the Rules of the City of New York and can be found in the CityFHEPS Landlord FAQ ..., Fill Dss 8f, Edit online. Sign, fax and printable from PC, iPad, tablet or mobile with pdfFiller Instantly. Try Now!, Landlord Portal is a new online tool that allows landlords with tenants on the. New York State Homes and Community Renewal (NYSHCR) Section 8. Emergency Housing Voucher (EHV) and Housing Choice Voucher (HCV) programs to review information pertaining to your issued payments, tenants, scheduled and completed inspections, and tax forms at your ..., Leases are most often between the landlord and non-profit provider. All tenants have a sub-lease and are responsible to contribute 30% of their income towards the rent and utilities. A subsidy managed by the non-profit provider is connected to each rented apartment so that the unit is affordable for the tenant. Social services staff are ..., Forms and Documents. Download important information and application forms for rental assistance programs. CityFHEPS Documents. FHEPS Documents., CityFHEPS Documents. Important forms and documents for CityFHEPS applicants, clients, landlords, and others: Applications Documents. Website Clearance Checklist; ... CityFHEPS Regularly Asked Inquiries for Clients stylish Shelter Available on English, ..., You can submit your CityFHEPS renewal application by: • scanning and emailing documents to [email protected], • mailing them to the address on the form, OR. • delivering the documents to: Rental Assistance Program Unit. OR. 109 East 16th Street, 10th Floor New York, NY 10003. (Turn Page), The person who signed the original "CityFHEPS Landlord Information Form"; OR. 3. The current owner. 1. Tenant Information. Name: _____ Program Type: _____ Address: _____ 2. Change of Payee Reason and Effective Date . Reason for Payee Change (check which box applies): Change in ownership (please provide bill of sale, deed, or other proof of ..., Finding a rental property that accepts DSS (Department of Social Security) can be a difficult task. With so many landlords and agencies not accepting DSS, it can be hard to find th..., CityFHEPS Documents. Important forms and documents for CityFHEPS applicants, clients, landlords, and others: Applications Documents. Website Clearance Checklist; ... CityFHEPS Regularly Asked Inquiries for Clients stylish Shelter Available on English, ..., Currently, the CityFHEPS program alone supports 30,000 households through the provision of a rental subsidy. "Children's Rescue Fund supports the expansion of CityFHEPS housing voucher for more New Yorkers to obtain permanent housing in all 62 counties of New York State," said Orlando Ivey, president and CEO, Children's Rescue Fund. "We ..., Piloting a limited bonus equal to one month's rent for landlords renting to CityFHEPS voucher-holders in high-cost neighborhoods, ... a lack of information about their ability to move, and voucher benefits that pay too little. As a result, more than half of the city's federal housing vouchers are used in a small number of communities ..., Landlord Utility Information. Instructions to Landlord: Please identify the utilities available for the available rental unit and whether the expense is incurred by you or the tenant. The unit I am renting is located at (list address): . Actual Number of Bedrooms: _____ Number of Bedrooms on Shopping Letter: _____ , The CityFHEPS Landlord Requirements are set forth in Chapter 10 of Title 68 of the Rules of the City of New ... I am authorized to sign this landlord information form and the lease on behalf of the owner of the unit identified above and have attached proof of such authorization., The following is the most recent information we have about the people who live in your householdand are working : Name Hours Monthly Income . Is the above information correct? ☐Yes ☐ No If “No,” please complete the chart below and send us proof of the information. See . page 6. for more information. Status* , Form W-147M Rev. 6/2/08. Landlord/Managing Agent's Statement. Center/DHS Site: Date: Case Name: Case Number: JOS Worker/DHS Worker: Telephone Number: and I am (or we are) not the broker nor in any way a ssociated with the Agency chargi ng a broker's fee for the procurement of the above premises. I (or we) agree that I (or we) will not receive ...