Tribal Based Rental Assistance Application and HUD Application for Rental Assistance - 2026

Tenant Based Rental Application

Sac & Fox Housing Development - 301 Meskwaki Road, Tama, IA 52339
Qualifying Criteria:

Must provide Tribal Enrollment

Must be 18 years and older

One application per household

Landlord/Property Manager (non-family member)

Required Verification:

Copy of Tribal ID, Social Security Card, Birth Certificates of ALL household members

Income Verification

Copy of Rental Lease

Vendor, W-9 form to be completed by each Landlord/Property Manager

All required verifications MUST submit with a fully and clearly completed application. Incomplete applications will not be considered - no exceptions.
Applicant Information
Date

MonthDayYear
Date
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
Email
example@example.com
Enrollment Number
Social Security No.
Tribal Affiliation
Household Members

List all household members that live with you.
1. Full Name and Tribal Enrollment Number

First NameMiddle NameLast NameEnrollment Number
2. Full Name and Tribal Enrollment Number

First NameMiddle NameLast NameEnrollment Number
3. Full Name and Tribal Enrollment Number

First NameMiddle NameLast NameEnrollment Number
4. Full Name and Tribal Enrollment Number

First NameMiddle NameLast NameEnrollment Number
5. Full Name and Tribal Enrollment Number

First NameMiddle NameLast NameEnrollment Number
6. Full Name and Tribal Enrollment Number

First NameMiddle NameLast NameEnrollment Number
7. Full Name and Tribal Enrollment Number

First NameMiddle NameLast NameEnrollment Number
Please list additional household members and their enrollment numbers below (if needed).
Disclaimer and Signature

By signing this form either manually or electronically, I agree that all the statements are true, accurate and complete to the best of my knowledge.
Applicant Signature
Date

MonthDayYear
Date
Copy of Tribal ID (File Upload)

Cancelof
Copy of Social Security Card (File Upload)

Cancelof
Copy of Birth Certificates for ALL Household Members (File Upload)

Cancelof
Copy of Income Verification(s) for ALL Household Members (File Upload)

Cancelof
Vendor completed and signed W-9 for each Landlord/Property Manager (File Upload)

Cancelof
"SFHD will not be responsible if a payment is made after a due date or if any late fees are incurred during the processing of applications"

**Assistance availability is based on funding provided by the HUD-IHBG. **

PLEASE PREVIEW THIS COMPLETED PDF FORM AND PRINT FOR YOUR RECORDS.

Please bring a copy of the completed form, along with all required verification forms listed above to the Housing Development Office, 301 Meskwaki Road, Tama, IA 52339

For help or questions, call: (641) 484-9260 or (641) 484-9261.
HUD APPLICATION FOR RENTAL ASSISTANCE

This application is specifically for HUD and will kept in the applicants file within the Sac & Fox Housing Development Office.
Applicant Name

First NameMiddle NameLast Name
Applicant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Format: (000) 000-0000.
Alternate Phone
Format: (000) 000-0000.
HOUSEHOLD COMPOSITION

List the Head of Household and all other members who will be living in the unit. Give the relationship of each family member to the Head of Household.
Household Member 1
Full Name
Household Member 1
Relationship
Household Member 1
Birthdate
Household Member 1
Age
Household Member 1
Sex
Household Member 1
Social Security No.
Household Member 2
Full Name
Household Member 2
Relationship
Household Member 2
Birthdate
Household Member 2
Age
Household Member 2
Sex
Household Member 2
Social Security No.
Household Member 3
Full Name
Household Member 3
Relationship
Household Member 3
Birthdate
Household Member 3
Age
Household Member 3
Sex
Household Member 3
Social Security No.
Household Member 4
Full Name
Household Member 4
Relationship
Household Member 4
Birthdate
Household Member 4
Age
Household Member 4
Sex
Household Member 4
Social Security No.
Please list additional household members including full name, relationship to head of household, birthdate, age, sex, and social security number below (if needed).
Is anyone in the household disabled?
HEAD OF HOUSEHOLD

(Check One) - Optional

This information is being collected to assure compliane with fair housing and equal opportunity rules.
INFORMATION FOR FEDERAL REPORTING ONLY
Race
Hispanic/Latino Ethnicity
If you answered "Yes", please specify below
If you answered "Other Hispanic/Latino", please specify below
INCOME INFORMATION

What is the total annual income of all household members? Include wages, salaries and tips; other income such as alimony, child support; and Social Security, AFDC or other benefits.
Household Member 1
Full Name
Household Member 1
Source of Income
Household Member 1
Annual Amount
Household Member 1
Payment Basis (Weekly, monthly, etc.)
Household Member 2
Full Name
Household Member 2
Source of Income
Household Member 2
Annual Amount
Household Member 2
Payment Basis (Weekly, monthly, etc.)
Household Member 3
Full Name
Household Member 3
Source of Income
Household Member 3
Annual Amount
Household Member 3
Payment Basis (Weekly, monthly, etc.)
Household Member 4
Full Name
Household Member 4
Source of Income
Household Member 4
Annual Amount
Household Member 4
Payment Basis (Weekly, monthly, etc.)
Please list additional household members income information including full name, source of income, annual amount and payment basis (weekly, monthly, etc.) below (if needed).
ASSET INFORMATION

List the type and source of any family assets. Provide both the current cash value and the estimated annual income from the asset.
Household Member 1
Full Name
Household Member 1
Type and Source of Asset (Bank accounts, investments, etc.)
Household Member 1
Cash Value of Asset
Household Member 1
Annual Income from Asset
Household Member 2
Full Name
Household Member 2
Type and Source of Asset (Bank accounts, investments, etc.)
Household Member 2
Cash Value of Asset
Household Member 2
Annual Income from Asset
Household Member 3
Full Name
Household Member 3
Type and Source of Asset (Bank accounts, investments, etc.)
Household Member 3
Cash Value of Asset
Household Member 3
Annual Income from Asset
Household Member 4
Full Name
Household Member 4
Type and Source of Asset (Bank accounts, investments, etc.)
Household Member 4
Cash Value of Asset
Household Member 4
Annual Income from Asset
Please list additional household members asset information including full name, type and source of asset (bank accounts, investments, etc.), cash value of asset and annual income from asset below (if needed).
EXPENSE INFORMATION
Does your household have un-reimbursed medical expenses in excess of 3 percent of annual income?
Does your household pay child care expenses for children under the age of 13 that enable a family member to work or go to school?
Does your household pay care expenses for the care of a family member with disabilities that enable a family member to work?
APPLICATION CERTIFICATION

I/we understand that the above information is being collected to determine if I/we are eligible to receive rental assistance. I/we authorize the Meskwaki Housing to verify all information provided on this application.
Head of Household Signature
Date

MonthDayYear
Date
Spouse Signature
Date

MonthDayYear
Date
Should be Empty: