Form H09FS "Saskatchewan Home Repair Program - Emergency Repair Application Form" - Saskatchewan, Canada

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Download Form H09FS "Saskatchewan Home Repair Program - Emergency Repair Application Form" - Saskatchewan, Canada

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Repair and Renovation
Homeowner Emergency Repair
• The household asset level must be at or below
the established asset limits as determined by
SHC.
Please contact Saskatchewan Housing
• Eligible repairs include those of an urgent
nature, (i.e. furnace replacement during the
Corporation at 1-800-667-7567 to
heating season).
discuss your emergency repairs.
Emergency Repair:
• Provides financial assistance for homeowners
with low incomes to undertake emergency
repairs required to ensure the safety of their
dwelling.
Assistance:
• A forgivable loan to a maximum of $12,000
is available to eligible clients to address
Other Details:
emergency health and safety standard issues.
The homeowner is responsible for all costs
• Repairs completed prior to receiving written
greater than the approved amount.
approval from SHC do not qualify for
assistance.
Eligibility:
• Once approval is granted, work must be
completed within three (3) months.
• Applicants must own and occupy the property
as their principal residence.
Mail completed application to:
• The annual household income must be
at or below the established income limits
Saskatchewan Home Repair Program
as determined by Saskatchewan Housing
11th Floor – 1920 Broad Street
Corporation (SHC).
Regina, SK S4P 3V6
Telephone: 1-800-667-7567
saskatchewan.ca |
toll free 1-800-667-7567 | H09FS-10/19
Repair and Renovation
Homeowner Emergency Repair
• The household asset level must be at or below
the established asset limits as determined by
SHC.
Please contact Saskatchewan Housing
• Eligible repairs include those of an urgent
nature, (i.e. furnace replacement during the
Corporation at 1-800-667-7567 to
heating season).
discuss your emergency repairs.
Emergency Repair:
• Provides financial assistance for homeowners
with low incomes to undertake emergency
repairs required to ensure the safety of their
dwelling.
Assistance:
• A forgivable loan to a maximum of $12,000
is available to eligible clients to address
Other Details:
emergency health and safety standard issues.
The homeowner is responsible for all costs
• Repairs completed prior to receiving written
greater than the approved amount.
approval from SHC do not qualify for
assistance.
Eligibility:
• Once approval is granted, work must be
completed within three (3) months.
• Applicants must own and occupy the property
as their principal residence.
Mail completed application to:
• The annual household income must be
at or below the established income limits
Saskatchewan Home Repair Program
as determined by Saskatchewan Housing
11th Floor – 1920 Broad Street
Corporation (SHC).
Regina, SK S4P 3V6
Telephone: 1-800-667-7567
saskatchewan.ca |
toll free 1-800-667-7567 | H09FS-10/19
Saskatchewan Home Repair Program – Emergency Repair
Make sure you have signed and dated the attached application and Asset Declaration Form in pen. Please
return your application to our office with ALL of the following information:
Property Tax Notice: send a copy of the last Property Tax Notice that you paid (confirming your
property tax account is current).
Lease Agreement: if you have a roommate or a boarder, send a copy of the lease agreement.
Asset Declaration form: this form collects information about the value of assets you own.
Proof of Household Income:
Income Tax Returns – Send a copy of last year’s income tax return to everyone in the
household, including children over age 18. Full-time students must send proof that tuition
has been paid to the university, college, school, or trade school.
Income Tax Notice of Assessment – Send a copy of the Canada Revenue Agency (CRA) Income
Tax Notice of Assessment for every working member in the household. If you are unable to
find this form, you may ask for a copy by calling the CRA at 1-800-959-8281.
Business, Rental, or Farming Income can be verified by submitting copies of the most recent
Income and Expense Statements.
Disability or Veteran Affairs Pension can be verified with a copy of the most recent pay stub,
and a letter of confirmation.
Child and Spousal Support Payments – If you paid or received child support or spousal
support, send a copy of the separation or divorce agreement.
Program funding is limited; only completed applications will proceed. Should you have
any questions, please contact our office at:
Saskatchewan Home Repair Program
11th Floor - 1920 Broad Street
Regina, SK S4P 3V6
Telephone: 1-800-667-7567
saskatchewan.ca
2
| toll free 1-800-667-7567 | repairstaff@gov.sk.ca | H09-AP-10/19 |
Repair and Renovation
Saskatchewan Home Repair Program – Homeowner Emergency Repair
You may be eligible if your household income and asset value is less than the limits stated in the tables
below:
Saskatchewan Household Income Maximums
(as of July 1, 2020)
One Bedroom
Two Bedroom
Three Bedroom
Four+ Bedroom
$37,500
$46,000
$55,500
$67,000
Bedroom count does not refer to the number of bedrooms in a specific house, but rather the
number of bedrooms required to accommodate household members.
Saskatchewan Household Asset Levels
All Households
$300,000
These Asset Levels are used for all programs offered by Saskatchewan Housing Corporation
to ensure the programs are serving those with the greatest need.
saskatchewan.ca
3
| toll free 1-800-667-7567 | repairstaff@gov.sk.ca | H09-AP-06/20 |
Saskatchewan Home Repair Program – Emergency Repair Application Form
First Name
Middle Name(s)
Last Name
Social Insurance Number:
Date of Birth:
Home Phone
Cell Phone
Email
Town/City
Postal Code
Mailing Address
First Name
Middle Name(s)
Last Name
Date of Birth:
Social Insurance Number:
Home Phone
Cell Phone
Email
Marital Status:
Married
Divorced
Single
Common-Law
Separated
Widowed
Optional Self Declaration:
First Nations
Métis
Inuit
Senior Citizen
Please list all people living in the home, including children:
Date of
Source of Income
Gender
Name
Relationship to Owner
Birth
(if applicable)
(F/M/X)
If you receive income assistance, please provide:
Worker’s Name:
Phone Number:
Property Information:
Legal Land Description:
Lot
Block
Plan
Extension
Have you received program assistance from SHC in the past?
Yes
No
When:
Which Program:
Is your property title free of defects?
Yes
No
Unsure
If no, list lien/writ/judgement.
saskatchewan.ca
4
| toll free 1-800-667-7567 | repairstaff@gov.sk.ca | H09-AP-10/19 |
Type of Repairs:
Please select the emergency repair that your home requires:
Furnace
Roof
Other:
Declaration/Consent:
• The applicant declares that all the facts given in this application form are true and complete.
• The applicant declares that the property listed in this application form is where they live for six (6) or
more months of the year.
• The applicant acknowledges and agrees that any work started before getting approval in writing from
Saskatchewan Housing Corporation (SHC) is not eligible for program funding.
• The applicant gives consent to SHC and its agents to use and disclose any of the facts given in this
application form for any of these reasons:
- to confirm household income;
- to confirm eligibility for program funding;
- to collect any amount owing to SHC;
- to Canada Mortgage and Housing Corporation for research purposes to assess the effectivenss of
the program; and
- to program funding partners for audit purposes.
• The applicant authorizes SHC or its agents to conduct an inspection(s) of the applicant’s property
for the purposes of confirming eligibility for program funding and that any approved work has been
completed.
• The applicant acknowledges and agrees that the facts given in this application form will be kept and
disposed of as required by The Archives and Public Records Management Act.
• The applicant agrees that SHC may contact them from time to time for the purpose of conducting any
client-related surveys about Repair Programs.
• The applicant understands this application does not obligate SHC to approve funding.
Applicant Signature
Date
Applicant Signature
Date
saskatchewan.ca
5
| toll free 1-800-667-7567 | repairstaff@gov.sk.ca | H09-AP-10/19 |
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