Please complete all required fields!
TO: people who use or apply to use PHA housing or services who are disabled.
If you are disabled and would like to ask for PHA for an accommodation or modification of a housing unit to help with a disability, please complete this form. The form will help the PHA understand your request and respond accordingly.
The following member of my household has a disability as defined here. (A physical or mental impairment that substantially limits one or more life activities; or a record of having such impairment, or regarded as having such impairment.)
Note: Where the individual with the disability is over 18 and is not the head of the household, he or she should sign the authorization above for verification.
Resident/Applicant Release:
DISABLED: Inability to engage in any substantial gainful activity by reason of any medically determinable physical/mental impairment which can be expected to last for a continuous period of not less than 12 months. In the case of an individual who has attained the age of 55 or is blind, inability by reason of such blindness to engage in substantial gainful activity comparable to those in which the person previously engaged with some regularity and over a substantial period.
HANDICAP: A person having a physical/mental impairment which is expected to be a long-continued and indefinite duration, substantially impedes his/her ability to live independently and is of such that the person’s ability to live independently could be improved by more suitable housing conditions.
DEVELOPMENTAL DISABILITY: A severe chronic disability which is attributable to a mental/physical impairment, was manifested before age 22, is likely to continue indefinitely, results in substantial functional limitations in 3 or more of the following areas: capacity for independent living; self-care; receptive and expressive language, learning; mobility; generic care, treatment, or other services which are of lifelong or extended duration and are individually planned and
