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West TN Homeless Hotline
1-866-307-5469

Tennessee Homeless Solutions

PSH Forms

The following PSH forms have been approved by the West TN CoC Board and HUD Knoxville Field office for use:

Form No.       Form Name

4 Homelessness Certification
5 Chronically Homeless Qualification Checklist and Timeline
6 Debilitating Condition Verification
Agency Example--Statement of Understanding and Agreement
Agency Example--Termination and Grievance Policy
Agency Lead Based Paint and Fair Housing Pamphlets
7 Housing Quality Inspection SEE APPENDIX --B
8 Inspection Deficiencies Notice (if applicable)
9 Limited Scope Environmental Review SEE APPENDIIX --C
10 Rent Reasonable Verification
11-13 Lead Based Owner Certification, Disclosure of Information, Risk Assessment
Agency Example--Lease and Lease Addendum
14

Resident Rent Calculation Worksheet

APPENDIX A
APPENDIX B
APPENDIX C
APPENDIX D

APPENDIX E

Tennessee Homeless Solutions
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