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Amy Young Barrier Removal Program Forms

Program Administration
Program Manual - updated 2024
Reservation System User Guide (PDF)
Audit Certification Form
Audit Requirements Checklist
Contract and Reservation System Access Request Form
Program flyer (PDF) \| Spanish version (PDF)
Program poster (PDF) \| Spanish version (PDF)
EPA Lead-Based Paint RRP Program (epa.gov)

Program Forms
Activity File Checklist (XLS)
Stage 1 - Intake Application (DOC)
Stage 1 - Certification of Disability (DOC)
Stage 1 - Income Certification effective October 1, 2023 (XLSX)
Stage 1 - Applicant Identification Document Form (PDF)
Stage 2 - Initial Inspection Checklist updated 11/23 (PDF)
Stage 2 - Work Write-Up & Cost Estimate
Stage 3 - Bldg. Contractor Elig. Verif (XLSX)
Stage 3 - Pre Construction Form (XLS)
Stage 3 - Bid Certification (Optional) (XLS)
Stage 3 - Bid Tabulation (Optional) (XLS)
Stage 3 - Pre-Bid Walkthru (Optional) (XLS)
Stage 4 - Final Inspection (XLS)
Stage 4 - Administrator Certification of Energy Efficiency Rule Compliance (PDF)
Stage 4 - Request for Payment (XLS)
Stage 4 - Soft Cost Invoice (XLS)
Stage 4 - Interim Inspection (Optional) (XLS)
Stage 4 - Change Order Form (optional) (XLS)

Optional Forms
Zero Income and Zero Assets Certification (PDF)
Verification of Recurring Cash Contributions (PDF)
Employment Verification (PDF)
Verification of Asset (PDF)
Verification of Income from Business (PDF)
Verification of Social Security Benefits (PDF)
Verification of Pension and Annuities
Verification of Veterans Administration Benefits
Verification of Public Assistance Income
Verification of Child Support Payments
Verification of Income from Military Service (PDF)
Record of Phone Verification (PDF)
Photo Release Form (PDF)
Sample Approval Letter Template (DOC)
Sample Denial Letter Template (DOC)