Housing (PH & HCV): Low or Sporadic Income Checklist

The Housing Authorities of Dickson and Waverly
Monday - Friday 7:30 a.m. - 4:30 p.m.
dicksonhousing.org

Dickson Housing
Waverly Housing

Administrative Offices
615-446-9371
333 Martin Luther King Jr. Blvd
Dickson, TN 37055

Fields marked with * must be completed or form will not submit.

Your household has indicated that you have no income or very low income. It is Dickson and Waverly Housing Authority's policy to ensure that you can pay your rent in accordance with the lease, that you can maintain the unit in accordance with the lease, and that you are fully disclosing all income as required. In order to receive assistance, you are required to supply the following information so that we can ensure that no income is overlooked. All responses are subject to verification. Incomplete worksheets will not be processed, which means that assistance and/or tenancy may be denied or terminated as appropriate. The form lists all cash and non-cash contributions you are receiving and assists the Public Housing Authority to determine the actual value of each contribution. You are required to submit documentation of amounts claimed.