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HCV Extension Request Form

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Housing Authority of South Bend
Phone: 574.235.9346 • Fax: 574.544.5165
501 Alonzo Watson Dr. • South Bend, IN 46601
Monday-Thursday 8:30 am-5:30 pm (Closed Fridays)

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Under the Section 8 Housing Choice Voucher (HCV) Program, applicants/participants have 60 days to find a suitable unit when they are first issued a voucher, or when they have moved out of assisted unit. If you have not been able to locate a suitable unit within this timeframe, you may request an extension from the Housing Authority.

Note: The fields at the bottom of this form marked "For HASB Use Only" should not be completed when submitting this form.

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

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Domestic Violence","value":"domestic violence"},{"label":"2. Death in Immediate Family","value":"death in immediate family"},{"label":"3. Under Doctor's Care or Hospitalized","value":"under doctors care or hospitalized"},{"label":"4. Disability","value":"disability"}]},{"type":"paragraph","subtype":"p","label":"Please note that written documentation is necessary to support your request. If you are seeking an accommodation under the ADA to complete this form, please contact your assigned caseworker. This request should be submitted no later than two (2) weeks prior to the expiration of the Initial Housing Voucher date.","className":"d-block"},{"type":"text","required":true,"label":"Signature of Applicant/Tenant","placeholder":"Disclaimer: By typing your name you are signing this document.","name":"signature-of-applicant-or-tenant","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Date of Signature","name":"Date-of-applicant-signature","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"Housing Authority of South Bend will decide whether to approve or deny an extension request within 10 business days of the date the request is received and will immediately provide the family written notice of its decision.","className":"d-block"},{"type":"header","subtype":"h4","label":"Please review your information above and confirm all is accurate. Once reviewed, please use the submit button at the bottom of this form to send this request to HASB.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"FOR HASB USE ONLY","className":"d-block"},{"type":"text","subtype":"disabled","label":"Original Issue Date (for HASB use only)","name":"Original-issue-date-for-internal-housing-authority-use-only","value":"HASB USE ONLY","className":"col-md-6"},{"type":"text","subtype":"disabled","label":"Original Expiration Date (for HASB use only)","name":"Original-expiration-date-for-internal-housing-authority-use-only","value":"HASB USE ONLY","className":"col-md-6"},{"type":"text","subtype":"disabled","label":"Is this the first Extension request? Yes or No. (for HASB use only)","name":"Is-this-the-applicant-or-tenants-first-extension-request","value":"HASB USE ONLY","className":"d-block"},{"type":"text","subtype":"disabled","label":"Extension Approved? (for HASB use only)","name":"If-the-extension-is-approved-the-Housing-Authority-can-write-the-new-issue-date-and-new-expiration-date-here","value":"HASB USE ONLY","className":"col-lg-4"},{"type":"text","subtype":"disabled","label":"Extension Denied? (for HASB use only)","name":"If-the-extension-is-denied-the-Housing-Authority-can-note-that-here-and-add-any-additional-notes-needed","value":"HASB USE ONLY","className":"col-lg-4"},{"type":"text","subtype":"disabled","label":"Final Voucher Extension, if applicable (for HASB use only)","name":"If-this-is-the-final-voucher-extension-the-housing-authority-can-note-that-here-and-add-additional-comments-as-needed","value":"HASB USE ONLY","className":"col-lg-4"},{"type":"text","subtype":"disabled","label":"HCV Specialist (for HASB use only)","name":"Name-of-the-Housing-Choice-Voucher-Specialist-assigned-to-this-applicant-or-tenant","value":"HASB USE ONLY","className":"col-md-6"},{"type":"text","subtype":"disabled","label":"Date (for HASB use only)","name":"date-when-housing-choice-voucher-specialist-completes-the-internal-information","value":"HASB USE ONLY","className":"col-md-6"}]

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