Hard-working, Obedient, Adaptable Employee seeker
Resume:
Sacramento Housing & Redevelopment Agency *** I Street, Sacramento CA 95814
916-***-**** TTY 711 or 1-800-***-**** www.shra.org Mover’s Briefing
Link to Voucher Briefing Video and Briefing Documents: HCV Voucher Briefing Documents SHRA
If you don’t understand English, please call 916-***-**** for translation assistance. Spanish/Español/ - Si no entiende inglés, llame al 916-***-**** para obtener ayuda con la traducción. Russian/Русский – Если вы не понимаете английский язык, позвоните по телефону (916) 440- 1390, чтобы получить помощь в переводе.
Vietnamese/tiếng việt - Neếu bạn không hieểu tieếng Anh, vui lòng gọi 916-***-**** đeể được hoỗ trợ dịch thuật.
Chinese/ 中国人 - 如果您不懂英语 请致电 916-***-**** 寻求翻译帮助
Hmong/ Hmoob - Yog koj tsis totaub lus Askiv, thov hu rau 916-***-**** rau kev pab txhais lus. Docusign Envelope ID: 2D4489B8-58A9-49D0-A441-E72646945D40 Page 1 of 2 form HUD-52646 (04/2023)
Previous editions obsolete
U.S. Department of Housing OMB No. 2577-0169
and Urban Development (exp. 04/30/2026)
Office of Public and Indian Housing
OMB Burden Statement: The public reporting burden for this information collection is estimated to be up to 0.05 hours, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This collection of information is required for participation in the housing choice voucher program. Assurances of confidentiality are not provided under this collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to the Office of Public and Indian Housing, US. Department of Housing and Urban Development, Washington, DC 20410. HUD may not conduct and sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid control number.
Privacy Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect the information on this form by 24 CFR § 982.302. The information is used to authorize a family to look for an eligible unit and specifies the size of the unit. The information also sets forth the family’s obligations under the Housing Choice Voucher Program. The Personally Identifiable Information (PII) data collected on this form are not stored or retrieved within a system of record.
Please read entire document before completing form Fill in all blanks below. Type or print clearly.
Voucher Number
1. Insert unit size in number of bedrooms. (This is the number of bedrooms for which the Family qualifies, and is used in determining the amount of assistance to be paid on behalf of the Family to the owner.) 1. Unit Size
2. Date Voucher Issued (mm/dd/yyyy) Insert actual date the Voucher is issued to the Family. 2. Issue Date (mm/dd/yyyy) 3. Date Voucher Expires (mm/dd/yyyy) must be at least sixty days after date Voucher is issued.
(See Section 6 of this form.)
3. Expiration Date (mm/dd/yyyy)
4. Date Extension Expires (if applicable)(mm/dd/yyyy)
(See Section 6. of this form)
4. Date Extension Expires (mm/dd/yyyy)
5. Name of Family Representative 6. Signature of Family Representative Date Signed
(mm/dd/yyyy)
7. Name of Public Housing Agency (PHA)
8. Name and Title of PHA Official 9. Signature of PHA Official Date Signed
(mm/dd/yyyy)
Voucher
Housing Choice Voucher Program
Docusign Envelope ID: 2D4489B8-58A9-49D0-A441-E72646945D40 1
10/15/2025
County of Sacramento Housing Authority
T0152456
Operations 1
Angela Thomas
10/15/2025
2/12/2026
10/15/2025
Page 2 of 2 form HUD-52646 (04/2023)
Previous editions obsolete
1. Housing Choice Voucher Program
A. The public housing agency (PHA) has determined that the above named family (item 5) is eligible to participate in the housing choice voucher program. Under this program, the family chooses a decent, safe and sanitary unit to live in. If the owner agrees to lease the unit to the family under the housing choice voucher program, and if the PHA approves the unit, the PHA will enter into a housing assistance payments (HAP) contract with the owner to make monthly payments to the owner to help the family pay the rent.
B. The PHA determines the amount of the monthly housing assistance payment to be paid to the owner. Generally, the monthly housing assistance payment by the PHA is the difference between the applicable payment standard and 30 percent of monthly adjusted family income. In determine the maximum initial housing assistance payment for the family, the PHA will use the payment standard in effect on the date the tenancy is approved by the PHA. The family may choose to rent a unit for more than the payment standard, but this choice does not change the amount of the PHA’s assistance payment. The actual amount of the PHA’s assistance payment will be determined using the gross rent for the unit selected by the family. 2. Voucher
A. When issuing this voucher the PHA expects that if the family finds an approval unit, the PHA will have the money available to enter into a HAP contract with the owner. However, the PHA is under no obligation to the family, to any owner, or to any other person, to approve a tenancy. The PHA does not have any liability to any party by the issuance of this voucher.
B. The voucher does not give the family any right to participate in the PHA’s housing choice voucher program. The family becomes participant in the PHA’s housing choice voucher program when the HAP contract between the PHA and the owner takes effect.
C. During the initial or any extended term of this voucher, the PHA may require the family to report progress in leasing a unit at such intervals and times as determined by the PHA. 3. PHA Approval or Disapproval of Unit or Lease
A. When the family finds a suitable unit where the owner is willing to participate in the program, the family must give the PHA the request for tenancy approval (of the form supplied by the PHA), signed by the owner and the family, and a copy of the lease, including the HUD-prescribed tenancy addendum. Note: Both documents must be given to the PHA no later than the expiration date stated in item 3 or 4 on top of page one of this voucher.
B. The family must submit these documents in the manner that is required by the PHA. PHA policy may prohibit the family from submitting more than one request for tenancy approval at a time. C. The lease must include, word-for-word, all provisions of the tenancy addendum required by HUD and supplied by the PHA. This is done by adding the HUD tenancy addendum to the lease used by the owner. If there is a difference between any provisions of the HUD tenancy addendum and any provisions of the owner’s lease, the provision of the HUD tenancy addendum shall control. D. After receiving the request for tenancy approval and a copy of the lease, the PHA will inspect the unit. The PHA may not give approval for the family to lease the unit or execute the HAP contract until the PHA has determined that all the following program requirements are met: the unit is eligible; the unit has been inspected by the PHA and passes the housing quality standards (HQS); the rent is reasonable; and the landlord and tenant have executed the lease including the HUD-prescribed tenancy addendum. E. If the PHA approves the unit, the PHA will notify the family and the owner, and will furnish two copies of the HAP contract to the owner.
1. The owner and the family must execute the lease. 2. The owner must sign both copies of the HAP contract and must furnish to the PHA a copy of the executed lease and both copies of the executed HAP contract. 3. The PHA will execute the HAP contract and return an executed copy to the owner. F. If the PHA determined that the unit or lease cannot be approved for any reason, the PHA will notify the owner and the family that:
1. The proposed unit or lease is disapproved for specified reasons, and 2. If the conditions requiring disapproval are remedied to the satisfaction of the PHA on or before the date specified by the PHA, the unit or lease will be approved. 4. Obligations of the Family
A. When the family’s unit is approved and the HAP contract is executed, the family must follow the rules listed below in order to continue participating in the housing choice voucher program. B. The family must:
1. Supply any information that the PHA or HUD determined to be necessary including evidence of citizenship or eligible immigration status, and information for use in a regularly schedule reexamination or interim reexamination of family income and composition. Docusign Envelope ID: 2D4489B8-58A9-49D0-A441-E72646945D40 Page 2 of 2 form HUD-52646 (04/2023)
Previous editions obsolete
2. Disclose and verify social security numbers and sign and submit consent forms for obtaining information.
3. Supply any information requested by the PHA to verify that the family is living in the unit or information related to family absence from the unit. 4. Promptly notify the PHA in writing when the family is away from the unit for an extended period of time in accordance with PHA policies.
5. Allow the PHA to inspect the unit at reasonable times and after reasonable notice. 6. Notify the PHA and the owner in writing before moving out of the unit or terminating the lease. 7. Use the assisted unit for residence by the family. The unit must be the family’s only residence. 8. Promptly notify the PHA in writing of the birth, adopting, or court-awarded custody of a child. 9. Request PHA written approval to add any other family member as an occupant of the unit. 10. Promptly notify the PHA in writing if any family member no longer lives in the unit. Give the PHA a copy of any owner eviction notice.
11. Pay utility bills and provide and maintain any appliances that the owner is not required to provide under the lease.
C. Any information the family supplies must be true and complete. D. The family (including each family member) must not: 1. Own or have any interest in the unit (other than in a cooperative, or the owner of a manufactured home leasing a manufactured home space).
2. Commit any serious or repeated violation of the lease. 3. Commit fraud, bribery or any other corrupt or criminal act in connection with the program. 4. Engage in drug-related criminal activity or violent criminal activity or other criminal activity that threatens the health, safety or right to peaceful enjoyment of other residents and persons residing in the immediate vicinity of the premises.
5. Sublease or let the unit or assign the lease or transfer the unit. 6. Receive housing choice voucher program housing assistance while receiving another housing subsidy, for the same unit or a different unit under any other Federal, State, or local housing assistance program. 7. Damage the unit or premises (other than damage from ordinary wear and tear) or permit any guest to damage the unit or premises.
8. Receive housing choice voucher program housing assistance while residing in a unit owned by a parent, child, grandparent, grandchild, sister, or brother of any member of the family, unless the PHA has determined (and has notified the owner and the family of such determination) that approving rental of the unit, notwithstanding such relationship, would provide reasonable accommodation for a family member who is a person with disabilities.
9. Engage in abuse of alcohol in a way that threatens the health, safety or right to peaceful enjoyment of the other residents and persons residing in the immediate vicinity of the premises. 5. Illegal Discrimination
If the family has reason to believe that, in its search for suitable housing, it has been discriminated against on the basis of age, race, color, religion, sex (including sexual orientation and gender identity), disability, national origin, or familial status, the family may file a housing discrimination complaint with any HUD Field Office in person, by mail, or by telephone. The PHA will give the family information on how to fill out and file a complaint. 6. Expiration and Extension of Voucher
The voucher will expire on the date stated in item 3 on the top of page one of the voucher unless the family requests an extension in writing and the PHA grants a written extension of the voucher in which case the voucher will expire on the date stated in item 4. At its discretion, the PHA may grant a family’s request for one or more extensions of the initial term. If the family needs and requests an extension of the initial voucher term as a reasonable accommodation, in accordance with part 8 of this title, to make the program accessible to a family member who is a person with disabilities, the PHA must extend the voucher term up to the term reasonably required for that purpose. Docusign Envelope ID: 2D4489B8-58A9-49D0-A441-E72646945D40 Sacramento Housing & Redevelopment Agency 630 I Street, Sacramento CA 95814
916-***-**** TTY 711 or 1-800-***-**** www.shra.org VOUCHER
EXPIRATION NOTICE
This Voucher Expires 120 Days from Today’s Date
If you are not living in a unit receiving housing assistance and fail to submit the required paperwork to complete the Request for Tenancy Approval (RFTA) process before your voucher expires, you will no longer be eligible to participate in the Housing Choice Voucher (HCV) program and will forfeit your right to a hearing.
24 Code of Federal Regulations § 982.303 Term of voucher.
(a) Initial term. The initial term of a voucher must be at least 60 calendar days. The initial term must be stated on the voucher.
(b) Extensions of term.
(1) At its discretion, the PHA may grant a family one or more extensions of the initial voucher term in accordance with PHA policy as described in the PHA administrative plan. Any extension of the term is granted by PHA notice to the family.
The voucher does not give the family any right to participate in the PHA’s housing choice voucher program. The family becomes a participant in the PHA’s housing choice voucher program when the HAP contract between the PHA and the owner takes effect. Please be aware that if this voucher expires and you have not found a unit to rent, your eligibility is terminated effective on the expiration date of this voucher. 24 Code of Federal Regulations § 982.554 Informal review for applicant
(c) When hearing is not required. The PHA is not required to provide the applicant an opportunity for an informal hearing for any of the following:
(4) An PHA determination not to approve an extension or suspension of a voucher term. 24 Code of Federal Regulations § 982.555 Informal hearing for participant.
(b) When hearing is not required. The PHA is not required to provide a participant family an opportunity for an informal hearing for any of the following:
(4) a PHA determination not to approve an extension or suspension of a voucher term. I do hereby certify and attest that I read and understand the Voucher Expiration Notice. I am aware that I have no hearing rights on an expired voucher. If I am not able to find an acceptable unit and submit the paperwork to the Housing Authority before this voucher expires, my eligibility is terminated effective on the expiration date of this voucher and no further notification from the PHA is required.
Tenant Name Tenant Signature Date
Docusign Envelope ID: 2D4489B8-58A9-49D0-A441-E72646945D40 Angela Thomas 10/15/2025
Rev 09/10/25
NOTICE OF
INTENTION TO VACATE
This Notice MUST:
1. Be used by Housing Choice Voucher Participants to inform a landlord of the tenant’s intent to vacate.
2. Be submitted with a Request for Tenancy Approval (RFTA) of a new rental unit. 3. Be for AT LEAST 30 days. (Due to processing the Housing Authority suggests that you give a 60-day notice).
TENANT DECLARATION
I,
Tenant Name Tenant Code
intend to vacate the unit located at
Address
on
Date
I understand that I am responsible for paying my portion of rent during this notice period. I further understand that the Housing Assistance Payment will terminate on the planned vacate date and the Housing Authority will have no further obligation unless this notice is either extended or rescinded by submitting a Notice to Extend/Rescind before the planned vacate date indicated above.
Tenant Signature Phone # Date
LANDLORD DECLARATION
I declare that I am the:
Owner
Agent
for the above listed property, and I acknowledge that I have been notified of the above-named tenant’s intent to vacate the above unit on the date specified. I further understand that my Housing Assistance Payment Contract will terminate on the planned vacate date and the Housing Authority will have no further obligations unless this notice is either extended or rescinded by submitting a Notice to Extend/Rescind before the planned vacate date indicated above. Landlord Signature Phone # Date
Docusign Envelope ID: 2D4489B8-58A9-49D0-A441-E72646945D40 Angela Thomas T0152456
Rev. 9/10/25
NOTICE TO
EXTEND/RESCIND
This Notice MUST:
1. Be used to inform a landlord of their intent to extend their notice to vacate 2. Have a copy submitted to the Housing Authority before the vacate date listed on the Notice of Intent to Vacate.
TENANT DECLARATION
I,
Tenant Name Tenant Code
currently live at the unit located at
Address
and wish to:
EXTEND my vacate date, I now plan to vacate on . Date
RESCIND my request to vacate. I no longer plan to move. I will be responsible for the full contract rent if this notice is not received by the Housing Authority prior to the vacate date.
Tenant Signature Phone # Date
LANDLORD DECLARATION
I declare that I am the:
Owner
Agent
for the above listed property, and I acknowledge and agree to the above-named tenant’s request to:
EXTEND their vacate date to the day specified above.
RESCIND their request to vacate. They no longer plan to move. I further understand that if this notice is not received by the Housing Authority prior to the vacate date my Housing Assistance Payments Contract for the above unit will terminate and the tenant will be responsible for full contract rent.
Landlord Signature Phone # Date
Docusign Envelope ID: 2D4489B8-58A9-49D0-A441-E72646945D40 Angela Thomas T0152456
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