Skip to form

Brevard County Housing and Human Services

bchhs@brevardfl.gov

2725 Judge Fran Jamieson Way, B-103, Viera, FL, 32940, US

321-633-2007

SeamlessDocs

EMERGENCY RENTAL ASSISTANCE PROGRAM

The Emergency Rental Assistance Program is to provide financial assistance and housing stability
services to income eligible households for rent, rental arrears, utilities and home energy costs,
utilities and home energy costs arrears, and other expenses related to housing.
Program Overview:

  1. Applicant is a resident of Brevard County.
  2. Applicant is at or below 80% of Area Median Income.
  3. The applicant must sign all required documents (application, social security number waiver, release/request of information, etc.) or their application will be rejected/denied.
  4. Documentation of all income from the entire Household as reported on the Household Income Section of the application (include 2 months of bank statements, paystubs, etc., or a 2020 tax return (IRS Form 1040)).
  5. All members of a household must be accounted for in the application.
  6. For applications filled out by hand, please make sure that the writing is clear and legible.



Please check that you agree before continuing.
By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.

The document you are currently trying to view is unavailable

Please contact the form administrator to resolve this issue

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

x

Signature Type

Type Draw Upload Custom
Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

x

Additional Signatures Required

Copy of Valid Identification for every household member 18 years and older (Florida Driver’s License, Florida Identification Card, etc.) with a Brevard County address. Click Here to Upload
Documentation of all income from the entire Household as reported above (corresponds to Household Income section and includes 2 months of bank statements, paystubs, etc.) or a 2020 tax return (IRS Form 1040). Click Here to Upload
Social Security Waiver (Attachment B). Click Here to Upload
Current Lease which corresponds to the time period requested for assistance (showing monthly rent). Click Here to Upload
Statement from a Landlord (showing the arrearage / amount due (for example, a ledger showing each month)). Click Here to Upload
Past due utility or rent notice or eviction notice. Click Here to Upload
Unemployment Documentation Click Here to Upload