Pasco County Homeless Prevention Intake Form

Program eligibility screening questionnaire

Please fill out the following questionnaire to determine if you are eligible. If you are eligible, you will receive a link to continue the intake process.

Indicate which hurricane you were impacted by *

Hurricane Milton

Hurricane Helene

None

If you were impacted by the listed hurricanes, but you are currently not residing in a declared disaster area, mark “None”

Does your household income fall at or below HUD AMI limit of 30% (29% or lower) *

Yes

What is your current housing situation? *

Renter

Living with family/friends

Homeless

None of the above

Have you received any of the following notices? (Check all that apply) *

30-day notice to vacate

Eviction notice

None

Sorry, you are not eligible for Homeless Prevention (Rental and Utility Assistance) as per the guidelines. For further inquiries, you can email at richa@heausa.org

Your Name *

Your Email *

If you are human, leave this field blank.