Dear Applicant,

Thank you for contacting Fair Housing Resource Center, Inc. (FHRC) regarding COVID-19 relief assistance. In order to submit your application to Lifeline for assistance there are several steps that need completed in order to come up with a determination for assistance.  This email is to help assist you during this process.

Application Process

  1. You must complete intake with Fair Housing Resource Center.
  2. After intake is completed at FHRC, you will be required to submit the documentation necessary for your application for assistance (Please see documentation listed below).
  3. Once the documentation is collected, FHRC will contact your landlord to request that a Landlord Verification Form and W-9 form to be completed.
  4. When the documentation from the landlord is submitted to FHRC, FHRC staff will complete a referral and submit it to Lifeline. This referral is your 1st step in the application process.
  5. After the referral is submitted, a representative from Lifeline will be getting in contact with you to request additional information/documentation to complete your application.
  6. Lifeline will then contact you to request an application to be signed and make the final determination on your application.
  7. If your application is approved for assistance, your landlord will receive an approval letter showing the amount of the payment being made and where the check will be mailed.

Please be patient during this process, as the demand for assistance is high and both agencies are working diligently to ensure all eligible households are receiving necessary COVID relief.


Documentation Check List

  1. Lease Agreement
  2. Account statement/ balance (document from landlord showing what you currently owe on your rent at this time)
  3. Self-Declaration statement- This is a written statement from you stating your COVID-19 hardship within your household.
  4. Please provide me with your landlord’s contact information.

You may submit this documentation via email or fax at 440-210-6556, if you do not have access to email or fax please reach out to your counselor for alternative options.

Please do not hesitate to contact me if you have any questions or concerns.



Self Declaration 

I hereby state that the total income of all persons residing at the address below for the last 30 days
equals$ _____ _

I understand that income means all of the money the household receives including:

Wages, interest, dividends, annuities and pensions, plus the following:

Social Security
Railroad Pensions
Retirement Pensions
Veterans Pensions
Company Disability
Black Lung
Strike Benefits
training Stipends
Ohio Works First (OWF)
Supplemental Security Income (SSI)
Child Support
Unemployment Benefits
Workers Compensation
Lump Sum Settlements
General Assistance

I understand that by signing this self-declaration I authorize L.E.D.C. to access bank, employment, welfare or
other records, which may or may not be in my possession needed to verify any statements made. I also signify
that I understand I have the right to appeal within 30 days of a written denial of the application. I verify that
ALL statements upon this application by me are true and correct and realize that I may be held civilly and
criminally liable under federal and state law for any knowingly FALSE or FRAUDULENT statement.


Signature ______________ ____________________Date ____________________________
Address ____________________________________________________________________

City: __________________      State:  _________________    Zip Code:___________________