Scituate CDBG - Intake

Please submit this form with information about your property and home repair needs. PRF will review your application and then email you a link to a secure portal to upload the documents necessary for income verification.

If you need any assistance in filling out this form, you can call our office at (401)272-2760 and a PRF representative can handle intake over the phone or mail a paper application to your home.

Homeowner First and Last Name

Please check this box if someone other than the homeowner is filling out this form.

Submitter Name

The name of the person filling out this form that is not the homeowner.

Relationship to Homeowner

Please explain how you are related to the owner of this property. Ex. "I am her son", "I am his spouse." The signature of the homeowner will be required to complete the next step of income verification.

Email Address

Primary Phone Number

Format: (000) 000-0000.

What is your preferred communication method?

This will determine how PRF reaches out to you with updates or requests for more information.

Full Property Address - No need to include Scituate or RI

Street Address

Street Address Line 2, Ex. "Unit 2"

Village, if applicable

Zip Code

Is the property a single or multi family home?

Homeowner Household Size

Total number of residents in homeowner's unit, including the homeowner.

How many units does the property have?

Does this property have tenants?

For the following tenant information fields, please use the primary lease holder's name and information for each unit.

As this program only requires that 1 of 2, 2 of 3, or 3 of 4 of a multi family home's units must income qualify, we do not require income information on all occupied units.

Tenant 1 First and Last Name

Tenant 1 Email

Tenant 1 Phone Number

Format: (000) 000-0000.

Tenant 2 First and Last Name

Tenant 2 Phone Number

Format: (000) 000-0000.

Tenant 2 Email

Tenant 3 First and Last Name

Tenant 3 Phone Number

Format: (000) 000-0000.

Tenant 3 Email

Please describe the repairs that your property needs

If you are not sure of how to describe any technical details, feel free to use plain language.

If you have any photos of the parts of your property that need repair work, you may upload them here for our construction managers to review.

Photos can be sent later in this process if that is more convenient for you.

Does a resident of this property have a mobility disability? If so, additional funds may be available for handrails, ramps, and other mobility modifications.

The signing and submission of this form give authorization for the Providence Revolving Fund to share this information with the town of Scituate for the purpose of home repair. The town of Scituate and State of Rhode Island reserve the right to request further information.

In accordance with federal law and U.S. Department of the Treasury policy, this institution is prohibited from discriminating based on race, color, national origin, sex, age, or disability. Submit a complaint of discrimination, by mail to U.S. Department of the Treasury, Office of Civil Rights and Equal Employment Opportunity , 1500 Pennsylvania Ave. N.W., Washington, D.C. 20220, (202) 622-1160 (phone), (202) 622-0367 (fax), or email crcomplaints@treasury.gov (email)

After this intake application is reviewed by our team for basic eligibility, PRF will contact you to begin the income verification process. You will need to gather the below documents so that PRF can verify that your household's income is at or below 80% of the Area Median Income for its size. PRF will send you a link to upload digital copies, but you are welcome to submit paper documents as well.

Income Verification Document Checklist:

Current Mortgage Statement - Payments must be up to date.
Any Tenant Lease Agreements
Proof of Homeowner's Insurance policy
- If environmental factors pose a threat to the property (ex. property is
  located on a flood plain), proof of additional insurance may be required.
For all of applicant's household members 18 and older, copies of:
- Photo ID
- IRS consent form 8821 to authorize PRF to receive and inspect your tax information. Both the form and instructions are on the website linked.
- Last year's Federal income tax return signed with all schedules and copies of W-2 forms. If you did not file a return, you will have to request a Certification of Non-Filing with the IRS.
- Most recent three (3) consecutive months of pay stubs, if employed
- Most recent six (6) months of bank statements from ALL accounts
- Documentation of Other Sources of Income (SSI, workers comp, unemployment or disability benefits, pension statements, taxable interest and dividends, tax refunds, business income, rental income from real estate income, etc.).
- If self-employed, year to date profit and loss statement
Dependents over 18 and in school full time need to submit a copy of their school schedule or submit a letter stating they are enrolled as a fulltime student from the school office.

Additional Eligibility

Scituate CDBG Home Repair: Intake

Property Information