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Forms
Meeting with a Housing Recovery Specialist
When you meet with a Housing Recovery Specialist for the first time, you will be asked to forms. Below are links to the actual forms as well as a brief description of what each form means. It is best to familiarize yourself with these forms before going into your first meeting. You may fill them out ahead of time and bring them with you if you wish. Please note this is not a complete listing oF-Forms and other forms may be added in the future.F1 - Notice and Acknowledgement of Limited Availability of Funding
Description: The total amount of funding provided to the Build It Back program by the federal government is limited. For that reason, it is possible that not all eligible applicants will receive benefits.
This form asks applicants to acknowledge that they understand this.
Must Sign: All owners
F1 - Notice and Acknowledgement of Limited Availability of Funding
F2 - Conflict of Interest Disclosure Form
Description: This form asks all applicants to indicate whether they, or any family members or business associates, have a conflict of interest in relation to the Build It Back program.
A conflict of interest is a situation in which the applicant, for financial or other reasons, may influence, or have the appearance of influencing, the professional judgment of Build It Back employees in following the rules and regulation of the program.
Must Sign: All owners named on the deed must submit their own F2
F2 - Conflict of Interest Disclosure Form
F3 - Right of Entry Permit
Description: Throughout the program, Build It Back contractors and damage assessors may need to enter the applicant's home for the purpose of performing inspections, rehabilitation, demolition and/or construction. This form grants permission for contractors to enter the home. Remember that any visits by an assessor would be by appointment and scheduled with the homeowner. Note that no assessment/inspection can be scheduled until this form is signed.
Must Sign: All owners
F4 - Insurance Consent and Release Form
Description: This form allows the program to share applicant information with insurance companies and allows those insurance companies to share information with the program, in order to access data about Sandy-related insurance claims, policies, and payouts.
Must Sign: All owners
F4 - Insurance Consent and Release Form
F6-C - 2017 - Income Self Certification Form for Occupant-Owners
Description: Owners who live at the damaged property must report their current annual household income and any anticipated changes using the F6-C form. The demographic questions must also be answered. No supporting documentation other than the accompanying IRS form is required.
Please submit documents containing personally identifiable information, documents containing bank account information, and scans of personal identification (driver's licenses, passports, etc.) at a Build It Back Center, by mail, or by fax. Note that the IRS form requires a Social Security number - please do not email us the completed IRS form. The IRS form may be submitted in person at a Build It Back Center, by mail, or by fax.
Must Sign: The head of household must fill out the F6-C form in its entirety. Each member of the household who files taxes must complete a separate IRS form.
Note: Please note that all owners must turn in an F6-C for each owner-occupied unit and F7-C for each tenant-occupied unit.
F6-C - 2017 - Income Self Certification Form for Occupant-Owners
F7-C - 2017 - Income Self Certification Form for Tenants
Description: Owners who are landlords must collect income information from each tenant currently living at the damaged property using the F7-C form. The demographic questions must also be answered. No supporting documentation is required.
Note: Please note that all owners must turn in an F6-C for each owner-occupied unit and F7-C for each tenant-occupied unit.
F7-C - 2017 - Income Self Certification Form for Tenants
F8 - Communication Designation Authorization
Description: Sometimes, it is convenient for an owner to have a trusted friend or family member receive notifications (containing otherwise private information) on his or her behalf, but the owner does not want this person to be able to make program decisions for him or her.
Must Sign: This form is optional. It should be used only for those owners who wish to have another receive correspondence on their behalf and be authorized to receive information from the program.
F8 - Communication Designation Authorization
F9 - Authorization for Release of Mortgage Loan Information
Description: This form allows the program to obtain information about the current status of an applicant's mortgage loans, from lenders or servicers. Applicants need to bring a mortgage statement to their intake appointment, and the information on that statement can be used to complete this form.
Please submit documents containing personally identifiable information, documents containing bank account information, and scans of personal identification (driver’s licenses, passports, etc.) at a Build It Back Center, by mail or by fax.
Must Sign: If the property owner has a mortgage on the property, then all owners must sign the form.
F9 - Authorization for Release of Mortgage Loan Information
F10 - Affidavit of Authority to Bind Corporation
Description: Sometimes property is owned by a corporation, partnership, family trust, or other entity. In such cases, an applicant must declare that they have the authority make decisions on behalf of that entity, for the purposes of the program. This form allows them to do that.
Must Sign: If the property is owned by a corporation, the applicant must have the authority to bind the corporation and be able to sign this document.
Note: This form requires notarization.
F10 - Affidavit of Authority to Bind Corporation
F11 - Affidavit of No Insurance
Description: The program needs to know whether owners had insurance on their property at the time of the storm. This form allows the owner to declare that they did not have a homeowner's insurance policy at the time of the storm.
Must Sign: Owners who only had a National Flood Insurance Policy (NFIP), and no additional policy, should sign this form.
Note: This form requires notarization.
F11 - Affidavit of No Insurance
F12 - Affidavit of One and the Same Name
Description: In some cases, an applicant's name may have changed since they recorded ownership of their home (for instance, because of marriage). This form allows the applicant to declare that the name appearing on the property record, though different than their current name, is in fact them.
Must Sign: Anyone whose name appears differently on their property records because their name has since changed.
Note: This form requires notarization.
F12 - Affidavit of One and the Same Name
F13 - Declaration of Sandy Expenses
In order for us to correctly coordinate your benefits and avoid issues regarding other benefits you may have received, you will be required to complete the Declaration of Sandy Expenditures form. The form asks you to provide details regarding the funds you spent recovering from Sandy, including total amounts you spent for repair activities as well as some non-construction items such as temporary housing and other post-storm recovery expenses.
Any amendment to the F13 after (a) 14 days following the signing of the F13 at an Option Review Meeting (ORM) or (b) following the applicant’s signing of the Coordination of Benefits (COB) worksheet – whichever comes first – will not be accepted by the NYC Build it Back Program.
F13 - Declaration of Sandy Expenses
F14 - Affidavit of Zero Income
Description: If an applicant has no income, the applicant must sign an affidavit stating that they have zero income. This form requires notarization.
Must Sign: Applicants who claim to have zero income.
Note: This form requires notarization.
F14 - Affidavit of Zero Income
F15 - Power of Attorney
Description: Owners may wish to be fully represented in the application process by a co-owner, a family friend, or another agent. This form enables the applicant to grant such a representative power for this purpose.
Must Sign: This form is optional. It should be used only for those owners who wish to be represented by someone else throughout the application process who has the ability to make binding decisions on their behalf.
Note: This form requires notarization.
F16 - Agreement to Maintain Tenant Contact Information
Description: An applicant must provide contact information for the property's tenants. This form acknowledges and fulfills that obligation.
Must Sign: All owners with tenants
F16 - Agreement to Maintain Tenant Contact Information
F17 - Reimbursement Certification of Decent, Safe and Sanitary Condition
Description: In order to receive reimbursement, your home must meet the Program's Decent, Safe, and Sanitary ("DSS") standards based upon US Department of Housing and Urban Development (HUD) requirements.
Must Sign: All owners seeking reimbursement for completed repairs.
F17 - Reimbursement Certification of Decent, Safe and Sanitary Condition
F20 - Temporary Housing Claim Form
Build It Back makes temporary relocation assistance payments to qualifying homeowners who must relocate due to construction activities on the home. You may use this form to request temporary relocation assistance.
F20 - Temporary Housing Claim Form
F21 - Moving and Storage Expense Claim
Build It Back provides moving and storage expense assistance to qualifying homeowners who must remove furniture and other items from their home due to Build It Back's construction activities. You must complete this form to receive assistance.
F21 - Moving and Storage Expense ClaimReasonable Accommodation Request (RAR) Form
If a property owner or resident has a disability and needs help participating in the Build It Back Program OR needs particular accommodations with respect to the repair or rebuilding of their home, the owner should complete this form. For more information about NYC Build It Back's Reasonable Accommodation/Modification Policy, please click here
Reasonable Accommodation Request (RAR) Form
Issue Resolution Process Policy
Applicants with questions about how a Build It Back determination was made should review the Program's Issue Resolution Process. Through the Issue Resolution Process, an applicant can learn about how the Program makes decisions and, if necessary, request a review of his or her application.
- If you are contesting a Program determination, please use the Request for Review Form
- If you are contesting a Request for Review determination, please use the Appeal Form
Issue Resolution Process Policy
Multi-Family Program Voluntary Withdrawal Request
This form should be filled out by applicants who no longer wish to participate in the Build It Back Multi-Family Program. Once the request is submitted, your application will be deactivated.
Multi-Family Program Voluntary Withdrawal Request
Cancelled SBA Loan Worksheet
Complete this worksheet to explain why you did not accept the SBA disaster recovery loan that was offered to you. Build It Back will review this worksheet and determine whether the SBA loan that you did not accept must count as a benefit that is available to you.