ADDRESS: 8273 156
TH
LANE MAYETTA, KS 66509 PHONE: (785)966-2756
Prairie Band Potawatomi Housing Department
Office of National Programs
Season Dominguez, National Programs Specialist
PROGRAM DESCRIPTION:
This program provides up $10,000 for eligible, tribal members towards homeownership. This award is to be
used as a down payment for the purchase of a single-family home in standard or better condition or toward
the build of a new single-family home.
Households may only receive one grant per three (3) year period. The Down Payment awards are based
on a first come, first served basis, approval is received only when all program information is received, and
awards distributed until funds are depleted for this program.
ELIGIBILE ACTIVITIES:
o Single family housing
o Manufactured Homes (MUST be on a placed on
a permanent foundation)
INELIGABLE ACTIVIES:
o rental properties
o commercial properties
o mobile homes
o travel trailers
o tiny homes
o rent to own
o lease purchase
o vacant land
o homes less than standard
o homes previously purchased and closed
ELIGIBILITY REQUIREMENTS:
• The applicant must be an adult, enrolled PBPN Tribal member.
• The applicant must not have any past due debts owed to PBPN or the PBPNHD
PROGRAM REQUIREMENTS:
• The Applicant(s) must obtain own financing.
• The Applicant(s) household annual gross income must be adequate to support a mortgage
payment, taxes, insurance, and maintenance.
• Applicant(s) will be required to participate in a homebuyer education program prior to commitment
of the award or loan. (Must obtain a Certificate of Completion.)
• Applicant(s) will be required to submit a copy of their Closing Statement upon final close of the home.
• FUNDING RECEIVED FROM THE DOWN PAYMENT PROGRAM PAST, PRESENT, OR FUTURE- Failure to
provide a Closing Statement will prevent the applicant from receiving any future housing services.
Your award will be the $10,000 down payment you received from this program is subject to a refund
and will be recorded as a “DEBT” owed to PBPNHD. The eligibility date to reapply for ANY Housing
Service, does not begin until this document is received by the program’s specialist.
• The sources to obtain Debt information includes but is not limited to the following Tribal entities:
o PBPN
o PBPN Housing Department
o Planning & Environmental Protection
o Prairie Band Propane
• The home to be purchased must be used as the Applicant’s primary residence.
• The home to be purchased must be located within the United States.
2022 DOWN PAYMENT GUIDELINES
ADDRESS: 8273 156
TH
LANE MAYETTA, KS 66509 PHONE: (785)966-2756
• The home to be purchased must be located on land zoned for residential purposes and must meet
all Tribal, State, and local construction and placement specifications applicable for the area in which
it will be located.
• The home to be purchased must be in standard or better condition and meet inspection
requirements of the Applicant’s lender.
PRIORITY ASSIGNMENT:
This program does not recognize HOUSING EMERGENCIES of any kind, NO EXCEPTIONS. For the purposes of
all NAHASDA Housing, preferences shall be as follows:
• Applicant or Co-Applicant is an enrolled Prairie Band Potawatomi Nation Tribal member 18 years or
older.
• Applicant family whose head of household is an enrolled member of any federally recognized tribe.
• Applicant non-Indian family determined to be eligible to receive assistance.
APPLICATION PROCESS:
Excluding all federal and Tribal holidays, the general timeframe to allow for processing a complete
application is 1-2 weeks. You will receive an Acceptance Letter explaining the information needed to
obtain an Approval. ALL loan and purchase contracts must have the Tribal member’s name. NO
EXCEPTIONS.
ACCEPTANCE PROCESS:
• PBPNHD Award Agreement- this must be received, original.
• Homebuyers Education Certificate- If you have participated in this program before, you may submit
your previous Homebuyers Certificate of Completion.
• $1,000 Down Payment to Escrow- to be applied to your down payment and cannot be reimbursed
back for ANY reason. Your total down payment will be, $11,000.
• Fully signed and executed Purchase Commitment-Must have the Tribal Member’s name on ALL
contracts.
• Wiring Instructions- Title Company who is closing your loan.
• W-9-Title Company who is closing your loan.
APPROVAL PROCESS:
For your application to be approved, all documents listed in the Acceptance Process must be received.
In addition, this department also needs 1-2 weeks to process a Wire for Closing, AFTER ALL correspondence
is received.
PAYMENT PROCESS:
Excluding all federal and Tribal holidays, the general timeframe to allow for processing a Wire Transfer is 1-
2 weeks. Wire Transfers are prepared for transfer one (1) day prior to closing and, are available to your Title
Company, the morning of your Closing date.
Payments for all National Programs are distributed directly from the PBPN Finance Department.
CLOSING STATEMENTS: A Closing Statement must be forwarded to this program. Failure to provide a
Closing Statement will prevent the applicant from receiving any future housing services. Your award will
be the $10,000 down payment you received from this program is subject to a refund and will be recorded
as a “DEBT” owed to PBPNHD. The eligibility date to reapply for ANY Housing Service, does not begin until
this document is received by the program’s specialist.
PROGRAM TERMS AND CONDITIONS:
• Applications will not be processed until all application requirements are received.
• The income limit for households applying for low-income assistance is 80% of the area median income
adjusted for household size. The U.S. Department of Housing and Urban Development User Guidelines
are used to determine the median household income. Households applying for assistance not within
ADDRESS: 8273 156
TH
LANE MAYETTA, KS 66509 PHONE: (785)966-2756
Prairie Band Potawatomi Housing Department
Office of National Programs
Season Dominguez, National Programs Specialist
“low-income” guidelines will be considered “over-income” and will be subject to the same median
income limit to verify household income and assistance amount.
• Applicants who meet the eligibility requirements may receive one Down Payment award per
household and may not be combined with any other grant or award.
• Approved Applicants will not be eligible to apply for assistance again for three (3) years from the
date of closing of their recently purchased home. Awards include:
o Renovation & Repair Grant from PBPN (1
st
year is considered your working year)
o Down Payment Grant from PBPN
o Rental Assistance Grant from PBPN (National Programs)
o BIA HIP Grant (Category B or C, depending on the year received) of more than $5,000.
• The Down Payment awards are based on a first come, first served basis.
• Official Sales Contracts and/or Purchase Agreements will only be accepted from Financers or Leasing
Agents. Copies will not be accepted from the Applicant or Co-Applicant.
• The Tribal Member must be listed on ALL Sales Contracts for the purchase of the home.
• Any new contractor, vendor, or recipient is required to provide a W9 form according to the Internal
Revenue Code 6109. Failure to furnish this information, payments will not be released and are subject
to up to a 30% backup withholding or penalty.
• Purchase commitments must be made within 90 days from the date of receipt of your application.
• This Award is a gift. No fees or other fees will be added for gift funds. Underwriter’s Letter available
upon request.
• This Award is a Grant. There is no recorded agreement filed against the property by PBPN or PBPNHD.
• If the recipient of this award sells the home within three (3) years from the completion date, the
recipient will be required to reimburse the PBPN a prorated amount contingent upon the date the
home is sold. The prorated amount will be determined by PBPN at their discretion.
• The 2022 Down Payment Guidelines supersede all previous Down Payment Guidelines.
ADDRESS: 8273 156
TH
LANE MAYETTA, KS 66509 PHONE: (785)966-2756
APPLICATION CHECKLIST:
You will need the following documents to complete this application. If you are missing any
documents with this application, the application will be returned to the applicant and the
application will not be processed until received complete.
APPLICANTS:
State Issued driver’s license or identification card for applying including.
For each Adult member in the
household.
Tribal identification (CDIB) or military identification for ALL individuals
applying.
For each person in the
household.
Social Security cards for ALL individuals applying.
For each person in the
household.
Authorization for the Release of Information
For each person in the
household.
INCOME:
Social Security income.
For each
person in the household that this applies to.
State disability award.
For each person in the
household that this applies to.
Unemployment award.
For each person in the
household that this applies to.
Per capita payment verification.
For each person in the
household that this applies to.
one (1) month of current and consecutive pay stubs.
For each person in the
household that this applies to.
Copies of W2’s or tax returns for 2020.
For each person in the
household that this applies to.
Zero Income Affidavit if applicable.
For each person in the
household that this applies to.
ADDRESS: 8273 156
th
Lane Mayetta, KS 66509 PHONE:-(785)966-2756
1. Tribal Member/Applicant:
Full Name:
(First, Middle, Last)
Address:
City:
State:
Zip:
County:
Phone number
Date of Birth:
Age:
Tribal Affiliation:
Email address:
2. Native or Non- Native Spouse/Co-Applicant: [ ] Not applicable
PRINT
Full Name:
(First, Middle, Last)
Address:
City:
State:
Zip:
Phone/Cell number
Message number
Date of Birth:
Age:
Tribal Affiliation:
Email address:
3. Household composition. List ALL persons residing in the home:
Name
Date of birth
Tribal enrollment number
Monthly Gross Earnings
Other income
Self
Self
Self
4. Alternate Contact Information:
First Name
Last Name
Phone number:
ADDRESS: 8273 156
th
Lane Mayetta, KS 66509 PHONE:-(785)966-2756
6. Earned Income:
List all earned income. Anyone in the household currently working, receiving money to care for another person
or is self-employed.
Name
Date of birth
Tribal enrollment number
Monthly Gross Earnings
Other income
Self
Self Self
7. Un-Earned Income:
List all unearned income the household is currently receiving. Please list from any source, such as:
(1) Unemployment Benefits (2) Welfare (3) Insurance Settlements (4) Worker’s Compensation (5) Financial Aid
(6) Veteran’s Benefits (7) Retirement Account (8) Dividends/Interest (9) Social Security/SSI (10) Food Stamps
(11) Child Support/Alimony (12) Per Capita (13) Other.
Name
Date of birth
Tribal enrollment number
Source of unearned
income
(enter # from above)
Paid how
often
Amount of each
payment
Self Self Self
8. Debts and Housing Services:
List all sources of debts owed and any housing services assistance received. Sources include but are not limited
to: (1) Prairie Band Potawatomi Nation (PBPN) (2) PBPN Housing Department (3) Planning & Environmental
Protection (4) Mayetta Propane. All questions must be answered.
Do you or anyone in your household currently have a debt that you owe to the PBPN
or any PBPN Tribal entities?
YES NO
Which Tribal entity do you owe a debt to?
How much is owed to each entity?
Have you or anyone in your household received any type of housing assistance
from BIA or PBPN?
YES NO
What kind of assistance?
When?
Is anyone in your household currently receiving any kind of Renovation or
Repair Assistance from any other Tribal entity?
YES NO
Name of Tribal entity:
Phone:
Address:
ADDRESS: 8273 156
th
Lane Mayetta, KS 66509 PHONE:-(785)966-2756
9.Housing Information:
All questions regarding your residence must be answered and explained.
Are you currently working with a Real Estate Agent?
YES NO
Agents name:
Agents phone number:
Agents email:
Have you secured financing, or have you been pre-approved for a mortgage? YES NO
Will the home you plan on purchasing, be your primary residence? YES NO
CERTIFICATION STATEMENT: I certify that I have read this application and that the information contained
herein is trye and
accurate to the best of my knowledge. I understand that I must comply with program
guidelines and provide additional documentation if required, and that falsification of information on this
application may be grounds for disqualification and/or claim action and refund of entire award.
PRINTED NAME OF APPLICANT:
DATE:
SIGNATURE OF APPLICANT
City:
State:
Zip:
Zero Income Affidavit
(Separate Zero Income forms must be completed by all adult household members if applicable)
First/Last name:__________________________________________________________________________________
Address:________________________________________________________________________________________
City:_______________________________________________ State:___________ Zip:_________________________
1. I hereby certify that I do not individually receive income from any of the following sources:
a. Wages from employment (including commissions, tips, bonuses, fees, etc.);
b. Income from operation of a business;
c. Rental income from real or personal property;
d. Interest or dividends form assets;
e. Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits;
f. Unemployment or disability payments;
g. Public assistance payments;
h. Alimony, child support, or gifts received from persons not living in my household;
i. Sales from self-employment resources (Avon, Mary Kay, Herbalife, Thrive, etc.);
j. Any other source not named above.
2. I currently have no income of any kind and there is no imminent change expected in my financial status or
employment status during the next 12 months.
3. I will be using the following sources of funds to pay for rent, utilities, and other necessities:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
The United States expressly disclaims any and all responsibility or liability to the Recipient or third persons for
the actions of the Recipient or third persons resulting in death, bodily injury, property damages, or any other
losses resulting in any way from the performance of this award or any other losses resulting in any way from
the performance of this award or any contract, or subcontract under this award.
The acceptance of this award by the Recipient does not in any way constitute an agency relationship between
the United States and the Recipient.
Funds provided by US Treasury for Low Income Families.
___________________________________________ _____________________________________________
Printed Name of Applicant/Tenant Signature of Applicant/Tenant
AUTHORIZATION FOR THE RELEASE OF INFORMATION
Organization Requesting Release of Information:
Prairie Band Potawatomi Nation Housing Department Applicant Name:__________________________________________
8273 156
th
Lane
Mayetta, KS 66509 Address:_________________________________________________
P: (785)966-2756
City, State, Zip:____________________________________________
The purpose in signing this Consent Form:
you are authorizing Prairie Band Potawatomi Nation Housing Department (PBPHD
) to
request information including but not limited to:
identity and marital status, income and
assets, public assistance, residences and rental activity, and/or criminal history. PBPNHD
and PBPNNP needs this information to verify your eligibility for housing assistance.
PBPNNP may participate in computer m
atching programs with these sources in order to
verify your eligibility and level of benefits.
Uses of Information to be obtained:
PBPNNP will protect the information it obtains with appropriate and reasonable security
measures. PBPNNP may disclose infor
mation (other than tax information) for certain
routine uses, such as other government agencies for law enforcement purposes and to
Federal and State agencies for employment suitability, accuracy of information and fraud
prevention purposes. PBPNNP is req
uired to protect the information it obtains in
accordance with any applicable privacy law. PBPNNP employees may be subject to
penalties for unauthorized disclosures or improper uses of information that is obtained
based on this consent form.
Who must sign the Consent Form:
Each member of your household who is 18 years of age or older must sign the consent
form. Also required to sign are those persons under age 18 who are the head of household
or co-head and are considered emancipated minors.
Failure to Sign Consent Form:
Your failure to sign the consent form may result in the denial of eligibility for housing
assistance.
Sources of Information:
The groups or individuals that may be
asked to release the authorized
information include but are not
limited to:
Current and Previous Landlords
Tribal/Public Housing Agencies
Courts and Post Offices
Law Enforcement Agencies
Schools and Colleges
Medical and Child Care Providers
Welfare Agencies
Support and Alimony Providers
Past and Present Employers
Banks and other Financial Institutions
State Unemployment Agencies
Social Security Administration
Veterans Administration
Credit Providers and Credit Bureaus
Retirement Systems
Utility Companies
Consent:
I consent to allow PBPNHD to request and obtain any information from any Federal, State, or local agency, organization, business,
or individual for the purpose of verifying my eligibility and level of benefits for housing assistance. By completing and submitting
this form I acknowledge that my types name shall have the same legal validity and enforcement as a manually executed signature
to the fullest extent permitted by applicable law.
Signatures:
Penalties for Misusing this Consent: HUD, the PBPNHD and any owner (or any employee of HUD, the PBPNHD or the owner) may be subject to penalties for
unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this form is restricted
to the purposes cited above. Any person who knowingly or willfully requests, obtains or discloses any information under false pretenses concerning an applicant
or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosures of information
may bring civil action for damages, and seek other relief, as may be appropriate, against the officer or employee of HUD, the PBPNHD or the owner responsible
for the unauthorized disclosure or improper use.
________________________________________________________ ____________________________________
Applicant/Tribal member Date
________________________________________________________ ____________________________________
Spouse/Co-head Date
________________________________________________________ ____________________________________
Other family member over age 18 Date
________________________________________________________ ____________________________________
Other family member over age 18 Date
________________________________________________________ ____________________________________
Other family member over age 18 Date
