San Diego Healthy Homes Collaborative Application
To qualify for the San Diego Healthy Homes Collaborative program, you must have at least one child less then 18 years of age diagnosed with asthma or other respiratory symptoms, who lives in or frequently visits the residence, and your combined household income must not be above the following limits.
| Family Size | Household Income |
|---|---|
| 1 | $44,250 |
| 2 | $50,550 |
| 3 | $56,900 |
| 4 | $63,200 |
| 5 | $68,250 |
| 6 | $73,300 |
| 7 | $78,350 |
| 8 | $83,400 |
Applicants are required to provide verification of income that was developed by a party independent of the applicant homeowner/lessor/tenant. Occupants must identify all income that is made within the household. Acceptable forms of documentation include:
- Copies of wages from current payroll stubs or signed employer certifications
- Copies of IRS Tax Forms 1040 and W2 for most recent year available
- Unemployment and disability compensation statements
- Worker's comp and severance pay statements
- Supplemental Security Income (SSI) statements
- Social Security earnings statements
- Retirement or annuity income statements
- Affidavits completed by the individual(s) or firm(s) that pay in cash or furnish child or spousal support
If you do not receive documentation from your employer, or you receive child support, you must have your employer or spouse complete and sign the attached affidavit (PDF: 18KB), and return it with your application. Your name will be entered in the top of the form, but your employer or spouse must complete and sign the bottom section.
Self-certification of income by residents can not be used unless third-party verification is not feasible. Self-certification is defined as income documentation verified by the resident that best estimates the annual income based on earnings for the previous twelve-months. To apply by using self-certification, complete the attached form (PDF: 14KB) and be sure to describe why you are unable to provide proof of income. List the amount of income you make annually and describe the type of income for each amount listed. Types of income that will likely be self-certified include:
- Self employed occupations such as general laborers, gardeners, etc.
- Gratuity income for waiters, waitresses and delivery persons
- Monetary donations received from individuals and groups for household use / living expenses
If you are interested in applying for this program, provide proof of your income eligibility and complete this application (PDF: 38KB). Submit all financial statements and a copy of the application by FAX, Mail or e-mail.
FAX (858) 492-5089
E-mail to lead-safe@sandiego.gov
Or Mail to:
Lead Safe Neighborhoods
9601 Ridgehaven Ct.
San Diego CA 92123
For additional information, send an e-mail to lead-safe@sandiego.gov or call: (858) 694-7000.
