0
2021 Resident Census
 

2021 Resident Census

Please Return by March 1, 2021

 

According to the CCA bylaws, Article IX, Section 9.3, and the Federal Fair Housing Amendments Act, you required to answer the following questions.  The information you provide will be treated with strict confidentiality. In order to comply with the regulations of the Department of Housing andUrban Development, this survey must be completed fully and returned to the administration office by March 1, 2021.

 

Every person residing in the unit must be listed when completing the census, including live-in home aides who will be considered full-time, permanent residents.  Even though the governing documents require a resident to be 48 years of age, the Federal Fair Housing Act mandates reasonable accommodations for those who are disabled to have home aides reside in the community.  If your home aide is under the age restriction requirement, you will be asked to write a letter requesting reasonable accommodations to the CCA Board of Directors. All home aides living in Clearbrook must be listed as residents accompanied by proof of age and residency.

 

Proof of age must be provided with this document. Acceptable forms of ID are any of the following:  Birth certificate, Driver’s license, Passport, State issued ID card, Military discharge papers, some other government issued document.  If we have your document on file, a copy is not necessary. You can contact the office if you are unsure about a copy being on file.



DO NOT PRINT THIS E-FORM, PLEASE ONLY HIT SUBMIT ONCE COMPLETED.  IF YOU NEED A PRINTABLE FORM, THEY ARE LOCATED UNDER RESOURCES AND DOCUMENTS AND FORMS!




Section:*
Address:*
Phone #:*
Email Address:*
Name 1:*
Date of Birth 1:*
Name 2:
Date of Birth 2:
Name 3:
Date of Birth 3:
Name 4:
Date of Birth 4:
Is anyone in the unit homebound requiring help in an emergency?:*
Person to Contact in Case of Emergency (Not Living with you in the household):*
Contact's Relationship:*
Contacts Phone Number:*
Contacts Alt Phone Number:
Signature - By typing your name your are acknowledging that all information is correct and accurate:*
Acceptable ID if not on file:
To prevent automated SPAM, please enter 9R1 to submit your form (case sensitive):*
 

* indicates required field