AFFORDABLE HOUSING LOTTERY APPLICATION

Disclaimer:
Applications are selected through a lottery and are randomly assigned a log number. Depending on
the volume of applications received, it may not be possible for all to be processed. Accordingly, it is
possible that you may not receive a response. We encourage you to apply online at
[Link] so that you are better able to monitor your status. You may be
disqualified if more than one application is received per lottery for your household.

Mail completed application to:

TF CORNERSTONE AFFORDABLE APARTMENTS

PO BOX 1543
NEW YORK, NY 10159

Or email completed application to:

AFFORDABLEHOUSINGAPPT@[Link]

DO DO NOT

✓ Submit one application per Submit multiple applications per

household (Only choose one person or household
option: paper or online
application)

Use whiteout or liquid paper on

application at any time
✓ Complete all sections
✓ Send by standard mail only
Use certified mail, return receipts or
any other method requiring a
signature confirmation

✓ Mail before application deadline

date Pay anyone in connection with the
preparation of filing this application

FAQ

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 1
HC2.0
1. What is a log number?
A log number is a unique, randomly assigned number that all successfully submitted applications
receive. The log number represents the applicant’s place in line. When resident selection begins,
marketing agents start with the lowest log number and move sequentially to higher log numbers to
find eligible applicants.

2. Are there any residency requirements?

Non-New York City residents can apply; however, preference is given to current New York City
residents. Any applicant ultimately approved for this development must maintain the new apartment
as their sole primary residence. If approved for an affordable housing unit, the applicant must
surrender any unit where the applicant is then currently residing. Each member of the applicant’s
household who leases rental residential real property must terminate the lease for and surrender
possession of such rental property on or before the move-in date for a rental affordable unit.

3. What are application preferences?

Preferences help select and determine applicants using fair criteria. Those who may be eligible for a
preference or set-aside include: current New York City residents; persons residing in this
development’s community board; and persons who are municipal employees of the City of New York.
A percentage of apartments is designated for persons with mobility, hearing, and vision disabilities.

4. What is Area Median Income (AMI) and how is it calculated?

Area Median Income refers to income levels modified by household size for the New York metropolitan
area, as determined by the United States Department of Housing and Urban Development (HUD). To
view the current income limits based on your family size, or for more information, visit [Link].

5. What are the eligibility factors?

a. Income Eligibility: Check the lottery advertisement to see if your income qualifies. The ad
shows the income level requirements, for each household size, for this housing opportunity.
b. Qualification as a Household: The New York City Department of Housing Preservation and
Development (HPD) and Housing Development Corporation (HDC) provide affordable housing
opportunities for individuals, families and households who can document financial
interdependence as a household unit.
c. Credit History
• Rentals: Applicants to rental units may choose to consent to a credit check or, provide evidence
of full payment of total rent amount for the last 12 months.
• Homeownership: Marketing agents and lenders evaluate credit history to determine if you may
qualify for a private mortgage and, if so, what the terms of the mortgage may be.
d. Criminal Background Checks
e. Continuing Need: Applicants to HPD/HDC’s affordable housing programs must demonstrate a
continuing need for housing assistance through an analysis of their assets and recent income
history.
f. Property Ownership
• Rental opportunities: Applicants to rental units may not own residential property, or shares in
a co-op, in or within one hundred (100) miles of New York City.
• Homeownership opportunities: No member of the applicant household may own, or have
previously purchased, any residential property, including shares in a co-op.
g. Asset Limits: There is a limit to the amount of total household assets allowed (excluding specifically
designated retirement and college savings accounts). The household asset limit for rental units is
equal to the maximum income limit for a four (4)-person household at the area median income
(AMI) level for which the unit is designated. For a homeownership unit, the value of the applicant’s

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 2
HC2.0
 household assets may not exceed the current four (4)-person HUD income limit for 175% of area
median income (AMI).

6. What happens if I get to the next step in this process?

If you appear eligible and undergo a credit check, you may be charged a credit check fee of $20 per
application When a credit check must be run, you may provide your own credit check instead, for no
fee, if completed within the last 30 days. Prepare for moving – if approved, you may have to move
into your new unit very quickly. You will also be required to provide first month’s rent plus a security
deposit of the same amount.

A. Name & Address

Current Living Address:

(If you are living in a City-run homeless shelter, please list your current shelter address)

First Name Middle Initial Last Name

Street Address Apartment #

City State Zip

Is this a NYCHA property? Yes No

If yes, is your name on the NYCHA household form? Yes No

Is this a City-run homeless shelter? Yes No

If yes, provide your last permanent address:

Building (House) # Street Apartment #

City State Zip

Your Pronouns (he/she/they) (optional): _________________________________________

Phone Numbers:

______________________ _________________________ _______________________

Cell Phone Home Phone Work Phone

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 3
HC2.0
 Check if mailing address is different than Current Living Address, above

Mailing Address (if different):

Building (House) # Street Apartment #

___________________
P.O. Box

City State Zip

Language Contact Preference: In what language would you prefer to receive written
communications about your application? Check one. (If you do not check a language, written
communication will be in English.)
English Español (Spanish) 简体中文 (Chinese)

‫( العربية‬Arabic) Français (French) Русский (Russian)

한국어 (Korean) ‫( اردو‬Urdu) বাাংলা ( Bangla)

Kreyòl Ayisyen (Haitian Creole)

B. Household Information

PRIVACY ACT NOTIFICATION - The Federal Privacy Act of 1974, as amended, requires agencies requesting Social
Security Numbers to disclose (a) whether compliance with the request is voluntary or mandatory, (b) why the
information is requested; and (c) how it will be used.

1. How many persons (including yourself) will live in the unit for which you are applying?

_________________

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 4
HC2.0
2. List ALL the people who will live in the unit for which you are applying, starting
with yourself (Self), and provide the following information.
Gender Identification: In this section, list how you identify (optional). Examples: Female;
Male; Non-binary; etc.
Disability: If a household member has an ongoing mobility (M), hearing (H), or visual (V)
disability and requires an accessible/adaptable unit, please check the relevant box. If
selected for further processing, you will be mailed a form that you and a medical
professional will need to immediately complete and send back. This form is to verify that
your household requires an accessible or adaptable apartment. The form can be used
for any other future applications for a period of up to 12 months.
First, Middle Initial SSN/TIN Relationship Birth Date Gender Disability?
& Last Name, Suffix (Optional) to Applicant MM/DD/YY Identification
(Optional) M V H
Self

If you checked either mobility, visual, or hearing disability, do you or a member

of your household require a special accommodation?

Yes – please specify the accommodation required:

__________________________________________________________________

No

3. Is anyone in the table above a full-time student?

Yes – please circle their names above and write their names here:

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 5
HC2.0
 ___________________________________________________________________

No full-time students in the household

C. Income and Assets

Note: Be sure to check the lottery advertisement to see if your income qualifies. The ad shows
the income level requirements, for each household size, for this housing opportunity.

Question 1
Are you or a member of your household an employee of Yes
the City of New York, the New York City Housing
Development Corporation, the New York City Economic No
Development Corporation, the New York City Housing
Authority, or the New York City Health and Hospitals
Corporation?
If “yes,” please specify the agency or entity at which you or
a member of your household is employed.
Question 2
If you answered “yes” to Question 1 above, have you Yes
personally had any role or involvement in any process,
decision, or approval regarding the housing development No
that is the subject of this application?

Note: If you answered “yes” to Question 1 above, you may be required to submit a statement
from your employer that your application does not create a conflict of interest. If you answered
“yes” to Question 2 above, you will be required to submit a statement from your employer that
your application does not create a conflict of interest. Such statement would not be required
until later in the application process, after you have been selected through the lottery, when you
will also be required to provide other documents to verify income and eligibility.

HPD EMPLOYEES ONLY: If you are an HPD employee, please read the Commissioner's Order
regarding conflicts of interest and consult with the agency's Office of Legal Affairs if you receive
a request to confirm your eligibility.

1. Income from Employment

Note: A “household member” is a person who will be living in the affordable unit.

For any job that is not self-employed, list the amount you make before taxes (Gross Income). For
self-employed individuals, use the amount you make after deductions (Net Income). If your
application is selected for further processing, you will be contacted with a list of documentation
that you will need to provide.

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 6
HC2.0
 List all full and/or part time employment income for ALL Household Members, including
yourself. Include self-employment earnings:
Household Employer Name & Length of Amount How Often? Annual
Member Address Employ- Paid ($) (Ex: weekly, Income
ment bi-weekly,
monthly,
Yrs. Mos. annually)
Self

1A. TOTAL ANNUAL INCOME FROM EMPLOYMENT AND SELF-EMPLOYMENT add all amounts
from “Annual Income” column in this table):

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 7
HC2.0
2. Income from Other Sources

List all other income sources for each household member, for example, welfare (including
housing allowance), AFDC, Social Security, SSI, pension, workers’ compensation,
unemployment compensation, interest income, babysitting, care-taking, alimony, child
support, annuities, dividends, income from rental property, Armed Forces Reserves,
scholarships and/or grants, gift income, etc.
Household Member Type of Income Amount Paid ($) How Often? Annual
(Ex: weekly, Income
bi-weekly,
monthly,
annually)
Self

2A. TOTAL ANNUAL INCOME FROM OTHER SOURCES (add all amounts from “Annual Income”
column in this table):

3. TOTAL ANNUAL HOUSEHOLD INCOME

Add together the total annual income amounts from 1A and 2A, above:

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 8
HC2.0
4. Assets
Are there assets for this household? Examples of assets include Yes
checking account, savings account, investment assets (stocks,
bonds, vested retirement funds, etc.), real estate, cash savings, No
miscellaneous investment holdings, etc.
If “yes,” please indicate assets for each household member:
Household Member Type of Asset or Account Bank/Institution
Self

D. Rental Subsidy
Are you presently receiving a Section 8 Housing Voucher or
Certificate, or any other form of rental assistance? Please
check the appropriate box at right.
 No
Examples of other rental subsidies/certificates include
 Yes – HPD Section 8
voucher
CITYFHEPS, NHTD (Medicaid Waiver), Individual Services and
Supports (ISS), and VASH.  Yes – NYCHA Section 8
Voucher
This information will not affect the processing of the
application. Minimum income listed may not apply to  Yes – Other Rental
Subsidy/Certificate:
applicants with Section 8 or other qualifying rental subsidies.
___________________

E. Ethnicity
This information is optional and will not affect the processing of the application. Please check
the group(s) that best identifies the household:
Hispanic or Latino Not Hispanic or Latino
Choose not to answer

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 9
HC2.0
F. Race
This information is optional and will not affect the processing of the application. Please check
the group(s) that best identifies the household:
White Black or African-American
Asian Native Hawaiian or Other Pacific Islander
American Indian or Native Alaskan Choose not to answer
Other:

G. Housing Choices – Re-rentals and Resales

When an existing affordable apartment becomes available in one of a wide range of

developments in New York City, a small number of interested and qualified Housing Connect
users are picked at random for the opportunity to apply for that unit.

You only have the chance to be randomly selected for re-rentals/resales if you indicate here
that you are interested. Also, you will only have the chance to be selected if your household
size and income match the unit requirements.

1. Are you interested in future affordable housing opportunities located in a different, existing
building that become vacant for re-rental or resale? Yes No

→ If you checked yes, Continue this section (G). If not, skip to Section H (Signatures).

If you are only willing to be considered for re-rental/resale units of specific sizes, locations,
accessibility, and/or pet policies, make those choices below. This will limit the types of units
for which you may be randomly picked to apply. We encourage you to keep your options
open, and only make specific choices below if necessary.

2. Please answer the following questions about your interest in future re-rentals or resales:

a. Which TF Cornerstone building are you interested in. Check all that apply.

455 West 37th St., NY, NY 595 Dean St., Brooklyn, NY

505 West 37th St., NY, NY 5203 Center Blvd
606 West 57th St., NY, NY 5241 Center Blvd
33 Bond St., Brooklyn, NY

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 10
HC2.0
b. What size re-rental or resale unit are you interested in, based on your household size?
Check all that apply.

All sizes that match my income 3-Bedrooms

Studios 4-Bedrooms
1-Bedrooms 5-Bedrooms
2-Bedrooms 6-Bedrooms

c. Which borough(s) are you interested in living in? Check all that apply.
All boroughs and neighborhoods Brooklyn
Manhattan Queens
Bronx Staten Island

d. Are you only interested in certain neighborhoods in the boroughs you checked
above? If yes, write the neighborhoods here:

______________________________________________________________

e. Are you only interested in units that are located in an elevator building and/or
located on the first floor?
Yes, only units in an elevator building or on the first floor
No, stairs to get to the apartment are okay

f. Are you only interested in units in buildings where there is a flat entrance and/or
accessible ramp?
Yes, only buildings with a flat entrance or ramp
No, steps to get in the building are okay

g. Are you willing to live in a building with a no-pet policy?

This does not include emotional support animals or service animals.
Yes, I can live in a building with a no-pet policy
No, the building must allow pets

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 11
HC2.0
H. Signatures (Required for All Household Members 18 and over)

I (WE) DECLARE THAT STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF
MY (OUR) KNOWLEDGE. I (We) have not withheld, falsified, or otherwise misrepresented any information. I (We)
fully understand that any and all information I (we) provide during this application process is subject to review by
The New York City Department of Investigation (DOI), a fully empowered law enforcement agency which investigates
potential fraud in City-sponsored programs. I (we) understand that consequences for providing false or knowingly
incomplete information in an attempt to qualify for this program may include the disqualification of my (our)
application, the termination of my (our) lease (if discovery is made after the fact), and referral to the appropriate
authorities for potential criminal prosecution.

I (WE) DECLARE THAT NEITHER I (WE), NOR ANY MEMBER OF MY (OUR) IMMEDIATE FAMILY, ARE
EMPLOYED BY THE BUILDING OWNER OR ITS PRINCIPALS.

_______________________________________________ ________________________
Signature Date

_______________________________________________ ________________________
Signature Date

_______________________________________________ ________________________
Signature Date

______________________________________________ ________________________
Signature Date

_______________________________________________ ________________________
Signature Date

ENGLISH APPLICATION | TF CORNERSTONE INC - AFFORDABLE APARTMENTS

Page 12
HC2.0