Pasadena, TX · Harris County
Individual Eligibility Form
This bilingual form collects client and household information for people seeking assistance through a Community Development Block Grant program.
What this form is
Agencies use this form to determine client eligibility and for general reporting for Community Development Block Grant programs. A person seeking to participate in a federally funded program must complete it accurately, providing contact and residency details, household size and income, and other information. The form includes a certification, signature, and date section for the client; a separate section is for subrecipient staff.
Who needs it
People seeking assistance through a Community Development Block Grant program must complete the form with accurate client and household information.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
No notary is required; the client signs and dates the certification, and the form identifies no notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the Individual Eligibility Form, available in English and Spanish.
- 2
Complete Client Information
Fill in the client, residency, household, and income information accurately and completely.
- 3
Gather Documentation
Provide proof of residency and income documentation, such as the examples listed on the form.
- 4
Sign And Submit
Sign and date the certification, then submit the form to the city department named on it.
Frequently asked questions
- What information does the Individual Eligibility Form request?
- It asks for client contact, residency, household, income, and demographic information, along with proof-of-residency and proof-of-income documentation details.
- Who completes this form?
- A client seeking to participate in a Community Development Block Grant program completes the eligibility information and certification. Subrecipient staff complete the separate staff-only section.
- Do I need a notary for the Individual Eligibility Form?
- No. The client signs and dates the certification; the form identifies no notarized or sworn attachment.
- How do I submit the Individual Eligibility Form?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Individual Eligibility Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.