Pasadena, TX · Harris County
Self-Declaration of Housing Status
Applicants or program participants use this form to self-certify housing status or other eligibility information when they cannot provide required verification documents.
What this form is
Complete this form when required verifications or other documents are unavailable and self-certification is the only way the agency can verify information related to program eligibility. It asks for program and household details, a housing-status explanation, and the applicant’s certification and signature. Attach documentation showing efforts to obtain the necessary information; the form includes English and Spanish versions.
Who needs it
Applicants or program participants who cannot provide required verification documents and need to self-certify information related to program eligibility should complete this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer certifies the information under penalty of perjury and attaches documentation of efforts to obtain the necessary information.
How to submit this form
- 1
Download The Form
Download the Self-Declaration of Housing Status form.
- 2
Complete The Form
Enter program, grant, applicant, and household details, then select and describe the applicable housing status.
- 3
Gather Supporting Documentation
Attach documentation showing all efforts made to obtain the necessary information.
- 4
Sign And Submit
Sign and date the certification, then submit the form to the city department named on the form.
Frequently asked questions
- Do I need a notary for the Self-Declaration of Housing Status?
- No. The form has signature and date fields but no notary block. The applicant certifies the information under penalty of perjury and must attach documentation showing efforts to obtain the necessary information.
- Who should complete this form?
- Applicants or program participants should complete it when they cannot provide required verifications or other documents and self-certification is the only way the agency can verify information related to program eligibility.
- What information does the form ask for?
- It asks for program, grant, applicant, contact, and household details, a description of housing status, and the applicant’s certification, signature, and date.
- How do I submit the Self-Declaration of Housing Status?
- The document does not give a submission address or method. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Self-Declaration of Housing Status doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.