Get Canada Discretionary Residency Benefit Application Form - City Of Kingston 2019-2024

00 You MAY be eligible for DRB if you did not exhaust your Community Start up and Maintenance Benefit in 20112012 AND you have not exhausted the Discretionary Residency Benefit in the past 36 months. 362 Montreal Street Kingston Ontario Canada K7K 3H5 City of Kingston Ontario Works Program Community and Family Services Department Telephone 613 546-2695 Fax 613 546-9658 Discretionary Residency Benefit DRB Request Form Ontario Works DATE MEMBER ID D. R Wishing to move to more affordable housing Comments Items that you are requesting help with ITEM Amount Requested Rent Arrears Last Month s Rent Deposit Utilities Arrears Utilities Deposit/Hook up Telephone/Internet Hook UP Moving Expenses Emergency Heating Fuel Other please list Total All payments approved will be paid directly to a third party e.g. Last Month Rent to Landlord Utilities arrears paid directly to Hydro etc. Participant s Signature Date OW DRB Request form Jan. 2013 REQUEST FOR DISCRETIONARY RESIDENCY BENEFIT INFORMATION SHEET DISCRETIONARY RESIDENCY BENEFIT DRB provides financial assistance to OW recipients who are homeless at risk of homelessness or moving to affordable housing. DRB can provide financial assistance to a maximum of 500. O. B. CASE MANAGER NAME Reason for request Are you r Currently homeless and living on the street or couch surfing r Currently living in temporary or transitional accommodations r Being discharged from an institution i*e* Prison Hospital etc r At risk of homelessness due to any of the following heat/utility arrears rent arrears living in a violent situation health safety concerns caregiver no longer available Landlord has sold building and terminated tenancy. 00 for recipient and spouse. If you have dependent children the maximum financial assistance is 1000. VERIFICATION is required to support your request for DRB i*e* CURRENTLY HOMELESS AND MOVING INTO HOUSING EITHER PERMANENT OR TRANSITIONAL New lease OR Intent to rent OR Receipt of paid rent OR Letter from manager / director of transitional home CURRENTLY LIVING IN TEMPORARY OR TRANSITIONAL HOUSING AND MOVING INTO LONG-TERM HOUSING BEING DISCHARGED FROM AN INSTITUTION Written confirmation of date of discharge from hospital jail mission or residence where your basic needs were provided i*e* Release papers AND New lease intent to rent or receipt of paid rent OR Confirmation of bed at emergency shelter OR AT RISK OF HOMELESSNESS Support to show reason for risk i*e* eviction notice utility disconnection notice copy of notice to vacate police report CAS report letter from a licensed healthcare practitioner property standards AND MOVING TO MORE AFFORDABLE HOUSING Cost of fuel and available funds to pay for fuel.