King County
Housing Authority
OFFICE USE ONLY
Form #: 12003
Subsidy #:
Unit #:
Effective Date:
SECTION 8 OFFICE
700 ANDOVER PARK W, SUITE A, TUKWILA, WA, 98188-3322
PHONE: (206) 214-1300 FAX: (206) 243-5927
LiveIn Aide Certification
Form to be completed and signed by households seeking approval of livein aide designation
I am seeking a reasonable accommodation approval for a livein aide. The livein aide accommodation carries several benefits, but also some
responsibilities. An alternative option to livein aide is the possibility of adding another person to my household composition which would
also be subject to approval of the Housing Authority.
LiveIn Aide:
The livein aide is a person who resides with one or more persons with disabilities and is determined to be essential for my care and well
being, is not obligated for my support, and would not be living in the unit except to provide the necessary supportive services.
z A livein aide may not be:
{ A family member who would otherwise be living with me, although this person may otherwise perform the necessary
supportive services;
{ Someone who is only providing services to me on an occasional, intermittent, or rotating basis (someone providing several
hours a day or even several days/nights a week may not be a designated as a livein aide if they are not living in the unit); OR
{ The head of household
z The livein aide has no residual rights to the unit. In other words, if I am no longer able to live in the unit and/or receive housing
assistance, or in the event of my death, my designated livein aide will not be allowed to continue to live in the unit, or receive the
housing assistance.
z A household with an approval livein aide may receive a maximum of one additional bedroom to their housing allowance.
z Income from a designated livein aide will not be counted in determining my household rent.
z The livein aide accommodation may be subject to continued need verification on part of the Housing Authority.
z If it is determined that I am no longer eligible for the services of a livein aide, the livein aide designation will be removed from my
household, and my bedroom eligibility subsequently adjusted.
Household Member:
I
am interested in adding an additional person of my choosing to my household composition (not a livein designation), subject to the
review, approval and screening of the Housing Authority.
z Eligible household members must meet one of the following definitions:
{ Be related to me by blood, marriage, adoption, or be to show a stable ongoing relationship;
{ Be disabled; or
{ Be 62 years of age or older.
z Household members may continue to receive housing assistance in the event that I am no longer able to live in the unit and/or
receive housing assistance, or in the event of my death.
z The income of an additional household member will be counted in the calculation of my household rent.
z My bedroom eligibility may increase with the addition of household members, subject to Housing Authority Occupancy Standards.
I have read and understand the terms and conditions of the livein aide. I have marked my choice. If I choose to proceed with the
reasonable accommodation of a livein aide and receive approval for this request, I agree to comply with the terms and conditions of the
livein aide program.
Signature of Head of Household: Date:
