Income Review Form

I/We have reported all income received, all assets currently owned and assets transferred by every member of the household.

All members of the household must report any change in information, in writing, to the Canadian Mental Health Association within 10 business days of the change occurring (i.e. change of phone number, family size, type or amount of income).

The undersigned consents to the exchange of information between the Canadian Mental Health Association and the party/parties providing supporting documentation/information on behalf of the household member(s), for the purpose of verifying the validity and accuracy of this information.

Any information contained on this form or in attachments is collected by the Canadian Mental Health Association, Windsor-Essex County Branch. Inquiries relating to this collection should be directed to the Canadian Mental Health Association. This information will be used to determine eligibility of and/or continuation of housing and may be used for the determination of subsidized rent.

FAILURE TO REPORT ON THE HIGHLIGHTED MANDATORY COMPONENTS LISTED ON THIS FORM WILL RESULT IN TERMINATION OF THE RENTAL SUBSIDY WITH NO ABILITY TO REINSTATE IT.