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2. Participant Name*

   Enter HCV voucher holder's name.

3. Email Address*

   Enter the email address of voucher holder.

5. Mailing Address*

   Enter the address where the voucher holder will receive mail.

7. City*
8. State*

   Enter state initials.

9. Zip Code*
11. Phone Number*

    Enter a contact phone number.

15. Per the Orange County Housing Authority's Administrative Plan:
    • It is necessary as a reasonable accommodation for a person with disabilities.
    • It is necessary due to reasons beyond the family's control, as determined by Orange County Housing Authority (OCHA). Following is a list of extenuating circumstances that OCHA may consider in making its decision. The presence of the circumstances does not guarantee that an extension will be granted.
      • Serious illness or death in the family;
      • Obstacles due to employment;
      • Whether the family has already submitted Requests for Tenancy Approval (RFTA) that were not approved by OCHA;
      • Whether the family size or other special requirements make finding a unit difficult;  or 
      • Other similar circumstances identified by OCHA.
17. Please provide the reason why you have not located a suitable unit within 120 days:*

    Give a brief explanation of why you have not located a suitable unit. 

19. Current Voucher Issue Date:*

    Enter the date your voucher was issued to you.

20. Current Voucher Expiration Date:*

    Enter the date your voucher expires.

21. Voucher extension expiration date:

    Enter your voucher extension expiration date.

25. OCHA Office Use Only:
27. Voucher Extension Status

    1. Voucher Extension Approved
    2. Voucher Extension Denied
28. Voucher Expiration Date:
    Voucher Expiration Date:
29. Termination Date:
    Termination Date:
31. Per OCHA Staff Member
    -- Select One --Felicia Mack, Housing TechnicianAlycia Brown, HCVP CoordinatorBlake Rosser, HCVP Manager
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field