HomeMy WebLinkAbouthcsa-housing-assistance-fund-vendor-forms-for-paymentDue to the confidential nature of client information, this information shall be used by authorized staff only.
Last revised May 2025
Information for Property Owners & Managers
Thank you for your support of the Housing Assistance Fund. The Fund provides financial assistance for housing
costs for qualified applicants and households who are receiving services from specific Alameda County service
providers.
All payments are made directly to third parties: landlords or property management companies.
This housing fund may be used for rental assistance like the first month’s rent and security deposit as well as
items and services needed to make the home safe and accessible.
Applications are submitted by service providers in partnership with applicants and include information about
the applicant’s housing situation. Information is also needed directly from the Property Owner (Landlord) or
Property manager for payments to be made on behalf of the applicant.
Required Documentation from Property Owner/Property Manager
In order to make a payment, our finance department requires three business vendor forms: a signed invoice, the
business vendor add update form and a signed W-9 form. Once the paperwork is complete, payment is typically
received within 30 days of application approval.
Please submit the following documents by email:
Fully completed, signed invoice
HCSA Housing Assistance Fund Vendor Form
W-9 form with signature
The name on the forms must remain consistent. For example, if the check is made payable to “ABC Property
Management,” the Business Vendor Add Update Form and W-9 form should include this name in the same spot,
written exactly the same, down to the punctuations.
In addition, in some cases the property owner or property manager may also be asked to provide a copy of the
lease, if the applicant does not have a current copy. We must establish tenancy to pay the requested housing
costs. Alameda County Health must be able to verify that the vendor has the right to rent the property. Alameda
County Health has search tools to do this, however if ownership cannot be verified the application cannot be
approved.
E-mail: HomeStretchFund@acgov.org
Fax: (877) 489-4642
Forms Attached: Invoice Form
Home Stretch Housing Assistance Fund Business Add/Form
W-9
For more information, please call Housing Assistance Fund at the (510) 567-8030.
ousing Assistance Fund
Housing Assistance Fund Invoice
Name of Property Owner/Vendor:
Remittance Address (Address where
check should be mailed to):
Owner/Vendor Phone Number:
Invoice Date:
Tenant/Applicant Name:
Tenant’s/Applicant’s New Address:
DESCRIPTION OF INVOICE CHARGES:
Rental Assistance:
For the Month of: _____________________
First Month’s Rent (if applicable): $____________________
Move in Security Deposit (if applicable): $____________________
Total Due from Alameda County: $____________________
Payments for Vendors other than Landlords/Property Managers (i.e. moving company):
Amount of Reimbursement to provider: $____________________
Amount Due to Vendor $____________________
Total Due from Alameda County: $____________________
Send Invoice to: Housing Assistance Fund – HomeStretchFund@acgov.org
Please make check payable to:
________________________________________________________
Property Owner or Representative Signature
______________________________________________________
Signor Above (Please Print Full Name)
Housing Assistance Fund
Business Vendor Add/Update Form
Instructions. This form is for property owners, business owners, and managers to complete on behalf of tenants or residents
approved to receive one-time housing related financial assistance from Alameda County. Housing assistance funds can be
used for security deposits, rental expenses, home furnishings and household items. Please complete this form along with
an original invoice and original W-9 form both forms with signatures to ensure timely payment to you by the County. This
vendor and W-9 forms are only required once to create a payment account within Alameda County.
E-mail this Form to:E-mail: HomeStretchFund@acgov.org; Phone: (510) 567-8030
1.Is an Alameda County Employee/Board Member/Commissioner affiliated with this business?
Yes No
If Yes, there may be a conflict of interest pursuant to Section 66 of the Alameda County Charter that requires further
action. Contact County Counsel to confirm there is no conflict or interest in order to proceed with this request.
2.Have you previously been set up as a vendor with Alameda County? Yes No
3.Is the business located in Alameda County? Yes No If yes, how long? Yrs ______Mos.
4. Supplier Information:
Federal Tax ID Number:______
Supplier Full Legal Name: __________
Supplier Doing Business As (DBA) Name (if applicable):______
Supplier Contact Name:
Supplier Address (Where check should be mailed):
City: State: Zip Code:
Supplier Contact Phone #: __ Supplier E-mail Address:
5. Type of Business Entity (Select ONE): Individual Sole Proprietor Partnership
Corporation Tax-Exempted Government or Trust
6.Check all boxes that apply to Alameda County payments you may receive:
Rents/Leases Rents/Leases paid to you as the agent Home Furnishings/Household Items
Moving Services Safety & Accessibility Modifications/Services
7. Business Ownership Composition:
Is this supplier a publicly traded entity, a public school, or government? Yes No
Is this supplier a non-profit or a faith-based organization? Yes No
Is this supplier an individual payee that is not providing goods or services to the County? Yes No
If “Yes” to any of the above, skip 8 and 9 below.
8. Business Ownershup Ethnicity:
African American or Black (> 50%) Hispanic or Latino (> 50%)
American Indian or Alaskan Native (> 50%) Native Hawaiian or other Pacific Islander (> 50%)
Asian (> 50%) Multi-ethnic minority ownership (> 50%)
Caucasian / White (> 50%) Multi-ethnic ownership (50% Minority – 50% Non-Minority)
Filipino (>50%) Decline to State
9. Business Ownership Gender Identity:
Female (> 50% ownership) Male (> 50% ownership) Non-Binary (> 50% ownership) Decline to State