Campbell County, Kentucky

Welcome to the official website of Campbell County, Kentucky!

Submit Housing Personal Declaration

 Step 1 of 1

Your Recertification Packet contains information regarding rules, regulations, policies, and procedures of Campbell County Department of Housing’s (CCDH) Housing Program.  CCDH administers Section 8 rental assistance in the Counties of Campbell and Pendleton, excluding the City of Newport.  This packet will be useful to you as an applicant, voucher holder, and program participant, so please keep the information and refer to it periodically.  This information is specific to CCDH’s Family Obligations and the agency’s Administrative Plan. 

ALL QUESTIONS MUST BE ANSWERED TRUTHFULLY AND ACCURATELY.  FAILURE TO PROVIDE TRUE AND COMPLETE INFORMATION WILL RESULT IN THE FAMILY’S INELIGIBLITY FOR ASSISTANCE. 

* Denotes a required field

Family Composition

*
*
*
*
ZIP*
-
Second portion of ZIP Code is optional.
*
Phone Number*
-- ext
Date of Birth*
 Date of Birth
Social Security Number*
--
*
 
Date of Birth 
 Date of Birth
Phone number 
-- ext
Social Security Number 
--
*
 

List all household members who reside in your assisted unit at least 50% of the time

List Name, Relationship, Date of Birth MM/DD/YYYY, Name of School, Race and Name of Absent Parent for Minor for each household member
 
 
 
 
 
 
 
*
 
*
 
 

Income

*
This includes money from wages, self-employment, child support, contributions, Social Security, disability payments (SSI), Workers Compensation, retirement/pensions, AFDC, Welfare, Veteran Benefits, unemployment benefits, rental property income, property settlement, stock dividends, interest from bank accounts and stock dividends, alimony, and all other income.
 
*
 
 
*
 

Student Status

*
 
 

Assets

*
*
*
*
 

Expenses

*
*
 
*
 
*
*

Program Integrity

*
 
*
 
*
 
*
 
*
 
*
 
*
 

Acknowledgements

I acknowledge that I have received the following documents (online):
Documents*
Acknowledgements*
Signature Line (all adult household members) = By typing in the name(s) of all adult household members this serves as your signature.
*
WARNING! SECTION 1001 OF TITLE 18 OF THE U.S. CODE makes it a criminal offense to make willful false statements or misrepresentation to any department of the United States as to any matter within its jurisdiction. It is also a criminal offense under the KENTUCKY REVISED STATUTES to make willful false statements to this agency.
*

Submission of this form confirms that you have read, understand, and agree to the terms of the CCDH Personal Declaration.

If you have questions regarding the information provided, please contact the office at (859) 261-5200.