The Kansas Eviction Prevention Program (KEPP) application closed at midnight on December 15. Applications submitted before 11:59 p.m. on Tuesday, December 15 will be processed, and applicants will be notified whether their application was approved or denied. Applications submitted after 12 a.m. on Wednesday, December 16 will not be considered for funding.

Kansas Eviction Prevention Program Application

Welcome to the application. Please fill everything out in full. If you are a landlord completing this application, do not start this application until you have the signed PDF Tenant Attestation form.

We care about your privacy. The KEPP application system operates on a secure platform accessible only to KEPP staff and applicants. Your application details will not be accessible to or shared with anyone except those KEPP team members tasked with processing your application. We pledge not to print, download, store, or otherwise capture your data in any way outside of the secure application system, and will access your personal information only for the purposes of application processing. 

Fields marked with an asterisk (*) are required.

 

If you have questions about our data security policies, please contact us at KEPP@kshousingcorp.org.

Applications Closed

Applications have now closed. The program application deadline of 12/15 has come to an end. If you have already applied for this program, we will be in touch about the status of your application.

Landlord / Property Information

What is your role?*

Please do not start this application until you have your signed PDF Tenant Attestation.

Have Your Tenant Complete a Tenant Attestation Online

This will open another form for your tenant to fill out the Tenant Attestation. All boxes must be able to be checked to qualify. Landlords, please distribute this link to your tenants to complete. Be sure to communicate your email address to the tenant, as they will need to input this information into the Tenant Attestation.

Once the Tenant submits the form, it will email a copy of the Attestation document to the email that's provided. Please then proceed to download this document and upload it here within the application. This must be completed before you submit this application.


Download our Tenant Attestation PDF

This will download a PDF of our Tenant Attestation. All boxes must be able to be checked to qualify. Landlords, please distribute this document to your tenants to complete. Be sure to communicate your email address to the tenant, as they will need to input this information into the Tenant Attestation.

Once you have the completed document back from your tenant, please then proceed to upload the document here within the application. This must be completed before you submit this application.

This number is assigned to Landlords after Landlord Certification is completed.

If you are a tenant and you are unsure about any of the information above, please contact your landlord. If you are a landlord and you have not submitted your KEPP Landlord Certification, please do so before completing this application.

Tenant Information

Tenant Name*
Date of Birth*
This will be used to verify the eligibility of this application
Tenant Address*

Tenant Income

If you are the Landlord, please complete this section based on the tenant.

Do you currently receive LIEAP, SNAP or TANF assistance?*
Have you applied for unemployment since January 20, 2020?*
Did you file a 2019 State Tax Return?*
$

2019 Federal Adjusted Gross Household Income (income before taxes are taken out), can not exceed 85% of Kansas Median Income (shown below) as measured from January 1st - December 31st, 2019.


All sources of income must be disclosed.

Federal Adjusted Gross Income Limits

Household Size

1 person
2 person
3 person
4 person
5 person
6 person
7 person
8 person
$44,710
$51,170
$57,545
$63,920
$69,020
$74,120
$79,220
$84,405

Please provide income documentation, in the file upload field below. Appropriate documentation might include (but is not limited to):

  • Tax documents
  • Pay Stubs
  • Bank Statements
  • Unemployment insurance statement
  • SSI/ SSDI verification
  • Child support/ alimony verification
  • Letter from employer
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Household Members

Other Household Member Information

Please provide the requested information for each member of your household (including children) even if there was no loss of income for each individual member.

Other Household Member (1)*
Date of Birth*
This will be used to verify the eligibility of this application
Did this household member have income in 2019? (1)*
Other Household Member (2)*
Date of Birth*
This will be used to verify the eligibility of this application
Did this household member have income in 2019? (2)*
Other Household Member (3)*
Date of Birth*
This will be used to verify the eligibility of this application
Did this household member have income in 2019? (3)*
Other Household Member (4)*
Date of Birth*
This will be used to verify the eligibility of this application
Did this household member have income in 2019? (4)*
Other Household Member (5)*
Date of Birth*
This will be used to verify the eligibility of this application
Did this household member have income in 2019? (5)*
Other Household Member (6)*
Date of Birth*
This will be used to verify the eligibility of this application
Did this household member have income in 2019? (6)*
Other Household Member (7)
Date of Birth
This will be used to verify the eligibility of this application
Did this household member have income in 2019? (7)*

Authorization and Release

All tenant applicants must submit a complete signed Authorization and Release form for every member of the household who claimed income in 2019.

Please upload the completed Authorization and Release forms as indicated below.

Download our Authorization Form

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This will be used to verify the eligibility of this application
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This will be used to verify the eligibility of this application
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This will be used to verify the eligibility of this application
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This will be used to verify the eligibility of this application
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This will be used to verify the eligibility of this application
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This will be used to verify the eligibility of this application
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This will be used to verify the eligibility of this application

COVID Hardship

Date hardship began*

Please upload COVID Hardship Documentation. This could include, but is not limited to:

If you are no longer employed, you may upload one of the following:
a. Proof of your unemployment benefits application submission
b. Termination Letter from your former employer
c. Self-certification of your loss of work, if you do not possess any third-party verification

If you are still working, but have experienced a reduction in income, you may upload one of the following:
a. Employer letter stating change in hours, wage reduction, or notice of furlough
b. At least two (before and after) paystubs from enough pay cycles to substantiate a reduction in income
c. Self-certification of reduction of income, if you do not possess any third-party verification

If you have incurred COVID-related medical hardship, you may upload the following:
a. Evidence of medical costs
b. Evidence of positive COVID test

If you have experienced a COVID hardship related to childcare:
a. Self-certification explaining the hardship

Note: Self-certifications may be in the form of an uploaded letter, signed by you, describing the situation.



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Assistance Needed

$
This can include manufactured home or lot rent. Please enter dollar amount to the nearest whole dollar (e.g. $425). Please provide only the rent amount for which this tenant is responsible.
$
This can include manufactured home or lot rent. Please enter dollar amount to the nearest whole dollar (e.g. $1,025). This amount is subject to verification and is not a guarantee of financial assistance.
$
Please enter dollar amount to the nearest whole dollar (e.g. $1,025). This amount is subject to verification and is not a guarantee of financial assistance.
The rental amount indicated above is for (select all that apply)*
The amount above represents unpaid rent (full or partial) for the following months:*

Tenant Attestation

Tenant Attestation - All boxes must be able to be checked to qualify.

If you cannot check all boxes and provide proof where appropriate, you do not qualify.

Tenant Certification:

I certify that the information presented in this application is true and accurate to the best of my knowledge and belief. I authorize Kansas Housing Resources Corporation (KHRC) and any other Federal or State agency, to verify and investigate such information, and commit my full cooperation at any time. I have been given the opportunity to ask questions and understand that I should seek legal counsel if Landlord/ Owner is in breach of this agreement. I understand that providing false, misleading or incomplete information may result in the application being declared void and may result in my having to repay any funds that my landlord receives on my behalf. I release and hold harmless the state of Kansas, KHRC, its grantees, agents, and employees from all claims and demands that relate to or arise out of my application to the KEPPP and any action or inaction taken by the state of Kansas, KHRC, its grantees, agents and employees in the administration and management of KEPP. I further understand that it is a criminal violation under Kansas law to make a false statement in writing for the purpose of procuring assistance from a state agency. I understand that all information submitted to KHRC related to this application may be subject to Kansas' Open Records Law. Furthermore, I am aware that KEPP funds will not be disbursed until it has been determined that I am eligible to participate, and all proper certifications have been submitted.

Date*
Use your mouse or finger to draw your signature above

Tenant Attestation

Have Your Tenant Complete a Tenant Attestation Online

This will open another form for your tenant to fill out the Tenant Attestation. All boxes must be able to be checked to qualify. Landlords, please distribute this link to your tenants to complete. Be sure to communicate your email address to the tenant, as they will need to input this information into the Tenant Attestation.

Once the Tenant submits the form, it will email a copy of the Attestation document to the email that's provided. Please then proceed to download this document and upload it here within the application. This must be completed before you submit this application.


Download our Tenant Attestation PDF

This will download a PDF of our Tenant Attestation. All boxes must be able to be checked to qualify. Landlords, please distribute this document to your tenants to complete. Be sure to communicate your email address to the tenant, as they will need to input this information into the Tenant Attestation.

Once you have the completed document back from your tenant, please then proceed to upload the document here within the application. This must be completed before you submit this application.

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File uploads may not work on some mobile devices.

Tenant Government Monitoring Questions

The following questions will not be used in determination of eligibility. They are asked in order to comply with government monitoring requirements.

Third Party Assistance

Did a third party (someone other than the landlord or tenant) assist you with completing this application?*
Please list hours and minutes in 15-minute intervals

KHRC Use Only - KEPP Partner Team

Verified third-party participation
This step is for the KEPP Partner Team. Clicking this box will authorize payment to be made to third-party vendor.

KHRC Use Only - Processing Lead - Processing Assignment

KHRC Use Only - Processing Team - First Pass Check

Is the Landlord Certification completed and the Vendor ID correct?*
If the landlord completed the form, are the attestations completed and signed?

Check the notes and see if there are any outstanding documents required from the DCF (LIEAP/ SNAP/TANF - automatic income qualifiers) and DOL (unemployment - automatic COVID Hardship qualifier) verification.

  


KHRC Use Only - Processing Team - Information needed to submit to KDOR

If you don't have all authorization & releases, and/or the Landlord Certification is not yet completed, please update this information BEFORE submitting to the next step. Do not select anything below until this is complete. Submitting this step sends the application to KDOR for income verification if needed.

Kansas Eviction Prevention Program (KEPP)

Income Limits
Amount Shown is 85% of Kansas Median Income

1 person
2 person
3 person
4 person
5 person
6 person
7 person
8 person
$44,710
$51,170
$57,545
$63,920
$69,020
$74,120
$79,220
$84,405
$
Are all authorization & releases included?*

KDOR Use Only - Income Qualification

Date/Time
Your Name

KHRC Use Only - Processing Team - Unemployment, LIEAP/SNAP/ TANF Verification

KHRC Employee Name

Income Verification

COVID Hardship Documentation

Are both Income and COVID auto qualified (Are the above two questions yes)?

Please enter a comment if you were not able to find confirmation of assistance after the tenant indicated they received assistance or unemployment.

KHRC Use Only - Processing Team - Income Qualification/ Verification through Uploaded Documentation

Income Qualification / Verification

Kansas Eviction Prevention Program (KEPP)

Income Limits
Amount Shown is 85% of Kansas Median Income

1 person
2 person
3 person
4 person
5 person
6 person
7 person
8 person
$44,710
$51,170
$57,545
$63,920
$69,020
$74,120
$79,220
$84,405
$
No File Chosen
File uploads may not work on some mobile devices.
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KHRC Use Only - Processing Team - COVID Hardship Qualification/ Verification through Uploaded Documentation

KHRC Use Only - Processing Team - Rent Review

Before moving to Funding Approval, please determine whether November and December rent should be included.

   


KHRC Use Only - Processing Team - Funding Decisions

KEPP Funding Approval

   

Max amount is $5,000.

   

Max number of months of assistance is 9.

$
Months approved for payment:
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KHRC Use Only - Compliance

Compliance Follow-up (KHRC Use Only)

Please don't change this value. It gets randomly chosen and will be used for compliance.

Compliance Check

If the number in the field above IS a "9" please check "Yes" for the compliance field and complete the compliance fields below. This field will populate into the email sent to this tenant. This email will be sent automatically from Formstack and is set on a 15-day delay from when this workflow completes.

Compliance Follow-up?
Your input to this field will be placed in the email body to the tenant.

The compliance email that sends will read as below

Hello >>>,

Thank you for participating in the Kansas Housing Resources Corporation, Kansas Eviction Prevention Program (KEPP). 

We want to follow-up to ensure your landlord has not charged you late fees or rent for the months of: 

>>>
>>>
>>> 

Please click here to submit a response (form link). 

Thank you for your time!

Compliance Status

Application Denial (For Steps 2, 4, & 7)

Select the button below to deny this application
This field is optional. It will auto-complete the workflow if selected.
This will show on e-mail to tenant and landlord.

KHRC Use Only - Processing Lead - Application Approval

Application Approved?

Hold or Fraud Status (For Steps 2, 4, & 7)

This field is optional. This will not complete the application.

Upload fields

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KHRC Use Only - Notes

KHRC Use Only - Adjustments to Payment

Type of adjustment needed
$
Negative if a refund, Positive if an additional payment
$
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KHRC Use Only - Paid Information

Paid (Rent Payment)
Date Paid (Rent Payment)
$
Paid (Third-Party)
Date Paid (Third-Party)