Click here for the PA 900V.
Someone at the PHA office should fill in blocks 1 – 10 as follows:
1. Enter the name and address of the PHA.
2. Enter the date the interview with the tenant took place..
3. Enter the name of CAO/district office.
4. Enter the tenant’s CAO case record number, if known.
5. Enter the tenant’s housing authority account number.
6. Enter the tenant’s name, address, phone number and social security number.
7. Enter the number of people living in the housing unit.
8. Enter the name, title, and telephone number of the person who interviewed the tenant. Enter the date of the interview.
9. Enter the amount of the monthly rent at the time of the interview.
10. If there is only one interview conducted with a client before a vendor payment referral is made, enter “same as #8” in block #10 and date it. If there is another interview, then enter the date of the second interviewer in block #10.
A CAO worker must fill in the information at the top-right corner of the form and then fill in blocks 11 – 15 as follows:
11. Enter the PHA’s vendor I.D. number.
12. Enter the client’s monthly and semi-monthly grant amounts before the rent is taken out.
13. Check the right category for the payment. Check a box to tell whether payments can be made directly to the PHA. If payments cannot be made directly to the PHA, tell why.
14. Enter the amount to be sent to the PHA and the effective date.
15. Sign, enter your phone number and today’s date.
Reissued March 4, 2010, totally replacing April 2, 2004; reviewed March 16, 2012