2021 Exterior Paint Program Application

The Department of Community Development
Division of Neighborhood Services

Announces the 2021 Exterior Paint Program!
Receive Paint Vouchers to Help Improve Your Neighborhood!

YOU MAY QUALIFY FOR UP TO $600.00 IN FREE PAINT AND SUPPLIES
LABOR NOT INCLUDED - APPLICANT MUST PAINT THEIR HOME OR HIRE CONTRACTOR.
TO QUALIFY, APPLICANTS:
• Must circle the size of their household on the chart below

• Must be a low or moderate-income family
• Must reside in the house being painted
• Must attend Lead Safe Work Practice Class
• If owner lives at property, he/she must be the applicant
PLEASE CIRCLE YOUR HOUSEHOLD SIZE AND INCOME BELOW
Household
1 2 3 4 5 6 7 8
Size*
Moderate
$51,600 $59,000 $66,350 $73,700 $79,600 $85,500 $91,400 $97,300
Income**
*Number of adults and children who reside at the property
**2020 Income guidelines are subject to change with new 2021 guidelines – Total Household Income
APPLICATION DEADLINE: To participate you must apply by Friday, February 28, 2021.
Applications received after 6:00 p.m. February 28, 2021 will NOT be accepted.
PROVIDE PROOF OF OCCUPANCY (Copy of water bill, W-2)
VERIFY ALL HOUSEHOLD INCOME. This program is for low to moderate income families
based on total household income. Therefore, participants must verify ALL household income.
IF YOU QUALIFY, PLEASE SUBMIT THE FOLLOWING WITH YOUR APPLICATION:
• If currently employed, two (2) current consecutive paycheck stubs;

• If unemployed, copy of current unemployment benefits;
• Retirement/Pension Statement;
• Public Assistance Award letter;
• OR Social Security/ SSI statements (1-800-772-1213) to request proof
COMPLETE APPLICATION ON THE REVERSE SIDE.

APPLICATION MUST BE FULLY COMPLETED TO BE PROCESSED.
AN EQUAL OPPORTUNITY EMPLOYER

2021 Exterior Paint Program Application
This application must be FULLY completed, or it will not be processed to receive a
paint voucher. PLEASE PRINT YOUR RESPONSES.
First
Last Name: Owner: Yes No
Name:
Zip
Address: Tenant: Yes No
Code:
Cell
Home Phone: Ward #
Phone:
When was the house last painted? # of
1 Unit 2 Units
(If unsure, enter “unknown”) Units:
Do any children under the age of 6 live or PRESENT PAINT COLORS
Yes No
regularly visit the property? (please list the current paint colors below)
If you are the tenant, do you have
Yes No Main Structure:
permission from your landlord to paint?
Will a professional painter/contractor be
Yes No Trim:
used?
If already selected, name of professional painter or Foundation:

contractor to be used: Porch:
Owner/Designee
Owner/Designee Name:
Contact Number:
Owner/Designee Signature: Date:
Owner/Designee Address:
ANNUAL HOUSEHOLD INCOME INFORMATION

Annual Income
Name: Type of Income:
Amount:
#1 $
#2 $
#3 $
Monthly Housing Payment Female-headed Are you a City of
(please circle answer below and list the monthly household? Cleveland Employee?
payment amount next to it) (please circle answer below) (please circle answer below)
Rent $ Yes Yes
Mortgage $ No No
DEMOGRAPHIC/RACE INFORMATION (please check one below)
White Black—African American
Native Hawaiian—Other Pacific Islander American Indian—Alaskan Native
Asian Asian & White
American Indian—Alaskan Native & White Black—African American & White
American Indian—Alaskan Native & Black Other/Multi-Racial
ETHNICITY (please check one below)
Hispanic or Latino Non-Hispanic or Latino
APPLICATION CONTINUES ON NEXT PAGE

2021 Exterior Paint Program Application
This application must be FULLY completed or it will not be processed to receive a
paint voucher.
PAINT VOUCHER INFORMATION

(PLEASE READ CAREFULLY)
• Paint vouchers are available to homeowners and tenants.
• You must complete a Lead Safe Work Practice class to receive paint and supply voucher.
• Labor is not included.
• You are required to complete painting by October 31, 2021.
• You must paint the main structure and the attached porches.
• Fences, sheds, garages or any other detached structures from the main dwelling are not
eligible.
ACKNOWLEDGMENT OF RECEIPT OF LEAD PAMPHLET

AND LEAD HAZARD INFORMATION FORM
I received a copy of the lead hazard information pamphlet, “Renovate Right” informing me of the
potential risk of lead hazard exposure from renovation activity to be performed in my home. I
received this pamphlet and completed the "Lead Hazard Information" form before the work began.
APPLICATION SIGNATURE
Applicant Signature: Date:
ADDITIONAL DOCUMENTATION TO SUBMIT WITH APPLICATION

• Proof of occupancy (Copy of water bill, W-2)
• If currently employed, two (2) current consecutive paycheck stubs;
• If unemployed, copy of current unemployment benefits;
• Retirement/Pension Statement;
• Public Assistance Award letter;
• OR Social Security/ SSI statements (1-800-772-1213) to request proof
RETURN COMPLETED APPLICATION TO:
City of Cleveland
Community Development Attention: Home Maintenance Programs Manager
601 Lakeside Avenue, Room 302
Cleveland, Ohio 44114
Exterior Paint Program Instructions
VOUCHERS: Contact the Division of Neighborhood Services for Paint Vouchers.
1. If you are accepted into the program you must attend a Lead Safe Work
Practice class. Once you have completed the class you will receive instructions
on how to obtain your paint and supply vouchers.
2. After you attend a Lead Safe Work Practice training, contact your Community
Engagement Specialist to receive a supply voucher.
3. Once you prep the house for painting, contact the Community Engagement
Specialist to receive a voucher for paint and any additional instructions.
4. You must fully paint your house between April 1, 2021 and October 31, 2021.
5. When you have finished painting your home, CONTACT US AT (216) 664-2045
or (216) 664-3385 TO OBTAIN CLEARANCE INSPECTION.
DO NOT PURCHASE PAINT—MUST USE PAINT VOUCHER!

Contact the City using the following information:
Department of Community Development
Attention: Exterior Paint Program
601 Lakeside Avenue Room #302
Cleveland, Ohio 44114
or call:
(216) 664-2045
(216) 664-3385

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The Department of Community Development

Division of Neighborhood Services

Receive Paint Vouchers to Help Improve Your Neighborhood!

• Must circle the size of their household on the chart below

PLEASE CIRCLE YOUR HOUSEHOLD SIZE AND INCOME BELOW

IF YOU QUALIFY, PLEASE SUBMIT THE FOLLOWING WITH YOUR APPLICATION:

• If currently employed, two (2) current consecutive paycheck stubs;

COMPLETE APPLICATION ON THE REVERSE SIDE.

AN EQUAL OPPORTUNITY EMPLOYER

If already selected, name of professional painter or Foundation:

ANNUAL HOUSEHOLD INCOME INFORMATION

APPLICATION CONTINUES ON NEXT PAGE

PAINT VOUCHER INFORMATION

ACKNOWLEDGMENT OF RECEIPT OF LEAD PAMPHLET

Applicant Signature: Date:

ADDITIONAL DOCUMENTATION TO SUBMIT WITH APPLICATION

RETURN COMPLETED APPLICATION TO:

DO NOT PURCHASE PAINT—MUST USE PAINT VOUCHER!

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