870.946.2622

Home Contact Us

Apply Online Pay Online

Apply Online Pay Online

Resident: Housing Choice Voucher Extension Request Form

Arkansas County Housing Authority
P 870.946.2622
Monday - Friday • 8:00 am - 4:30 pm
105 W. 4th Street • P.O. Box 447 • DeWitt AR, 72042
[email protected]

Equal Housing, Handicap Accessible, and Accessibility Icons.

Fields marked with * must be filled out, or the form will not submit.

[{"type":"text","required":true,"label":"Name","name":"Full-name","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","required":true,"label":"Phone Number","name":"Phone-number","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email Address","name":"email","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email Address Confirmation","name":"email-confirmed","className":"col-md-6"},{"type":"text","required":true,"label":"Street Address","name":"Address","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"City","name":"City","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","required":true,"label":"State","name":"State","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR","selected":true},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC"},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","required":true,"label":"Zip Code","name":"zip-code","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div><b><br></b></div><div><b>Requests must be submitted in writing before the voucher expiration date.</b></div><div><b>One 30-day extension will be automatically approved upon written request. </b></div><div><b>Additional extensions may be granted only for circumstances beyond the family's control and are not guaranteed.</b></div><div><br></div><div><br></div>","className":"d-block"},{"type":"checkbox-group","required":true,"label":"<b>Requesting First 30-Day Extension (Automatic)</b>","inline":true,"name":"Requesting-First-30-Day-Extension","className":"d-block","values":[{"label":"YES","value":"YES"},{"label":"NO","value":"NO"}]},{"type":"radio-group","required":true,"label":"<b><u>You MUST select one:</u></b>","name":"Select-One","className":"d-block","values":[{"label":"Unable to locate a unit that meets program requirements","value":"Unable to locate a unit that meets program requirements"},{"label":"Located a unit, but it will not be available until: (Date Below)","value":"Located a unit, but it will not be available until: (Date Below)"},{"label":"Located a unit, but repairs/inspection will not be complete until: (Date Below)","value":"Located a unit, but repairs/inspection will not be complete until: (Date Below)"}]},{"type":"date","label":"<b>Date it will be available / complete</b>","name":"Date-it-will-be-available--complete","className":"d-block"},{"type":"text","label":"<b>Other (must explain):</b>","name":"Other","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div><b><br></b></div><div><b>ADDITIONAL INFORMATION (REQUIRED FOR ADDITIONAL EXTENSIONS)</b></div>","className":"d-block"},{"type":"text","label":"<div>Explain why additional time is needed (if requesting more than the first extension):</div>","name":"Explain-why-additional-time-is-needed-if-requesting-more-than-the-first-extension","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div><b><br></b></div><div><b>REASONABLE ACCOMMODATION</b></div>","className":"d-block"},{"type":"checkbox-group","required":true,"label":"<div>Is this request related to a disability?</div>","inline":true,"name":"Is-this-request-related-to-a-disability","className":"d-block","values":[{"label":"YES","value":"YES"},{"label":"NO","value":"NO"}]},{"type":"text","label":"<b>If yes, explain (or attach documentation):</b>","name":"Reasonable-Accommodation","className":"d-block","subtype":"text"},{"type":"header","subtype":"h4","label":"*By typing your name below, you are signing this document.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"I understand that:<div>- I must continue searching for housing</div><div>- I must submit a Request for Tenancy Approval before my voucher expires</div><div>- Failure to locate housing may result in the expiration of my voucher</div>","className":"d-block"},{"type":"text","required":true,"label":"Signature of Applicant/Tenant","name":"signature-of-applicant-or-tenant","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Date of Signature","name":"Date-of-applicant-signature","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"Arkansas County Housing Authority will decide whether to approve or deny an extension request within 10 business days of the date the request is received and will immediately provide the family with written notice of its decision.","className":"d-block"},{"type":"header","subtype":"h4","label":"Please review your information above and confirm all is accurate. Once reviewed, please use the submit button at the bottom of this form to send this request to ACHA.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"<b>Upload Supporting Documents</b>","className":"d-block"},{"type":"file","label":"Please attach Reasonable Accommodation documentation if needed","description":"Please select one or more files for upload. You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format. To upload multiple files, please hold control while clicking on multiple files before clicking \"Open\".","name":"Supporting-Documents","subtype":"file","multiple":true,"className":"col-lg-4"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h4","label":"FOR ACHA USE ONLY - Please do not complete the information below.","className":"d-block"},{"type":"text","subtype":"disabled","label":"Original Issue Date","name":"Original-issue-date-for-internal-housing-authority-use-only","value":"ACHA Use Only","className":"col-md-6"},{"type":"text","subtype":"disabled","label":"Original Expiration Date","name":"Original-expiration-date-for-internal-housing-authority-use-only","value":"ACHA Use Only","className":"col-md-6"},{"type":"text","subtype":"disabled","label":"Is this the first Extension request? Yes or No.","name":"Is-this-the-applicant-or-tenants-first-extension-request","value":"ACHA Use Only","className":"d-block"},{"type":"text","subtype":"disabled","label":"Extension Approved?","name":"If-the-extension-is-approved-the-Housing-Authority-can-write-the-new-issue-date-and-new-expiration-date-here","value":"ACHA Use Only","className":"col-lg-4"},{"type":"text","subtype":"disabled","label":"Extension Denied?","name":"If-the-extension-is-denied-the-Housing-Authority-can-note-that-here-and-add-any-additional-notes-needed","value":"ACHA Use Only","className":"col-lg-4"},{"type":"text","subtype":"disabled","label":"Final Voucher Extension, if applicable","name":"If-this-is-the-final-voucher-extension-the-housing-authority-can-note-that-here-and-add-additional-comments-as-needed","value":"ACHA Use Only","className":"col-lg-4"},{"type":"text","subtype":"disabled","label":"HCV Specialist","name":"Name-of-the-Housing-Choice-Voucher-Specialist-assigned-to-this-applicant-or-tenant","value":"ACHA Use Only","className":"col-md-6"},{"type":"text","subtype":"disabled","label":"Date","name":"date-when-housing-choice-voucher-specialist-completes-the-internal-information","value":"ACHA Use Only","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"}]