Step-Up Registration

This information is confidential and kept on a secure server.

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Includes income and assets of all household members over the age of 18 including students.

In the event we must go virtual:

This employer or program has received federal funding assistance. Participation requires demographic information to be tracked however this information will only be used for purposes related to this request or program.

Does anyone in your household receive any of the following assistance? Please select Yes or No for each category.

Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.

By submitting this form, I agree to make my financial records available to the City of Omaha, its designee, or HUD for verification of above information. I certify that the information above is, to the best of my knowledge and belief, a true, correct and complete statement of my financial conditions as of the date stated herein. I am aware that Section 1001 of Title18 of the U.S. Code makes it a criminal offense to make false statements or misrepresentation to any Department or Agency of the U.S. as to matters within its jurisdiction.

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