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GA ERA Recert Household Members
GA ERA Recert Household Members
GA ERA Recert Household Members
Please choose one of the following, to describe the current number of household
members since the time you originally applied for rental assistance: (Use additional space
as needed)
Name
Relation
DOB
SSN #
Gender
Name
Relation
DOB
SSN #
Gender
Name
Relation
DOB
SSN #
Gender
Increase: list names, age, gender of any person who is now living at the household, but
was not living there at the time of initial application to the rental assistance program
Name
Relation
DOB
SSN #
Gender
Name
Relation
DOB
SSN #
Gender
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GEORGIA RENTAL ASSISTANCE
RECERTIFICATION: HOUSEHOLD MEMBERS
Name
Relation
DOB
SSN #
Gender
___________________________________ 06/08/2022
____________________
Applicant Signature Date
____________________________________ ____________________
Signature of Person Helping Complete Form Date
________________________________________
Printed Name of Person Helping Complete Form
Page 2 of 2