- Location Information
- Eastern Carolina Housing Organization (ECHO)'s service area includes the South Carolina counties of Chesterfield, Clarendon, Darlington, Dillon, Florence, Georgetown, Horry, Kershaw, Lee, Marion, Marlboro, Sumter, and Williamsburg. We are also able to serve qualifying Veterans in the North Carolina counties of Columbus, Robeson, and Scotland.
  
  Completing this form in no way guarantees services. Everyone is encouraged to continue attempting to resolve their housing crisis through other community resources. 211 serves as a state resource guide and can be reached by dialing 211 from your mobile phone or visiting the 211.org website.
- What county are you currently located in?*
  Select your current county.
- Veteran Status*
- Veteran Status*
- You have indicated that you are not within our qualifying service area however there are still resources available for you. 211 serves as a resource listing and we encourage you to dial 211 from a mobile phone or visit:
- What is your current situation?*
  - I am currently experiencing homelessness.
  - I am in danger of becoming homeless or I am being evicted.
- Non-Veterans

Eviction Prevention/Homeless Prevention Eligibility Notice
Updated as of 02/22/2021

If you are being evicted, please confirm that you meet the basic eligibility guidelines below before proceeding with your Get Help application form. Applications that do not meet these eligibility guidelines cannot be processed.

Applicants must have:

A formal notice stating that eviction will occur within 21 days, AND
Examples: Letter from a landlord, Magistrate’s Court notice
The total annual gross income (all household members 18+) must be within allowable Income Limits for household size specific to the county they are currently in (see chart below), AND
Proof of financial hardship resulting from COVID-19 (includes layoffs, reduced hours, unpaid leave, shutdowns, and closures beginning on March 10, 2020 or after).

NOTE: Regular Unemployment Insurance, Pandemic Unemployment Assistance, and Pandemic Emergency Unemployment Compensation (up to 13-week extension) income SHOULD be included when calculating income. Federal Pandemic Unemployment Compensation (temporary additional $600 weekly increase) should NOT be included.

	Persons in Family/Household Size
	1	2	3	4	5	6	7	8
Chesterfield	18,350	21,000	23,600	26,200	28,300	30,400	32,500	34,600
Clarendon	18,350	21,000	23,600	26,200	28,300	30,400	32,500	34,600
Darlington	18,350	21,000	23,600	26,200	28,300	30,400	32,500	34,600
Dillon	18,350	21,000	23,600	26,200	28,300	30,400	32,500	34,600
Florence	20,200	23,100	26,000	28,850	31,200	33,500	35,800	38,100
Georgetown	21,900	25,000	28,150	31,250	33,750	36,250	38,750	41,250
Horry	20,400	23,300	26,200	29,100	31,450	33,800	36,100	38,450
Kershaw	22,450	25,650	28,850	32,050	34,650	37,200	39,750	42,350
Lee	18,350	21,000	23,600	26,200	28,300	30,400	32,500	34,600
Marion	18,350	21,000	23,600	26,200	28,300	30,400	32,500	34,600
Marlboro	18,350	21,000	23,600	26,200	28,300	30,400	32,500	34,600
Sumter	19,150	21,900	24,650	27,350	29,550	31,750	33,950	36,150
Williamsburg	18,350	21,000	23,600	26,200	28,300	30,400	32,500	34,600

HUD FY 2020 Income Limits Documentation System

If referred to a program, households will be required to provide documentation to confirm eligibility, including:

State-issued ID
Social Security Card
Eviction Notice
Proof of decrease in income/employment due to COVID-19

If you do not meet these eligibility requirements, please reach out to other community resources that may be able to help you by calling 2-1-1. You may also come back to check for updates, as this notice will change if/when eligibility changes.

Please understand that assistance is limited, and completing an application does not guarantee that you will receive assistance.

COMMUNITY NEWS: SC Stay is now offering a COVID-19 Housing Assistance program for eligible South Carolina residents that are behind on rent or mortgage payments due to COVID-19. Please go to the SC Stay website to complete an application at scstay.org. (Eligibility for SC Stay does NOT require an eviction notice and has the ability to serve households whose gross annual income exceeds our allowable income limits.)

- Everyone
- Consent*
  I agree to allow for my information to be entered into a secure and encrypted database. I also understand that I may be contacted by a coordinating service provider regarding my housing crisis.
  How this data is used:
  ● To provide or coordinate services on behalf of an individual or household;
  ● For payment or reimbursement for services;
  ● To carry out administrative functions, including but not limited to oversight and management functions; or
  ● For creating summary reports without identifying you or confusing you with someone else
  
  We collect personal information directly from you and your household to determine your eligibility for services and connect you with other helping agencies. We only collect personal information that is considered appropriate for getting your housing crisis resolved. The collection and use of all personal information is guided by strict standards of confidentiality.
  
  View the HMIS Privacy Statement
- Contact Information
- Contact Phone*
- No Phone
  - I do not have a phone
- Email Address*
  
  If you do not have an email address you may visit gmail.com or outlook.com to get a free email address.
- Alternate Contact Name*
  First Last
- Relationship to Alternate Contact*
- Alternative Contact Phone*
- Is an agency or person assisting you with this application?*
- Name of Assisting Agency or Organization*
- Name of Person Directly Assisting You*
- Contact Number for Person Directly Assisting You*
- How did you hear about ECHO?*
- Please specify:*

- Household Information
- Your Name (Head of household)*
  First Last
- Age
- Date of Birth*
  Date Format: MM slash DD slash YYYY
- Social Security Number
- Gender*
- Veteran Status*
- Primary Race*
- Secondary Race
- Ethnicity*
- Are you currently employed?*
- Do you have a long term disabling condition?*
- Disability Types*
  - Alcohol Abuse
  - Substance Abuse
  - Chronic Health Condition
  - Developmental
  - HIV / AIDS
  - Mental Health Problem
  - Physical Disability
- Do you have health insurance?

Additional Household Members

Name	Age	Relationship to Head of Household	Actions
			Edit Delete
There are no Household Members.

Maximum number of household members reached.

Please add all other members of your household that are currently experiencing a housing crisis.

- Number of People in Household (Including Yourself)*
  Please enter a number from 1 to 10.
- Is anyone in the household currently pregnant?*
- Approximate Due Date*
  Date Format: MM slash DD slash YYYY
- Total Monthly Household Income*
  Please enter a number greater than or equal to 0.
  Include current income total for all adult household members. Be sure to include any current regular earned income (if you are currently employed), unemployment insurance, SSI, SSDI, VA Disability Compensation, private disability insurance, Worker's Compensation, TANF, retirement, pension, child support, alimony, or any other regular income source that you are currently receiving. Please note that the temporary unemployment increases related to COVID-19 are not considered regular income and should not be included in this total. However, the regular base unemployment income amount should be included.
- Select any non-cash benefits received:
  - SNAP
  - WIC
  - Child Care Vouchers
  - TANF Transportation
  - Other TANF Services

- Current Situation
- Have you ever experienced domestic violence?*
- Are you currently fleeing domestic violence?*
- When did the domestic violence experience occur?*
- Do you need a confidential location to stay?*
- Where did you sleep last night?*
- How long did you stay there?*
- Before entering the previous situation where did you sleep?*
- Will you be (or have you been) discharged without a housing destination?*
- Approximate Discharge Date*
  Date Format: MM slash DD slash YYYY
- Do you have an eviction notice from the landlord or magistrate?*
  - Landlord
  - Magistrate
  - No Notice
- Must vacate by date*
  Date Format: MM slash DD slash YYYY
- Approximate date this most recent episode of homelessness started*
  MM
  DD
  YYYY
  
  A break in homeless episodes includes:
  7 days or more in a rental unit, staying with family or friends, hotel or motel paid for by self
  -or-
  90 days or more in an institution such as hospital, jail, detox, or inpatient treatment.
- Total months in last 3 years experiencing homelessness*
- Number of episodes in past 3 years experiencing homelessness*
- Do you identify as having a substance use disorder (either drugs and/or alcohol)?*
- Are you interested in shared temporary housing for individuals seeking recovery where you could stay until a permanent housing opportunity is available?*
- If housing became available in another county would you be willing to move?*
- Select which of the following items you currently have:
  - State Issued ID, Driver's License, or Passport
  - Social Security Card
- On a regular day where and when is it easiest to find you?
- Current Address*
  Street Address Address Line 2 City State ZIP Code
- Is your current situation a result of financial hardship related to COVID-19?*
- Tell us more about your situation*
- Homeless Prevention Notice
- We cannot process your application if your eviction is more than 21 days away. Please come back to complete your application immediately after you are within this 21 day window.
- All applicants for Homeless Prevention assistance must meet income and other eligibility requirements. You will be asked to provide documentation including verification of household income and either a Magistrate’s Court Order of Eviction or a letter from the landlord stating the applicant is behind on rent and will be evicted within 21 days.
  ECHO may not be able to serve everyone that needs assistance. You are encouraged to continue attempting to resolve your housing crisis through other community resources. 211 serves as a state resource guide and can be reached by dialing 211 from your mobile phone or visiting the 211.org website.

- Additional Information
- HP Scoring
  HP Scoring Information
- In the past 6 months have you experienced a sudden and significant decrease in income or an unavoidable increase in non-discretionary expenses (e.g., rent or medical expenses)?*
- In the past 12 months have you experienced a major change in household composition (e.g., death of a family member, separation/divorce from adult partner, birth of child)?*
- How many formal rental evictions have you had that resulted in the loss of housing within the past 7 years?*
- How many times have you experienced homelessness (living in a shelter, on the street, or in transitional housing) in the past three years?*
- Do you have any criminal felony offenses against persons or property that may interfere with obtaining a new lease?*

- Additional Information
- Acuity Tool
  Acuity Measures
- In what language do you feel best able to express yourself?*
- How many times have you been to the emergency room in the past 3 months?*
- How many times have you been hospitalized as an inpatient in the past year?*
- Have you ever been in jail?*
- Have you ever been in prison?*
- Have you ever been in foster care?*
- Do you have now, have you ever had, or has a healthcare provider ever told you that you have any of the following medical conditions?*
  Check all that apply.
  - Kidney disease/ End Stage Renal Disease or Dialysis
  - History of frostbite, Hypothermia, or Immersion Foot
  - History of Heat Stroke
  - Liver disease, Cirrhosis, or End-Stage Liver Disease
  - Heart disease, Arrhythmia, or Irregular Heartbeat
  - HIV+/AIDS
  - Emphysema
  - Diabetes
  - Ashthma
  - Cancer
  - Hepatitis C
  - Tuberculosis
  - COVID-19 / Coronavirus Positive or Presumed Positive
  - None of the above
- Please select all of the following which are true.*
  Check all that apply.
  - You have ever been the victim of a violent attack while experiencing homelessness.
  - You have a physical disability that limits your mobility. (i.e. wheelchair, amputation, unable to climb stairs, etc.)
  - You have had a serious brain injury or brain trauma that required hospitalization or surgery.
  - You have ever been diagnosed as Coronavirus(COVID-19) Positive or Presumed Positive.
  - You have ever abused drugs/alcohol, or been told that you do.
  - You have consumed alcohol every day for the past month.
  - You have ever injected drugs intravenously.
  - You have ever been treated for drug or alcohol abuse.
  - You have ever received treatment for mental health issues.
  - You have ever been taken to the hospital against your will for mental health reasons.
  - None of the above

- Documentation
  We will need each of the following documents submitted. If you do not have them at this time, please begin attempting to get replacement copies.
  - Government Issued ID
  - Social Security card
  - Proof of income or verification of no income
  - Eviction notice (where applicable)
  If you do not have access to a scanner or fax machine, cell phone pictures of your documents are sufficient. Office DEPOT/OfficeMax is also offering FREE faxing and scanning services in all of their retail stores (limits apply). Faxed documents should be sent to 843-213-1800.
- Upload Identifying Documents
  Drop files here or
  
  Accepted file types: jpg, gif, png, jpeg, bmp, pdf.
  Please upload a copy of the photo IDs, social security cards, or other valid identifying documents you have available for all adult household members.
  Cell phone photocopies are sufficient. Uploads are encrypted in transit and at rest once uploaded for your security.
- Upload Income Documentation
  Drop files here or
  
  Accepted file types: jpg, gif, png, jpeg, bmp, pdf.
  Please upload your last 2 payroll stubs, or your last statement for any unemployment insurance, SSI, SSDI, VA Disability Compensation, private disability insurance, Worker's Compensation, TANF, retirement, pension, child support, alimony, or any other regular income source.
  Cell phone photocopies are sufficient. Uploads are encrypted in transit and at rest once uploaded for your security.
- Upload Proof of Decrease in Income/Employment Due to COVID-19
  Drop files here or
  
  Accepted file types: jpg, gif, png, jpeg, bmp, pdf.
  Please upload any documentation you may have pertaining to a decrease of income related to COVID-19.
  Cell phone photocopies are sufficient. Uploads are encrypted in transit and at rest once uploaded for your security.
- Upload Notice to Vacate
  Drop files here or
  
  Accepted file types: jpg, gif, png, jpeg, bmp, pdf.
  Please upload any formal notices from the landlord, magistrate, or other supporting documentation.
  Cell phone photocopies are sufficient. Uploads are encrypted in transit and at rest once uploaded for your security.
- Upload Notice from Hotel or Motel
  Drop files here or
  
  Accepted file types: jpg, gif, png, jpeg, bmp, pdf.
  Please upload a letter from the hotel on letterhead or invoice from the hotel that shows past due balance.
  Cell phone photocopies are sufficient. Uploads are encrypted in transit and at rest once uploaded for your security.