SUPPORTIVE HOUSING MANAGEMENT SERVICES

803 EAST PITTSBURGH PLAZA

EAST PITTSBURGH, PA 15112
(412) 829-3910
1-800-238-7555

Dear Applicant:

Supportive Housing Management Services is the property management division of ACTION Housing, Inc.
Attached is a listing of the rental properties we offer.

Listed below is a chart indicating program income guidelines by family household size. Our property listings
indicate which program guidelines are in effect for each site. Please note these guidelines represent Maximum income
amounts. If your household income is lower than the designated program percentage, you may still qualify for
occupancy, as long as the property you select does not also require a minimum household income.

Pittsburgh Area Median Incomes for Year 2022

Program 1 Person 2 Persons 3 Persons 4 Persons
30% $19,950 $22,800 $25,650 $28,450
50% $33,200 $37,950 $42,700 $47,400
60% $39,840 $45,540 $51,240 $56,880
80% $53,100 $60,700 $68,300 $75,850

Please note in reviewing our application the following sites offer admission priority to those eligible households
whose family household income falls below 30% of the area median income:
1. Allegheny Independence House
2. Leetsdale High Rise

PLEASE DO NOT SEND ANY IMPORTANT DOCUMENTS (Original or copy: Birth Certificate, Social Security
Cards, ID and income because this will be asked for when you are considered for an apartment)

Due to the multi-program nature of our portfolio, we understand you may have questions as you review this
application package. Please feel free to contact us with any questions. You may reach us by calling 412.829.3910 or
1.800.238.7555. We look forward to serving you with your housing needs.

Sincerely,
Jill Harding
Jill Harding
Waiting List Coordinator

****PLEASE DO NOT DETACH ANYTHING, ALL PAGES SHOULD BE RETURNED***

REVISED 8/31/2022
.
 SUPPORTIVE HOUSING MANAGEMENT SERVICES (SHMS)
803 EAST PITTSBURGH PLAZA, EAST PITTSBURGH, PA 15112
(412) 829-3910 or 1-800-238-7555

APPLICATION

Instructions
1. All * (Asterisk) Areas need to be completed or Application will be sent back
2. All Information Must be Printed and Legible
3. If you change your Address, you MUST notify SHMS in writing as soon as possible. If we do not have a current
address at all times, you may lose your position on the waiting list.
4. Applications can be mailed to address above, faxed to (412) 829-3914 or emailed to shms@actionhousing.org

I. APPLICANT

*First Name: Taniya Middle: Theresa Aliceson Last: Pryer

*Address 801 Walnut St Apt 309 City McKeesport
* State PA Zip 15132 *Phone 412-636-3765 Email taniyapryer2@gmail.com

II. CURRENT LANDLORD

*Current Landlord's Name Fethi
*Address City McKeesport State PA Zip 15132
Phone +1 (412) 805-0508
How Long did you reside at this address: From 11/07/2023 To Current

III. HOUSEHOLD INFORMATION

*Name of Each Household * Social Security *Relationship to
Member Who is Applying Number Head of Household Sex * Date of Birth
Taniya Pryer Head of Household Male
211-78-4996 07/26/2000
Applicant Name Female

Male
Co-Applicant/Dependent Female

Male
Dependent Female

Male
Dependent Female

IV. ADDITIONAL CONTACT- List any additional responsible party with whom we should correspond, e.g.,
mailings, telephone (family member, agency, or caseworker)
Contact Name JeQuaia Willis
Address 1101 Hartman St
City McKeesport State PA Zip 15132
Phone 412-303-1626

1
V. Accommodation
Please list any accommodation for mobility impairment, visual impairment, or hearing impairment needed for you or a
member of your household

*VI. Income *VII Net Family Assets

Income Source Monthly Amount Asset Source Approximate Value
Gross Wages, Salaries $ 980 Checking $ 0
Net Business Income $ 0 Savings $ 0
Gross Social Security $ 0 Direct Express Card $ 0
Gross Pension $ 0 CD's $ 0
Public Assistance $ 0 Money Market $ 0
Alimony/Child Support $ 0 Other (Bonds, Annuities, etc.) $ 0
Unemployment/Workers Comp $ 0
SSI (Supplemental Security Income) $ 0
Other (insurance, IRA, etc.) $ 0

*VIII. Additional Questions

Please circle Yes or No to the following questions:
Yes No 1. Is any member of the household enrolled as a student at an Institute of Higher Education?
Yes No 2. Have you or any household member ever been convicted of a felony or drug related activity?
Yes No 3. Are you or any household member(s) subject to any State Lifetime Sex Offender Registration?
Yes No 4. Do you currently have a Section 8 Voucher?

List all States in which you and all household members have lived: Pennsylvania

If you answered Yes to any of these questions, please explain below:

I certify the above information is true and complete to the best of my knowledge. I understand and authorize inquiries
to be made to verify I meet the tenant selection criteria and to verify the above statements. I also authorize a credit and
criminal background check.

* *
Applicant Signature Co-Applicant Signature

10/23/2024
Date Date

2
 SUBSIDIZED HOUSING APPLICATION FOR PERSONS WITH ……... DISABILITIES Page 3
Put a check mark in the “check here” box for as many properties for which you are interested
# of * Check
Property Name & Address Housing for Disability: Amenities Bdrms Here
Allegheny Independence House ONLY for persons with 3 or more physical A/C, range & refrig, roll-in 1
210 Marguerite Ave. functional disabilities showers, laundry, elevator,
Wilmerding, PA 15148 30% & 50% Area Median Income on-site parking 2
Bausman Street Independent Living For persons with physical, mental or A/C, cook-top & refrig, roll- 1
251, 259, 269 Bausman Street developmental disabilities in showers, elevator, laundry
Pittsburgh, PA 15210 (Knoxville) 50% Area Median Income room, , on-site parking 2
Crafton Towers Apartments ONLY for persons with mobility A/C, range & refrig,
1215 Foster Avenue impairment or legally blind laundry, community room, 1
Pittsburgh, PA 15205 30%, 50%, 80% Area Median Income elevator, on-site parking
HUD has established a waiting list preference for the apartments at Crafton Towers for persons who have been displaced by a presidentially
declared disaster. Are you applying for this owner preference?: _____YES _____NO

Subsidized Housing for PERSONS WITH DISABILITIES

Darlington Road Apartments Only for Persons with developmental A/C, Range & Refrig,
5841 Darlington Rd. disabilities elevator, laundry, street 1
Pittsburgh, PA 15217 50% Area Median Income parking, community room
Dravosburg Apartments ONLY for persons with physical A/C, Range & Refrig, Roll- 1
100 Third Street disabilities in shower, Laundry, On site
Dravosburg, PA 15034 50% Area Median Income parking 2
Independent Hs. Resources East ONLY for persons with physical or mental Four locations, A/C, range
5657 Stanton Avenue, 15206 health disabilities and refrigerator, and on-site 1
117 N. Winebiddle St., 15224 parking
2533-43 S. Braddock Avenue, 15218 30% & 50% Area Median Income 2
606 Swissvale Avenue, 15221
Landmark Court A/C, range & refrig, roll in
ONLY for persons with mobility
showers, laundry room,
326 Olivia Street impairment 1
community room, on-site
McKees Rocks, PA 15136 50% Area Median Income parking
Leetsdale Manor A/C, range & refrig, laundry
Persons 62 yrs. or older or with disabilities room, elevator, community
27 Spencer Street 1
/computer room and on-site
Leetsdale, PA 15056 30% & 50% Area Median Incomes parking
Munhall Road Apartments Only for Persons with developmental A/C, range & refrig,
5680 Munhall Road disabilities laundry, 3 story walk-up, 1
Pittsburgh, PA 15218 50% Area Median Income street parking, comm. room
Pitcairn Apartments ONLY for persons with physical A/C, range & refrig, roll-in
1
408 Broadway Avenue disabilities showers, laundry room,
Pitcairn, PA 15140 50% Area Median Income elevator, on-site parking 2
Towne Place Apartments (Uptown) ONLY for persons with mental health A/C, range & refrig,
1600 Colwell Street disabilities elevator, laundry, community 1
room, on-site parking
Pittsburgh, PA 15219 50% Area Median Income
White Street Apartments ONLY for persons with mental health A/C, range/ refrigerator, 3-
1
502 White Street disabilities story walk up, laundry,
McKeesport, PA 15132 50% Area Median Income community room, parking 2

*The properties listed above require a HUD verification of a disability form, which will be processed
once your application is submitted. Head of Household must be person with qualifying disability
 SUBSIDIZED HOUSING APPLICATION FOR…SENIOR CITIZENS ( 62 or older) Page 4
Put a check mark in the “check here” box for as many properties for which you are interested
# of * Check
Property Name & Address Housing for: Amenities Bdrms Here
Bessemer Manor ONLY for persons 62 yrs. or older A/C, range & refrig,
850 Main Street, laundry, community room, 1
East Pittsburgh, PA 15112 50% Area Median Income elevator, on-site parking
Center Township ONLY for persons 62 yrs. or older A/C, range & refrig,
3671 Brodhead Rd. laundry, community room, 1
Monaca, PA 15061 50% Area Median Income elevator, on-site parking
Crafton Towers Apartments ONLY for persons 62 yrs. or older A/C, range & refrig,
1215 Foster Avenue laundry, community room, 1
Pittsburgh, PA 15205 30 %, 50% & 80% Area Median Income elevator, on-site parking
HUD has established a waiting list preference for the apartments at Crafton Towers for persons who have been displaced by a
presidentially declared disaster. Are you applying for this preference?: _____YES _____NO
Dormont Place ONLY for persons 62 yrs. or older A/C, range & refrig,
2900 Belrose Avenue laundry, community room, 1
Dormont, PA 15216 50% Area Median Income elevator, on-site parking

Subsidized Housing for SENIOR CITIZENS

Forest Hills Senior Apartments ONLY for persons 62 yrs. or older A/C, range & Refrig,
2111 Ardmore Blvd. laundry, community 1
Forest Hills, PA 15221 50% Area Median Income room,elevator,
Greenfield Terrace (Greenfield) ONLY for persons 62 yrs. or older A/C, range & refrig,
3909 Raff Street laundry, community room, 1
Pittsburgh, PA 15207 50% Area Median Income elevator, on-site parking
Leetsdale Manor ONLY for persons 62 yrs. or older or A/C, range & refrig,
27 Spencer Street person with disability laundry, elevator, comm. 1
Leetsdale, PA 15056 30%, 50% Area Median Income room, on-site parking
Miller Avenue Senior Apartments ONLY for persons 62 yrs. or older A/C, range & refrig,
16 Miller Avenue elevator, laundry, comm. 1
Duquesne, PA 15110 50% Area Median Income room, on-site parking
Northside Coalition Senior Apts ONLY for persons 62 yrs. or older A/C, range & refrig,
1500 Brighton Place elevator, laundry, comm. 1
Pittsburgh, PA 15212 50% Area Median Income room, on-site parking
Ormsby Manor (Mt. Oliver) ONLY for persons 62 yrs. or older A/C, range & refrig,
113 Ormsby Avenue laundry, community room, 1
Pittsburgh, PA 15210 50% Area Median Income elevator, on-site parking
Primrose Apartments ONLY for persons 62 yrs. or older A/C, range & refrig,
1240 Denning Way laundry, community room, 1
North Versailles, PA 15137 50% Area Median Income elevator, on-site parking
Second Baptist Senior Apts ONLY for persons 62 yrs. or older A/C, range & refrig,
128 W. 12th Avenue laundry, community room, 1
Homestead, PA 15120 50% Area Median Income elevator, on-site parking
Sylvania Place (Beltzhoover) ONLY for persons 62 yrs. or older A/C, range & refrig,
29 Sylvania Avenue laundry, community room, 1
Pittsburgh, PA 15210 50% Area Median Income elevator, on-site parking
West Lake Apartments (Elliot) ONLY for persons 62 yrs. or older A/C, range & refrig,
1015 Crucible Street laundry, community room, 1
Pittsburgh, PA 15220 50% Area Median Income elevator, on-site parking
MARKET RENT - UNSUBSIDIZED HOUSING APPLICATION- Section 8 Voucher Welcome
MINIMUM HOUSEHOLD INCOME APPLIES (2.5 x rent amount)
Do you have a Section 8 Voucher? ___Yes ___No
Are you a U.S. Armed Services Veteran? ___ Yes ____No

FAMILY NON-SUBSIDIZED HOUSING- Section 8 Voucher Welcome

* Check
# of Bdrms
Property Name & Address Housing for: Amenities Here
Ardmore Apartments 1 Bedroom $585
2104 Ardmore Blvd. 2 Bedroom $700 A/C, range and refrigerator, 1
Forest Hills, PA 15221 Studio $535 on-site parking, on bus line. 2
Plus Electric and Gas No pets, 2-Story Walk-up. Studio
80% Area Median Income
Dave Wright Apartments 1 Bedroom Starting $575
Equipped kitchen, laundry
1842 Washington Street 2 Bedroom Starting $675 1
room, parking, on bus line,
Heidelberg, PA 15106 Plus Electric
A/C, Elevator.
Non-Smoking 50%, 60% Area Median Income 2

MARKET RENT - NON-SUBSIDIZED HOUSING

Owner has established waiting list preference for half the apartments at Dave Wright Apartments for persons who have been
diagnosed as being on the Autism Spectrum. Are you applying for this owner preference: _____YES _____NO
Forest Hills Veterans and Seniors 1 Bedroom Starting $585
Equipped kitchen, laundry
1844 Ardmore Blvd. 2 Bedroom Starting $688 1
room, parking, on bus line,
Pittsburgh, PA 15221 Plus Electric
A/C, Elevator.
Non-Smoking 50%, 60% Area Median Income 2
Owner has established waiting list preference for half the apartments at Forest Hills Veterans and Senior Housing for US Military
Veterans. Are you applying for this owner preference: _____YES _____NO
Krause Commons 1 Bedroom Starting $588
Equipped kitchen, laundry
2615 Murray Ave 2 Bedroom Starting $833 1
room, parking, on bus line,
Pittsburgh, PA 15217 Plus Electric
A/C, Elevator.
Non-Smoking 50%, 60% Area Median Income 2
Owner has established waiting list preference for half the apartments at Krause Commons for persons with an intellectual and/or
mental health disability. Are you applying for this owner preference: _____YES _____NO
Mackey Lofts 1 Bedroom $625
Equipped kitchen, laundry
1819 Forbes Ave 2 Bedroom $745 1
room, parking, on bus line,
Pittsburgh, PA 15219 All Utilities Included
A/C, Elevator.
Non-Smoking 50%, 60% Area Median Income 2
15 Miller Avenue Apartments 1 Bedroom $445 Plus Electric Newly remodeled, equipped
15 Miller Avenue kitchen, wall-to-wall carpet, 1
Duquesne, PA 15110 laundry room, elevator,
50%, 60% Area Median Income community room, parking,
on bus line, A/C
Sixth Ward Flats 1 Bedroom starting at $715, 2 1
Equipped kitchen, laundry
Bedroom $1,065, 3 Bedroom $1,235.
207 34th St. & 3350 Penn Ave. room, parking, on bus line, 2
Plus Electric
Pittsburgh, PA 15201 A/C, Elevator.
50%, 60% Area Median Income 3
Owner has established waiting list preference for 8 apartments at Sixth Ward Flats for persons with disabilities. Are you applying
for this owner preference: _____YES _____NO

5
 FAMILY SUBSIDIZED HOUSING APPLICATION

SINGLE & FAMILY SUBSIDIZED HOUSING

* Check
# of Bdrms
Property Name & Address Housing for: Amenities Here
Charles Street Apartments Three Story walk-up, 1
333 Charles Street 30% - 50% Area Median Income laundry, parking, refrig &
Turtle Creek, PA 15145 range, storage shed
Allegheny County 2

SINGLE & FAMILY SUBSIDIZED HOUSING

6
MARKET RENT - UNSUBSIDIZED HOUSING APPLICATION- Section 8 Voucher Welcome
MINIMUM HOUSEHOLD INCOME APPLIES (2.5 x rent amount)

MARKET RENT - NON-SUBSIDIZED HOUSING

NON-SUBSIDIZED HOUSING- Persons 62 and Older- Section 8 Voucher Welcome
* Check
# of Bdrms
Property Name & Address Housing for: Amenities Here
Crafton Towers Apartments Only persons 62 years or Older A/C, range & refrig,
1215 Foster Avenue Rent fixed $718 (3 units only) laundry, community room, 1
Pittsburgh, PA 15205 80% Area Median Income elevator, on-site parking
HUD has established waiting a list preference for the apartments at Crafton Towers for persons who have been displaced by a
presidentially declared disaster. Are you applying for this owner preference: _____YES _____NO

Note: You will receive a letter once your application is processed

APPLICATIONS CAN BE MAILED TO:

SUPPORTIVE HOUSING MANAGEMENT SERVICES
803 EAST PITTSBURGH PLAZA
EAST PITTSBURGH, PA 15112

7
 Race and Ethnic Data U.S. Department of Housing OMB Approval No. 2502-0204
Reporting Form and Urban Development (Exp. 06/30/2017)
Office of Housing

Name of Head of Household Name of Household Member

Date (mm/dd/yyyy): 10/23/2024

Select
Ethnic Categories* One

Hispanic or Latino

Not-Hispanic or Latino
Select
Racial Categories* All that
Apply
American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other

*Definitions of these categories may be found on the reverse side.

There is no penalty for persons who do not complete the form.

_____________________________________
10/23/2024
____________________________
Signature Date
Public reporting burden for this collection is estimated to average 10 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This
information is required to obtain benefits and voluntary. HUD may not collect this information, and you are not required to complete this form,
unless it displays a currently valid OMB control number.
This information is authorized by the U.S. Housing Act of 1937 as amended, the Housing and Urban Rural Recovery Act of 1983 and Housing
and Community Development Technical Amendments of 1984. This information is needed to be incompliance with OMB-mandated changes to
Ethnicity and Race categories for recording the 50059 Data Requirements to HUD. Owners/agents must offer the opportunity to the head and co-
head of each household to “self certify’ during the application interview or lease signing. In-place tenants must complete the format as part of
their next interim or annual re-certification. This process will allow the owner/agent to collect the needed information on all members of the
household. Completed documents should be stapled together for each household and placed in the household’s file. Parents or guardians are to
complete the self-certification for children under the age of 18. Once system development funds are provide and the appropriate system upgrades
have been implemented, owners/agents will be required to report the race and ethnicity data electronically to the TRACS (Tenant Rental
Assistance Certification System). This information is considered non-sensitive and does no require any special protection.

1 form HUD-27061-H (9/2003)

Instructions for the Race and Ethnic Data Reporting (Form HUD-27061-H)

A. General Instructions:
This form is to be completed by individuals wishing to be served (applicants) and those that
are currently served (tenants) in housing assisted by the Department of Housing and Urban
Development.
Owner and agents are required to offer the applicant/tenant the option to complete the form.
The form is to be completed at initial application or at lease signing. In-place tenants must
also be offered the opportunity to complete the form as part of the next interim or annual
recertification. Once the form is completed it need not be completed again unless the head of
household or household composition changes. There is no penalty for persons who do not
complete the form. However, the owner or agent may place a note in the tenant file stating
the applicant/tenant refused to complete the form. Parents or guardians are to complete
the form for children under the age of 18.
The Office of Housing has been given permission to use this form for gathering race and
ethnic data in assisted housing programs. Completed documents for the entire household
should be stapled together and placed in the household’s file.
1. The two ethnic categories you should choose from are defined below. You should check one
of the two categories.
1. Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race. The term “Spanish
origin” can be used in addition to “Hispanic” or “Latino.”
2. Not Hispanic or Latino. A person not of Cuban, Mexican, Puerto Rican, South or
Central American, or other Spanish culture or origin, regardless of race.
2. The five racial categories to choose from are defined below: You may mark one or more.
1. American Indian or Alaska Native. A person having origins in any of the original
peoples of North and South America (including Central America), and who maintains
tribal affiliation or community attachment.
2. Asian. A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China,
India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and
Vietnam.
3. Black or African American. A person having origins in any of the black racial
groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to
“Black” or “African American.”
4. Native Hawaiian or Other Pacific Islander. A person having origins in any of the
original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
5. White. A person having origins in any of the original peoples of Europe, the Middle
East or North Africa.

2 form HUD-27061-H (9/2003)

 OMB Control # 2502-0581
Exp. (02/28/2019)
Supplemental and Optional Contact Information for HUD-Assisted Housing Applicants

SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING

This form is to be provided to each applicant for federally assisted housing

Instructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing,
the name, address, telephone number, and other relevant information of a family member, friend, or social, health, advocacy, or other
organization. This contact information is for the purpose of identifying a person or organization that may be able to help in resolving any
issues that may arise during your tenancy or to assist in providing any special care or services you may require. You may update,
remove, or change the information you provide on this form at any time. You are not required to provide this contact information,
but if you choose to do so, please include the relevant information on this form.

Applicant Name:
Mailing Address:

Telephone No: Cell Phone No:

Name of Additional Contact Person or Organization:

Address:

Telephone No: Cell Phone No:

E-Mail Address (if applicable):

Relationship to Applicant:
Reason for Contact: (Check all that apply)
Emergency ■ Assist with Recertification Process
Unable to contact you ■ Change in lease terms
■ Termination of rental assistance Change in house rules
■ Eviction from unit Other: ______________________________
Late payment of rent
Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues
arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the
issues or in providing any services or special care to you.

Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the
applicant or applicable law.

Legal Notification: Section 644 of the Housing and Community Development Act of 1992 (Public Law 102-550, approved October 28, 1992)
requires each applicant for federally assisted housing to be offered the option of providing information regarding an additional contact person or
organization. By accepting the applicant’s application, the housing provider agrees to comply with the non-discrimination and equal opportunity
requirements of 24 CFR section 5.105, including the prohibitions on discrimination in admission to or participation in federally assisted housing
programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on
age discrimination under the Age Discrimination Act of 1975.

Check this box if you choose not to provide the contact information.

Signature of Applicant Date

The information collection requirements contained in this form were submitted to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The
public reporting burden is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers
participating in HUD’s assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option to include in the application for occupancy the name,
address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such
information is to facilitate contact by the housing provider with the person or organization identified by the tenant to assist in providing any delivery of services or special care to the tenant and assist with
resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information.
Providing the information is basic to the operations of the HUD Assisted-Housing Program and is voluntary. It supports statutory requirements and program and management controls that prevent fraud,
waste and mismanagement. In accordance with the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless the
collection displays a currently valid OMB control number.

Privacy Statement: Public Law 102-550, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be
used by HUD to protect disbursement data from fraudulent actions.
Form HUD- 92006 (05/09)