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Received Financial Aid
Small Business Administration (SBA)
Federal Emergency Management Agency (FEMA)
National Flood Insurance Program (NFIP)
U.S. Department of Housing and Urban Development (HUD)
Central Office For Recovery, Reconstruction, And Resiliency (COR3)
Increased Cost of Compliance coverage (ICC)
Nonprofit or Charitable Funding (Red Cross, United Way, local church, etc.)
Community Development Block Grant Program - Coronavirus Response Grants (CDBG-CV)
Business Interruption Grant (BIG) from the Puerto Rico Department of Economic Development and Commerce (DDEC, for its Spanish acronym)
Economic Injury Disaster Loan (EIDL) from the Small Business Administration (SBA)
Paycheck Protection Program (PPP) from the Small Business Administration (SBA)
Puerto Rican Central Government and Municipalities
Other benefits or economic incentives
Family Income Information
Indicate the annual family income
* Select the box that represents the range of annual household income. Be sure to include all sources of income that apply: wages, earnings, welfare, child support, alimony, pensions, social security, child income, and/or any other income. The amount must be before any deductions for taxes, insurance, medical expenses, child support, etc.
**Note: Income information will not be used to determine eligibility for Fase1.
Other Training Programs
I/we certify that the information provided in this Workforce Training Intake Form is true and correct to the best of my knowledge. I/we acknowledge that false, misleading, or incomplete information constitutes just cause for denial of participation in the Community Development Block Grant – Disaster Recovery (CDBG-DR Program) Program. I further acknowledge that providing false, misleading or incomplete information may result in the restitution of funds incurred in any type of assistance provided to me under the Program. I/we agree to provide, upon request, documentation on all income sources to the Puerto Rico Department of Housing (PRDOH), the U.S. Department of Housing and Urban Development (HUD), and/or the Subrecipient.
Warning: Any person who knowingly makes a false claim or statement to HUD may be subject to civil or criminal penalties under 18 U.S.C. § 287, 1001 and 31 U.S.C. § 3729.
I understand that including my name in the box below is equivalent to accepting and signing this form.