Apply for USDA / VA Home Repair Assistance

This secure online application allows eligible homeowners to apply for USDA or VA home repair assistance. Please complete all required fields accurately and upload all required documentation. Incomplete applications may delay review or funding consideration. After submission, our team will carefully review your information and contact you if additional documentation or clarification is needed.

Watch Video (Required): Please watch before completing the application

Video loading — please watch before applying.

Document Readiness Checklist

Before starting the application, confirm you have the following documents ready to upload. Incomplete submissions may delay review.

Important: If required documents are missing, your application cannot move forward for packaging and submission.

Understanding Grant vs Loan Options

The grant pathway focuses primarily on health and safety hazards. Loan options may cover a broader range of essential repairs depending on eligibility.

Funding Cycles and Why Time Matters

Please do not delay if you are eligible and your documents are ready.

Funding is limited and processed in cycles. Complete applications move faster because missing documents and incorrect information create delays. If you are eligible and your documents are ready, submit your application now.

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1Step 1: Applicant & Property

2Step 2: Household & Income

3Step 3: Repair Details

4Step 4: Required Documentation Uploads

5Final Review & Submit

Name *

First

Middle

Last

Phone *

Email *

Property Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Parish/County *

Do you own the home? *— Select Choice —YesNoThird Choice

Is this your primary residence? *— Select Choice —YesNoThird Choice

Applicant Age *

Next

Primary Applicant Employment Information

Provide current employment details. If retired or disabled, indicate income source instead.

Are you currently employed? *— Select Choice —YesNoRetiredDisabledSelf-Employed

Business Name

Type of Business / Work Performed

Average Gross Monthly Income (Self-Employed)

Employer Name *

Employer Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Position / Job Title *

Length of Employment (Years) *

Gross Monthly Income ($) *

Total Household Members *

List all household members and relationship (Example: John Doe – Self, Jane Doe – Spouse) *

Non-Employment Income Information

Complete this section if you selected Retired, Disabled, or Not Employed.

Select all sources of household income *

• Employment (Wages)
• Self-Employment
• Social Security
• SSI / Disability
• Pension / Retirement
• SNAP / Food Stamps
• Child Support
• Other

Describe all income received and monthly amounts for each household member *

SNAP Yes/No *— Select Choice —YesNoThird Choice

Banking & Liquid Assets

“List all checking and savings accounts held by any household member.”

Do you or any household member have a checking or savings account? *— Select Choice —YesNo

Name of Financial Institution

Account Type *— Select Choice —CheckingSavingBoth

Current Account Balance (Total of all listed accounts)

Monthly Debt & Financial Obligations

“List all recurring monthly debt payments for the household.”

Mortgage Payment (Monthly)

Auto Loan Payments (Total Monthly)

Credit Card Minimum Payments (Total Monthly)

Personal Loans or Other Loan Payments (Monthly)

primary savings concerns)

Child Support or Court-Ordered Payments (Monthly)

Total Monthly Debt Payments

Homeowners Insurance Yes/No *— Select Choice —YesNoThird Choice

Next

What repairs are needed? (Select all that apply) *

• Roofing
• Structural / Framing
• Electrical
• Plumbing
• HVAC
• Accessibility Modifications (Ramps, Rails, Bathroom Modifications)
• Windows / Doors
• Flooring
• Other

Describe the repair issues in detail (Include how long the problem has existed and any safety concerns) *

How urgent is the repair? *— Select Choice —Emergency (Active Leak / Safety Hazard)Urgent (Needs repair within 30 days)Moderate (Needs repair within 90 days)Minor (Not urgent)

Upload 3–5 photos of visible damage- (If Available)

Drag & Drop Files, Choose Files to Upload You can upload up to 15 files.

Next

Required Documentation Uploads

Please upload clear copies of all required documents. Incomplete submissions will delay approval.

Upload Government Issued ID (Driver’s License or State ID)- (If Available)

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Upload Social Security Cards (All Household Members)- (If Available)

Drag & Drop Files, Choose Files to Upload You can upload up to 8 files.

Upload Proof of Home Ownership (Deed, Tax Record, Mortgage Statement)- (If Available)

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Upload Proof of Household Income (Last 2 Months Pay Stubs, SSI, SSDI, Pension, etc.)- (If Available)

Drag & Drop Files, Choose Files to Upload You can upload up to 15 files.

Last 2 Months Bank Statements (All PAGES)- (If Available)

Drag & Drop Files, Choose Files to Upload You can upload up to 36 files.

Upload Homeowners Insurance Declaration Page (If Applicable)

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Next

Applicant Certification *

“I certify that all information provided is true and complete to the best of my knowledge. I understand that false statements may result in denial of assistance. I authorize Motivative Consulting LLC to verify information and communicate with USDA/VA regarding this application.”

Applicant Signature (I certify all information provided is accurate) *

Clear Signature

Date Signed *

Submit