Visual Reference Datasheet

This file is complete and finalized. It visually connects each section of your summarized application text to its source document image. The only form without a visual source is the "Criminal History Request".
Summarized Text Section Visual Source Document

HACLA Section 8 HOPWA Program Form

This form collects information specific to the Housing Opportunities for Persons with AIDS/HIV program...

[cite_start]Client name: Duran [cite: 263]
[cite_start]Client#: V715794 [cite: 263]
...
[cite_start]CLIENT SIGNATURE: Duran [cite: 266]

HOPWA Program Form

This image is from your latest document set and matches the data in your summary.

Visual of HOPWA Program Form

Applicant Questionnaire and HUD Debts Notice

This questionnaire gathers general information about residency history, criminal background, and contains the Certified Statements.

[cite_start]Registrant's Name: Duran Keoni Penamante [cite: 364]
...
HOUSING AUTHORITY OF THE CITY OF LOS ANGELES
CERTIFIED STATEMENT
...
[cite_start]Signature: Duran Keoni Penamante [cite: 273]

Certified Statement (RE-46)

This is the Certified Statement (RE-46) which is part of this summarized section.

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HACLA Application Form (HAPP-27P)

This is the main application form, which collects detailed personal, financial, and household information.

Head of Household Name: Duran Keoni Penamante
...
* Do you or any household member receive Social Security or SSI benefits? [cite_start]☑ Yes [cite: 31]
   a. Name of Household Member: Duran Keoni Penamante
   [cite_start]Monthly Amount: $1,200.49 [cite: 33]
...

Main Application Form (First Page)

This image is the primary household composition page from the original document set.

Visual of Main Application (HAPP-27P)

HACLA Rental Assistance Program Forms

These forms cover family obligations, language preference, and citizenship status.

Statement of Family Responsibility
Signature of Family Representative: Duran Keoni Penamante
...
DECLARATION OF CITIZENSHIP/ELIGIBLE IMMIGRATION STATUS
[cite_start]Signature: Duran Keoni Penamante [cite: 489]

Family Obligations & Citizenship Forms

This shows the Statement of Family Responsibility and Declaration of Citizenship forms.

Visual of Rental Assistance Program Forms

HACLA Consent and Verification Forms

These forms authorize the Housing Authority to collect and verify information from various external sources.

...
Authorization for the Release of Information...
[cite_start]Signature: Duran Keoni Penamante [cite: 306]

Consent to Release Information (HUD-9886-A)

This is the crucial authorization form from your latest document set.

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HOPWA Certification of Medical Condition

This is a certification of a medical condition required for the HOPWA program, to be filled out by a licensed medical professional.

CERTIFICATION OF MEDICAL CONDITION
Signature: Duran Keoni Penamante
[cite_start]Date: 8/2/25 [cite: 112]

HOPWA Medical Certification Form

This is the HOPWA-2 form requiring a doctor's signature, from the original document set.

Visual of HOPWA Certification of Medical Condition

HACLA Criminal History Request

This form is a request for criminal history information, authorized by the applicant.

REQUEST FOR CRIMINAL HISTORY
[cite_start]Adult Signature: Duran Keoni Penamante [cite: 121]
...
Driver License/ ID Number: D6078999

Source Image Not Found

This is the only section for which a source document image has not been provided.