HOPA OnLine Questionnaire

HUD Title 24, Subtitle B; The Housing for Older Persons Act (HOPA) was signed into Federal law on December 28,1995. This law is to ensure resident occupancy in planned residential retirement communities remain in the 55+ community age status. The HOPA survey's intent is to identify housing occupancy levels of at least one person 55 years of age or older per unit.

Under NJ Law, HOAs are required to perform a biennial collection and verification of occupancy with age identities of all residences.


It is mandatory that you complete this survey and return it by clicking the "Submit Request" button below. This will complete your HOPA survey for 2024 and you do not have to submit the paper form.

Deadline is December 31, 2024.


HOPA Questionaire

Homeowner or Renter

 

Homeowner/Renter Name(s)

 

Street Address

 

Primary Phone

 

Emergency Contact Person

 

Emergency Contact Phone

 

Your Email

 
Total number of people living in your home (including yourself),
including assistants, housekeepers, aides, etc.

 

 

List below the name(s); age(s) and birthday(s) of all residents including yourself:

 

Person 1

Person 1 Name

Person 1 Birthday (mm/dd/year)

Person 1 Age

 

Person 2

Person 2 Name

Person 2 Birthday (mm/dd/year)

Person 2 Age

 

Person 3

Person 3 Name

Person 3 Birthday (mm/dd/year)

Person 3 Age

 

Person 4

Person 4 Name

Person 4 Birthday (mm/dd/year)

Person 4 Age
 

Additional Questions

Do you have pets?

Do you have access to WIFI?

Do you have your own transportation?

Do you live in your home full time?
 

Your Signature

Signature (your name)
 

SRP Westerly HOA Disclaimer:

By submitting this form, you agree that the information provided is accurate to the best of your knowledge. You understand that the data collected will be used in accordance with our privacy policy and may be stored for internal record-keeping. Furthermore, you acknowledge that the transmission of information via the internet is not completely secure, and therefore, we cannot guarantee the security of data sent over the internet.

By clicking the submit button, I/We certify this form be an accurate statement of the number of persons living in my home with their accurate birth dates. Under penalty of perjury, I/we declare that the above information is true, correct, and complete.