To be placed on AA letterhead

Date

Participant Name

Participant Address

City/Town, MA Zip Code

Re: Termination of Rental Subsidy

Dear Participant Name:

Please be advised that Administering Agency (AA) is terminating your participation in the Massachusetts Rental Voucher Program (MRVP) effectivedate. This means you and your entire household will no longer receive rental assistance and will not be entitled to any of the benefits of MRVP. Afterdate, the AA will no longer make rental subsidy payments.

This action is being taken for the following reason:

Description of reason for termination in plain language

The rules governing the Massachusetts Rental Voucher Program state:

Text of specific regulation violated (760 CMR 49.xx(xx))

Your MRVP Voucher, which was signed by you ondate, states in Sectionxx:

Text of specific section of the Voucher violated

If you disagree with the decision to terminate you from the Massachusetts Rental Voucher Program, you are entitled to file a grievance. If you wish to file a grievance, your request must be in writing and should be directed to:

Specific Person at Agency

Agency Name

Full Address

Your request to file a grievance must be received within 14 days from the date of this letter. If you do not avail yourself of this opportunity to file a grievance, you may not be entitled to any further appeals. Requests received after the allotted time will not be considered.

If you file a grievance, you will be offered an opportunity to attend an informal settlement conference. An informal settlement conference allows you to discuss your termination and seek a resolution. If the matter is not resolved or you do not wish to attend an informal settlement conference, a grievance hearing will be held.

You are entitled to examine agency documents directly relevant to your termination. Please contact the above-mentioned person to request copies of relevant documents.

A reasonable accommodation request will be considered when a participant is being terminated from the program as a result of program violations when failure to comply is the result of a disability. If you have a disability and wish to make a request for a reasonable accommodation, please return the enclosed Request for Reasonable Accommodation form to the above-mentioned person atAA.

If you have any questions in regards to this letter, please feel free to contact me at my direct phone number,phone number.

Sincerely,

Staff Person’s Name

Staff Person’s Title

phone number(phone)

fax number (fax)

email

Certified and Regular Mail

Cc: Tenant File, Name of Person Who Receives Grievances

Enclosure: Reasonable Accommodation Form