Property Name:      						Minnesota Housing D#:      
Head of Household Name:      	Unit #:      

You have applied for or currently reside in a rental housing unit located in a property that received or will receive HIB financing from Minnesota Housing. This financing requires us (owner/agent) to rent units in the property to households with behavioral health needs because at least one individual meets the definition of:
1.	People with Mental Illness
2.	People with Substance Use Disorders

Refer to the Housing Infrastructure Bonds Behavioral Health Unit Eligibility Details page for detailed definitions. 

Self-Certification of Behavioral Health Needs	
I hereby certify that my household meets the above definition of a household with behavioral health needs because at least one person who lives/will live in the unit is a person with Mental Illness or has a Substance Use Disorder.
	     	     	
Signature of Head of Household	Printed Name of Head of Household	Date	
Providing false or misleading information may result in termination of tenancy. 
Owner/agent may not inquire as to the specific Mental Illness or Substance Use Disorder.

Service Provider Certification (for use only if Head of Household is unable to complete the self-certification)
Service Provider Organization Name:      
Service Provider Staff Phone Number and Email Address:      

The Head of Household is unable to complete the self-certification of eligibility. As the service provider for the above-named household, I hereby certify that the household meets the above definition of a household with behavioral health needs because at least one person who lives/will live in the unit is a person with Mental Illness or has a Substance Use Disorder.

	     	     	
Signature of Service Provider Staff	Printed Name of Service Provider Staff	Date	

Owner/Agent: Retain signed form in tenant file; submit to Minnesota Housing upon request.

Housing Infrastructure Bonds (HIB)
Behavioral Health Needs Unit Eligibility Details

The following information is provided to assist in determining eligibility for units set aside for People with Behavioral Health Needs. 
1.	People with Mental Illness
Means people with an organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory, or behavior that is detailed in a diagnostic codes list published by the Commissioner of the Minnesota Department of Human Services, and that seriously limits a person’s capacity to function in primary aspects of daily living such as personal relations, living arrangements, work, and recreation. 
MN DHS diagnostic codes
2.	People with Substance Use Disorders
The meaning is provided in the current Diagnostic and Statistical Manual of Mental Disorders (DSM): 
https://www.psychiatry.org/psychiatrists/practice/dsm 
The DSM (vol. 5 2021) recognizes substance-related disorders resulting from the use of 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other stimulants); tobacco; and other or unknown substances.

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
1.	Taking the substance in larger amounts or for longer than you're meant to.
2.	Wanting to cut down or stop using the substance but not managing to.
3.	Spending a lot of time getting, using, or recovering from use of the substance.
4.	Cravings and urges to use the substance.
5.	Not managing to do what you should at work, home, or school because of substance use.
6.	Continuing to use, even when it causes problems in relationships.
7.	Giving up important social, occupational, or recreational activities because of substance use.
8.	Using substances again and again, even when it puts you in danger.
9.	Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10.	Needing more of the substance to get the effect you want (tolerance).
11.	Development of withdrawal symptoms, which can be relieved by taking more of the substance.