1. At the top of the page, click "New Rent Assistance Request. This file provides a sample letter to request rent relief or a payment plan from a landlord.Documentation of expenses is required for all requests. To Whom It May Concern: I am writing to request rental assistance due to a COVID19 hardship. Help pay for housing programs and help in Fairfax, va. Search 83 social services programs to assist you. Detailed instructions are laid out within. Person completing the form any financial responsibility of outstanding medical debt due from the patient who is applying for financial assistance. The personal representative should request from each life insurance company a completed IRS Form 712: Life Insurance Statement. Tenant Authorization Form Fairfax – Fill Out and Use This PDF.