Laserfiche WebLink
Enter the date of birth, student status, and Social Security number or alien registration number <br />for each occupant. <br />rf there are more than seven occupants, use an additional sheet of paper to list the remaining <br />household members and attach it to the certification, <br />Part III - Annuat Income <br />See HUD Handbook 4350.3 for complete instructions on verifying and calculating income, <br />including acceptable forms of verification. <br />From the third party verification forms obtained from each income source, enter the gross <br />amount anticipated to be received for the 1.2 months from the effective date of the <br />(re)certifrcation. Complete a separate line for each income-earning member. List the respective <br />household member number from Part II. <br />Column (A) Enter the annual amount of wages, salaries, tips, commissions, bonuses, <br />and other income from employment; distributed profits and/or net income <br />from. a business. <br />Column (13) Enter the annual amount of Social Security, Supplemental Security <br />Income, pensions, military retirement, etc. <br />Column (C) Enter the annual amount of income received from public assistance (i.e., <br />TANF, general assistance, disability, etc.} <br />Column {D} Enter the annual amount of alimony, child support, unemployment <br />benefits, or any other income regularly received by the household. <br />Row {E) Add the totals from columns (A) through (D) above. Enter this amount. <br />Part IV -Income from Assets <br />See HUD Handbook 4350.3 for complete instructions on verifying and calculating income from <br />assets, including acceptable forms of verification. <br />From the third party verification forms obtained from each asset source, list the gross amount <br />anticipated to be received during the 12 months from the effective date of the certification. List <br />the respective household member number from Part iI and complete a separate line for each <br />member. <br />Column. (F) List the type of asset (i.e., checking account, savings account, etc.) <br />Column (G) Enter C (for current, if the family currently owns or holds the asset), or I <br />(for imputed, if the family has disposed of the asset for less than fair <br />market value within two years of the effective date of {re)certification). <br />2029975v1 $-2 <br />