Zero Income Verification Form

The form should be completed prior to admission and at recertifications.

Zero income verification form. This form should be completed by every adult household member of households claiming zero income. You must supply additional information to verify all yes answers. Zero income verification this checklist and worksheet is to be completed for all families whose total tenant payment equals the minimum rent or for all families reporting less than 250 per month in total income. Within the next 12 months will you receive income from any of the following sources.

Participant name participant address city state zip code ssn. Wages from employment including commissions tips bonuses fees etc. Zero income verification form according to the federal processing center you reported zero 0 income for yourself and or a family member on your free application for federal student aid fafsa. The form should be completed prior to admission and at each recertification which may be monthly or quarterly depending on the pha s policy on re examination of tenants with minimum rents or zero income.

Zero income step 1 tell us about yourself please print. 1 i hereby certify that i do not individually receive income from any of the following sources. In order to continue the verification process of your file. Last name last 4 numbers of.

Certification of zero income to be completed by adult household members only if appropriate household name. Step 2 read and sign this form. The form first lists all the cash and non cash contributions the family is receiving and then assists pha staff to compute the annual value of such contributions. I do not receive any income at this time.

Social security number ref id. Certification of zero income each adult household member must complete this form head of household name. Self certification of zero income. Development name and address.