Loss of income attestation form 2026

1. Click ‘Get Form’ to open the loss of income attestation form in the editor.
2. Begin by entering your name in the designated field where it states 'I, _____________ (Applicant)'. This identifies you as the applicant.
3. Next, indicate your household income prior to COVID-19 by filling in the amount in the field labeled 'Prior to COVID19, my household income used to be $_____ per month.'
4. Then, specify your current household income by completing the section 'My household income now is $____ per month.'
5. Select one of the applicable situations from the list provided. Mark your choice clearly by checking the box next to the relevant statement regarding employment changes due to COVID-19.
6. If none of the listed situations apply, use the 'Other' section to describe your circumstances in detail.
7. Finally, sign and date the form at the bottom where it states 'Applicant Signature certifying above information' and 'Date'.

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