CERTIFICATION OF ZERO INCOME 2025

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The purpose of the Certification of Zero Income form is to provide an official declaration by adult household members stating they receive no income. This form is vital for individuals applying for housing assistance programs and helps landlords verify tenant eligibility.
Proof that you have no income If a household member is not currently working and was asked to submit proof that they have no income, they may submit a signed written statement (also called an affidavit). The affidavit needs to state that they do not have any income and must be signed under penalty of perjury.
Unemployment benefits or disability insurance statements. Recipients of unemployment, disability insurance, or other forms of government support can request and provide a letter or statement proving their income from these sources.
I certify that I have not been employed, self-employed, completed odd jobs, or had any source of income including gifts or loans during the past 30 days. For the amount of $. I received my last payment from this source on or about .
I hereby certify that I do not receive income from any of the following sources: a. Wages from employment (including commissions, tips, bonuses, fees, etc.); b. Income from operation of a business; c. Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits; d.

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Any documents from state or federal benefit agency that show zero income. These can be eligibility notices for food stamps or Medicaid for instance. If zero income is due to the loss of a job, this can be proven by a termination letter or a notice of severance pay on your last paycheck stub.
How to fill out the Self-Certification of No Income Form Instructions? Enter your full name in the client section. Confirm that you do not have income by checking applicable sources. Review the information provided for accuracy. Have the staff review and affirm your statement.

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