CDBG Self-Certification of Annual Income Form - HUD Exchange 2025

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A verifiable self-certification is where the beneficiary states and signs-off on their income at the time of assistance.
Certification: Once the tenants income is verified and calculated, a Tenant Income Certification form is completed. This form includes the tenants income details, household size, and the determined eligibility status.
Tenant Income Certification means a certification as to income and other matters executed by the household members of each tenant in the Development, in such form as reasonably may be required by the Department in satisfaction of the criteria prescribed by the Secretary of Housing and Urban Development under 8(f)(3)
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.
​ Form 1040/1040A showing amount earned and employment period. ​ Notarized statement or affidavit signed by applicant showing amount earned and pay period. ​ Social security number.

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(a) Annual income means all amounts, monetary or not, which: (1) Go to, or on behalf of, the family head or spouse (even if temporarily absent) or to any other. family member; or. (2) Are anticipated to be received from a source outside the family during the 12-month period.
A proof of income letter, otherwise known as a salary verification letter, is an official document that proves youre currently employed and earning a salary. Providing a proof of income letter is common for those needing to prove they have a job to secure a loan or sign a lease.
This form includes the tenants income details, household size, and the determined eligibility status. Approval and Record Keeping: The certification form is signed by both the tenant and the property manager or housing authority representative.

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