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HUD’s Office of Affordable Housing Programs (OAHP) updated the sample self-certification of income form originally published in June 2020. The revised form supersedes previous form and is valid for use through September 30, 2021, the extended HOME COVID-19 waiver period.View the Updated HOME Sample Self-Certification of Income Form.

Participating Jurisdictions (PJs) can use the sample self-certification of income form to document the annual income of:

  • New applicants of HOME-assisted rental units
  • New applicants of HOME Tenant-Based Rental Assistance (TBRA) programs, including emergency and short-term TBRA
  • Existing TBRA tenants requiring assistance under an emergency TBRA program
  • Existing tenants of HOME rental units up for income re-examination (annual and 6th year redeterminations)
  • Prior applicants denied assistance due to the inclusion of excludable unemployment benefits

(source: HUD Exchange Mailing List 12/18/20)

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