• Tools and Templates

Updated HOME Sample Self-Certification of Annual Income Form


Date Published: February 2021


In an April 10, 2020 memorandum (the "April 2020 Memo"), HUD waived the HOME regulations at 24 CFR 92.203(a)(2) which requires Participating Jurisdictions (PJs) to determine annual household income by examining at least two months of source documentation.

On December 4, 2020, HUD issued an updated memorandum (the "December 2020 Memo") that extended the waiver period through September 30, 2021.

On September 27, 2021, HUD issued additional revisions and updates to the memorandum, effective as of September 30, 2021, that amends the December 2020 Memo to further revise or extend certain statutory suspensions and regulatory waivers.

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

The sample form is provided as a guide and should be adapted to include the PJ's policy and procedures regarding income eligibility requirements for emergency TBRA/rental assistance. The income sources listed on the form reflect annual income as defined by 24 CFR 5.609 (a)-(c) (Part 5) which is commonly used in HUD's rental and TBRA programs. PJs must update this form if they use the IRS 1040 adjusted gross income definition for its TBRA/rental programs.

Note: The HOME COVID-19 waiver which permits PJs to use self-certification of income, in lieu of source documentation to determine eligibility for HOME assistance, expires on September 30, 2021. As of October 1, 2021, PJs must resume conducting income determinations in accordance with 24 CFR 92.203(a)(1) and (2) and document their project files accordingly.

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