• Tools and Templates

Section 3 and Targeted Section 3 Worker Self-Certification Sample Form


Date Published: January 2022


This sample form can help grantees certify and track Section 3 Workers and Targeted Section 3 Workers seeking certification and/or a preference in employment. This tool can also help provide the appropriate documentation to support the workers' Section 3 status claims.

Grantees are encouraged to adapt the form to fit the resources within their individual communities and to meet the needs of their program. Grantees and Public Housing Agencies (PHAs) should work with their legal counsels to ensure it meets all local and state laws.

Resource Links

Tags: Section 3
Author Organization
  • HUD
Resource Approver
  • HUD Approved