Public Housing Tenant Income Recertification Worksheet

Worksheet to recalculate tenant rent at annual recertification using verified income, assets, and family composition.

Worksheet Overview and Consent

• Household Head / Primary Contact Name
• Unit Number
• Recertification Effective Date
• I consent to the housing authority verifying the information provided in this worksheet with employers, benefit agencies, financial institutions, and other authorized sources.
• I understand this form collects PII needed for rent recertification and will be used only for eligibility, verification, and rent calculation purposes.
• Applicant Signature

Household Composition

• Household Members
• Have there been any changes to household members since the last certification?
• Describe the household change
• Reason for change

Income Sources

• Does any household member have employment income?
• Employment Income Details
• Does the household receive any other income?
• Other Income Types
• Other Income Details

Assets and Deductions

• Does the household have assets that must be reported?
• Asset Types
• Asset Details
• Are there any allowable deductions to report?
• Deduction Types
• Deduction Details

Verification and Certification

• Verification Status
• Missing Documents or Follow-Up Items
• Staff Review Notes
• Review Date
• Reviewer Name