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❑ New Certification ❑ Recertification <br />INCOME COMPUTATION AND CERTIFICATION <br />I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following questions <br />for all persons who are requesting to occupy the apa rim ent# in <br />1. 2, 3. 4. 5. <br />First and Last Name of Members of Relationship of Age Current city of Current city of <br />the Household head of residence Employment <br />Household <br />HEAD <br />Income Computation <br />6. The total anticipated income, calculated In accordance with this paragraph, of all persons (except minors under 18 <br />years) listed above for the 12 -month period beginning the earlier of the date that Ilwe plan to move into a unit or sign a <br />lease for a unit is $ <br />Included in the total anticipated income listed above are: <br />a) the full amount, before any payroll deductions, of wages and salaries, overtime pay, commissions, fees, tips and bonuses and <br />other compensation for personal services; <br />b) the net Income from the operation of a business or profession. Expenditures for business expansion or amortization of capital <br />indebtedness shall not be used as deductions in determining net income. An allowance for depreciation of assets used in a <br />business or profession may be deducted, based on straight line depreciation, as provided in Internal Revenue Service <br />regulations. Any withdrawal of cash or assets from the operation of a business or profession vAI be included in income, except <br />to the extent the Withdrawal is reimbursement of cash or assets in vested in the operation by the family; <br />c) interest and dividends and other net income of any kind from real or personal property. Expenditures for amortization of capital <br />indebtedness shall not be used as deductions in determining net income. An allowance for depreciation is permitted only as <br />authorized In paragraph (6)(b) of this section. Any withdrawal of cash or assets from an investment will be included in income, <br />except to the extent the withdrawal Is reimbursement of rash or assets Invested by the family. Where the family has net family <br />assets, annual income shall include the greater of the actual income derived from all net family assets or a percentage of the <br />value of such assets based on the current passbook savings rate, as determined by the Department of Housing and Urban <br />development; <br />d) the full amount of periodic payments received from Social Socurity, annuities, retirement funds, pensions, disability benefits, <br />and other similar types of periodic receipts, including any lump sum amount except deferred periodic amounts from <br />supplemental security income and social security benefits that are received In a lump sum amount or in prospective monthly <br />amounts; <br />a) payments in Ilse of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; <br />I) welfare assistance. If the welfare assistance payment Includes an amount specifically designated for shelter and utilities that Is <br />subject to adjustment by the welfare assistance agency in accordance with the actual cost of shelter and Office, the amount of <br />welfare assistance <br />g) periodic and determinable allowances, such as alimony payments, and regular contributions or gifts received from organizations <br />or from persons not residing in the dwelling; <br />h) all regular pay, special pay and allowances of a member of the Armed Forces except the special pay to a family member serving <br />In the Armed Forces except the special pay to a family member serving In the Armed Forces who is exposed to hostile fire; <br />Excluded from such anticipated income are: <br />i) income from employment of children (in duding foster children) under the age of 18 years; <br />J) payments received for child support anchor the care of foster children or foster adults (usually persons with disabilities, unrelated <br />to the tenant family, who are unable to live alone) <br />k) lump sum additions to family assets, such as inheritances, willed or monetary gifts, Insurance payments (including payments <br />under life, health and accident insurance), capital gains and settlement for personal or property losses except payments in Ileu <br />of earnings, such as unemployment and disability compensation, worker's compensation and severance pay; <br />I) amounts mceNed by the family that are specifically for, or In reimbursement of, the cost of medical expenses for any family <br />member; income of a live -in aide, <br />m) the full amount of student financial assistance paid directly to the student or to the educational institution (including but not <br />limited to financial aid, scholarships and grants) <br />19H -50 <br />