Privacy Act Notice

The Department of Housing and Urban Development (HUD) is authorized to collect this information under the U.S. Housing Act of 1937, as amended, and the regulations issued pursuant thereto. Collection of this information is mandatory for the purpose of determining eligibility and level of benefits.

Purpose

Your income and other information are being collected by HUD to determine your eligibility, the appropriate bedroom size, and the amount your family will contribute toward rent and utilities.

Other Uses

HUD uses your family income and other information to assist in managing and monitoring HUD-assisted housing programs, to protect the Government's financial interest, and to verify the accuracy of the information you provide.

Penalty

You must provide all the information requested by the owner, including the social security numbers of all household members, regardless of age. Failure to provide any of the requested information may result in a delay or rejection of your eligibility determination. If you provide false or incomplete information, you may be rejected for housing assistance, and the owner may take action against you up to and including termination of your housing assistance and eviction.

CERTIFICATION

I certify that the information provided is true and complete to the best of my knowledge. I understand that any false or incomplete information may result in the rejection of this application or termination of housing assistance. I authorize the owner to verify all information provided and to obtain credit reports and criminal background checks as necessary.