1. Relevant information to verify with third party:

• a. Nonmilitary employment

  • (1) Date first employed,

  • (2) Base pay rate (Gross) (check one)

Per hour $______ or per week $______

OR per month $_____

Date present rate became effective ____________

Expected average hours to be worked during next 12 calendar months at base pay rate _____________

Per week __________ or per month________,

• (3) Overtime pay rate

Per hour $____________

Expected average number of hours to be worked per week during next 12 calendar months ____________________,

• (4) Other compensation not included above (specify for commissions, bonuses, tips, etc.)

For ___________________ $__________ per _________,

HUD Occupancy Handbook Appendix 6-C: Guidance About Types of Information to Request When Verifying Eligibility and Income

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Appendix 6-C

4350.3 REV-1

• (5) Total anticipated base pay earnings for the next 12 calendar months $_____________________,

Total anticipated overtime earnings for the next 12 calendar months $_____________________,

• (6) Medical insurance premium deducted (if any). (This would be relevant only for families eligible for the medical deduction.),

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• (7) Has employment been terminated? ___________________

If yes, is individual eligible for unemployment benefits?

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• b. Military employment

  • (1) Years ____ and months _____ of services for pay purposes.

Number of dependents claimed____________,

• (2) Monthly income from the following sources: