E. Unemployment Compensation

1. Relevant information to verify with third party:

   • a. Gross weekly payment;

   • b. Date of initial payment;

   • c. Duration of benefits: ______ weeks;

   • d. Is the claimant eligible for further benefits?

   • e. If yes, how many weeks?

   • f. If no, what is the date the benefits are terminated?

2. Acceptable forms of verification:

   • a. Verification form completed by the unemployment compensation agency; and

   • b. Records from unemployment office stating payment dates and amounts.

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

• F. Public Benefits

  1. Relevant information to verify with third party:

     • a. Number of members in the family;

     • b. Names of the children for whom benefits are received and their social security numbers;

     • c. Date of initial assistance;

     • d. Is recipient covered by Medicaid? If yes, what is the Medicare spend down amount?

     • e. Does the recipient meet his/her spend down amount each period?

     • f. What is the rate per month under the following grant:

       • (1) Temporary Assistance to Needy Families (TANF),

       • (2) Supplemental Social Security,

       • (3) Other assistance: Type ___________________, and

     • g. The following question applies only to "as-paid" States only: Amount specifically designated for shelter and utilities (This is the maximum allowance for rent and utilities);

     • h. The grant is increased by the following amounts (Specify purpose):

       • (1) Employment income $ ______________

       • (2) Child care allowance $ ______________ (3) Transportation $ ______________

       • (4) Other _____________ $ ______________;

     • i. The grant is reduced by the following amounts:

       • (1) Alimony $_______________ (2) Child support $_______________

       • (3) Other (specify) $____________________________;

     • j. Is there anything else that will influence the amount of the grant? If yes, specify purpose and amount. $_______________

     • k. Has the monthly payment been reduced for overpayment of previous benefits? If so, by how much? $_______________

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

6/07

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Appendix 6-C

4350.3 REV-1

l. TOTAL MONTHLY GRANT $ _____________.