EXAMPLE – Information That Is Not Necessary to Determine Eligibility or Level of…

In a verification for termination of employment, it would not be appropriate to ask “would you rehire this person?” But, it would be appropriate to ask “do you anticipate rehiring this person and, if yes, when?”

In a medical verification, it would not be appropriate to ask the purpose of an office visit or to ask for a diagnosis.

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

6/07

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4350.3 REV-1

Appendix 6-A

NOTE : Concerning verifications of disability (handicap), Appendix 6-B provides a specific explanation to the applicant/tenant on the limitations on any verification of disability (handicap).

• d. Include the following certification statement to be signed by the applicant/tenant:

"I hereby authorize the release of the requested information. Information obtained under this consent is limited to information that is no older than 12 months. There are circumstances that would require the owner to verify information that is up to 5 years old, which would be authorized by me on a separate consent attached to a copy of this consent."

• e. Provide a space for the title, agency/organization, and signature of the third party who is supplying the information. This information will be provided by the third party. For example:

___________________________ _______________________ NAME AND TITLE OF PERSON AGENCY/ORGANIZATION SUPPLYING THE INFORMATION (PRINT)

___________________________ ______________________ SIGNATURE DATE