HUD’s Office of Affordable Housing Programs (OAHP) has provided a sample self-certification of income form that Participating Jurisdictions (PJs) can use to document annual income of (a) individuals and families that have lost employment or income either permanently or temporarily due to the COVID-19 pandemic and (b) homeless individuals and families who are applying for admission to a HOME rental unit or to participate in a HOME-funded emergency Tenant-Based Rental Assistance (TBRA) program.

View the HOME Sample Self-Certification of Income Form.

Visit the HUD Exchange HOME COVID-19 Guidance page for additional information and resources.