Requesting HUD Self-certification of Income Waiver
HUD has published waiver guidance allowing the use of self-certification of income in lieu of source documentation to determine eligibility to reside in HOME-assisted units for people impacted by COVID-19. This waiver is effective April 10, 2020 - September 30, 2021. DCA properties seeking this waiver must complete this form prior to utilizing the waiver. DCA will conduct on-site rent and income reviews within 90 days after the waiver period of September 30, 2021 for all properties requesting this waiver.
Property Name
*
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Georgia ID
*
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
-
Area Code
Phone Number
Submit
Should be Empty: