NCLT 2020 income verification

NCLT 2020 income verification
Please complete the below information and upload a SIGNED copy of your 2019 tax
returns by June 15, 2020. Below is a description of a complete package, which we will treat with discretion and confidentiality.

Only the head of household needs to fill out the first form, Household Information Sheet. In addition, if filing separately each household member 18 years or over in your household must fill out an individual Income Verification form and submit a copy of their Federal Income Tax Return.

If you are filing your tax returns late this year, please complete your forms to the best of your ability and submit whatever information you have about your income (such as copies of your W-2s) as well as a note indicating when we can expect to receive a copy of your 2019 tax returns.

If for whatever reason you are unable to submit the paperwork by June 15, 2020, please call or email Marissa Ashkar at marissa.ashkar@nclt.org. As outlined in your lease, failure to provide this information may result in a rent increase for your unit. Please do not hesitate to contact our office with any questions you might have.

Thank you in advance for your cooperation. We look forward to receiving your complete income verification package soon.
If you are ready to complete the form please have your 2019 US Federal Income Tax form (the IRS 1040) for reference.

During the completion of the form you will be asked to securely upload a copy of the return as either a PDF (if using a computer) or by taking a picture (if using a phone).

After your submission is complete you will be asked to certify your submission using docusign. At this time we recommend that you save a PDF or print this certified copy of the submission. If you prefer we can email you a pdf copy of your submission.

Household Information Sheet
2019 Confidential Household Information Sheet and Income Verification

about your household
Name *

First Name Last Name
Current email *

Confirmation Email your email
Project name or new application
Your address *

Street Address

Unit number / Street Address Line 2

City State / Province

Postal / Zip Code
Total Number of Household Members *
total # of members of your household
Total Number of Adult Household Members (18 or over) *
Please enter the number of adults over the age of 18 who are resident members of your household. If you are the only adult enter 1. The form will provide an individual declaration for each person listed.

About your Unit
# of Bedrooms
Total monthly rent paid by you *
For most residents this is your total rent. If your household receives rental assistance from a non-NCLT source (like Section 8) please enter the amount of rent paid by your household
If you have a rental subsidy, total amount of your monthly subsidy
Please enter the monthly amount of any outside assistance or subsidies paid on your behalf. For example Section 8 HAP payments, Shelter plus care or other ongoing subsidies. If you do not receive an ongoing subsidy this field should be 0.
Utilities paid by tenant (check all that apply):

Gas Electricity Water Garbage Sewer
Are there any unaddressed maintenance or other problems with your unit you would like a property manager to follow-up with you about?

Household Annual Income and demographic survey
**Note - See this page for details on how to fill out Ethnicity and Race information below and additional background information. Our funding agreements require that we ask, but a response is voluntary.

Income information is required.

Please list household members and their adjusted gross annual income *

	Name of household member	Relationship to head of household	age range**	ethnicity**	race**	Adjusted ANNUAL Gross Income
1
2
3
4
5
6

TOTAL HOUSEHOLD INCOME FROM ALL MEMBERS (calculated)
Total Adjusted Gross Income for all household members, if different.
please enter the total on line 8b of your 2019 IRS 1040, or equivalent.
By initialing here I certify that the the household income information listed above for the tax year 2019 as well as all accompanying documentation is true and correct. *
Click NEXT to continue on to enter detailed income information for each adult household member. When done you will be prompted to electronically sign the form via docusign and submit.


Gross income from employment
Net income from business or self employment
Gross amount of SS/SSI (before Medicare deduction)
Periodic payments from retirement/pension funds, insurance policies, annuities and SS death payments
Payments in lieu of earnings, such as unemployment, disability insurance, worker’s compensation, and severance pay, which includes lump sum payments due to delay in processing claims.
Welfare assistance
Alimony and child support
Interest, dividends, and other income from non-retirement assets (See asset info page).
Other Income
HUD exclusions from gross income

	entry household member 2
Gross income from employment
Net gains from business
Gross amount of SS/SSI (before Medicare deduction)
Periodic payments from retirement/pension funds, insurance policies, annuities and SS death payments
Payments in lieu of earnings, such as unemployment, disability insurance, worker’s compensation, and severance pay, which includes lump sum payments due to delay in processing claims.
Welfare assistance
Alimony and child support
Interest, dividends, and other income from assets (See asset info page)
Other Income
HUD exclusions from income


Gross income from employment
Net gains from business
Gross amount of SS/SSI (before Medicare deduction)
Periodic payments from retirement/pension funds, insurance policies, annuities and SS death payments
Payments in lieu of earnings, such as unemployment, disability insurance, worker’s compensation, and severance pay, which includes lump sum payments due to delay in processing claims.
Welfare assistance
Alimony and child support
Interest, dividends, and other income from assets (See asset info page)
Other Income
TOTAL ADJUSTED GROSS INCOME for the year 2019 (1040 Line 8b)


Gross income from employment
Net gains from business
Gross amount of SS/SSI (before Medicare deduction)
Periodic payments from retirement/pension funds, insurance policies, annuities and SS death payments
Payments in lieu of earnings, such as unemployment, disability insurance, worker’s compensation, and severance pay, which includes lump sum payments due to delay in processing claims.
Welfare assistance
Alimony and child support
Interest, dividends, and other income from assets (See asset info page)
Other Income
TOTAL ADJUSTED GROSS INCOME for the year 2019 (1040 Line 8b)


Gross income from employment
Net gains from business
Gross amount of SS/SSI (before Medicare deduction)
Periodic payments from retirement/pension funds, insurance policies, annuities and SS death payments
Payments in lieu of earnings, such as unemployment, disability insurance, worker’s compensation, and severance pay, which includes lump sum payments due to delay in processing claims.
Welfare assistance
Alimony and child support
Interest, dividends, and other income from assets (See asset info page)
Other Income
TOTAL ADJUSTED GROSS INCOME for the year 2019 (1040 Line 8b)

Confirm your submission and sign

Please review your answers and then sign and certify under penalty of perjury that all of your answers are true and correct to the best of your knowledge. If there are comments, notes or clarifications that you need to add please add below.
Please enter any notes, qualifications or clarifications about your submission
Do you have any other suggestions, issues or concerns you would like to share or that you would like to request further follow-up information from NCLT?
Would you like to receive a copy of your approved submission by email or mail? If so please indicate below
How easy was this form to submit?
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NCLT 2020 income verification

2019 Confidential Household Information Sheet and Income Verification

About your Unit

Household Annual Income and demographic survey

Confirm your submission and sign

Please Sign and certify using DocuSign