Agencies To Provide Information
State Wage Information Collection Agencies. HUD and PHA). This consent is limited to wages and unemployment compensation you have received during period(s) within the last 5 years when you have received assisted housing benefits.
U.S. Social Security Administration (HUD only). This consent is limited to the wage and self employment information from your current form W-2.
National Directory of New Hires contained in the Department of Health and HumanServices' system of records. This consent is limited to wages and unemployment compensation you have received during period(s) within the last 5 years when you have received assisted housing benefits.
U.S. Internal Revenue Service (HUD only). This consent is limited to information covered in your current tax return. This consent is limited to the following information that may appear on your current tax return:
1099-S Statement for Recipients of Proceeds from Real Estate Transactions
1099-8 Statement for Recipients of Proceeds from Real Estate Brokers and Barters Exchange Transactions
1099-A Information Return for Acquisition or Abandonment of Secured Property 1099-G Statement for Recipients of Certain
Government Payments 099-DIV Statement for Recipients 1 of Dividends and Distributions
1099 INT Statement for Recipients of Interest Income
1099-MISC Statement for Recipients of Miscellaneous Income 1099-OID Statement for Recipients of Original Issue Discount
1099-PATR Statement for Recipients of Taxable Distributions
Received from Cooperatives 1099-R Statement for Recipients of
W2-G Statement of Gambling Winnings
1065-Kl Partners Share of Income, Credits, Deductions, etc. 104-1 Kl Beneficiary's Share of Income, Credits, Deductions, etc. 1120S-Kl Shareholder's Share of Undistributed Taxable Income, Credits, Deductions, etc.
I understand that income information obtained from these sources
will be used to verify information that I provide in determining initial or continued eligibility for assisted housing programs and the level
No action can be taken to terminate, deny, suspend, or reduce the assistance your household receives based on information obtained about you under this consent until the HUD Office, Office of Inspector General (OIG) or the PHA (whichever is applicable) and the O/A have independently verified: 1) the amount of the income, wages, or unemployment compensation involved, 2) whether you actually have (or had) access to such income, wages, or benefits for your own use, and 3) the period or periods when, or with respect to which you actually received such income, wages, or benefits. A photocopy of the signed consent may be used to request a third party
to verify any information received under this consent (e.g., employer).
HUD, the 0/ A, or the PHA or the owner shall inform you, or a third party which you designate, of the findings made on the basis of information verified under this consent and shall give you an opportunity to contest such findings in accordance with Handbook 4350.3 Rev. 1.
If a member of the household who is required to sign the consent form is unable to sign the form on time due to extenuating circumstances, the 0/ A may document the file as to the reason for the delay and the specific plans to obtain the proper signature as soon as possible.
This consent form expires 15 months after signed.
Privacy Act Statement The Department of Housing and Urban Development (HUD) is authorized to collect this information by the U.S. Housing Act of 1937, as amended (42 U.S.C. 1437 et. seq.); the Housing and Urban-rural Recovery Act of 1983 (P.L. 98-181); the Housing and Community Development Technical Amendments of 1984 (P.L. 98-479); and by the Housing and Community Development Act of 1987 (42 U.S.C. 3543). The information is being collected by HUD to determine an applicant's eligibility, the recommended unit size, and the amount the tenant(s) must pay toward rent and utilities. HUD uses this information to assist in managing certain HUD properties, to protect the Government's financial interest, and to verify the accuracy of the information furnished. HUD, the owner or management (O/A), or a Public Housing Authority (PHA) may conduct a computer match to verify the information you provide. This information may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory investigators and prosecutors. However, the information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law. You must provide all of the information requested. Failure to provide any information may result in a delay or rejection of your eligibility approval.
Penalties for Misusing this Consent:
HUD, the O/A, and any PHA (or any employee of HUD, the O/A, or the PHA) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form.
Use of the information collected based on the form HUD 9887 is restricted to the purposes cited on the form HUD 9887. Any person who knowingly or willfully requests, obtains or discloses any information under false pretenses concerning an applicant or tenant may be subject to a misdemeanor and fined not more than
Any applicant or tenant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, against the officer or employee of HUD, the Owner or the PHA responsible for the unauthorized disclosure or improper use.
Applicant's/Tenant's Consent to the Release of Information Verification By Owners of Information Supplied by Individuals Who Apply For Housing Assistance and Urban Development Office of Housing Federal Housing Commissioner
1. Give the documents listed below to the applicants/tenants to sign. Staple or clip them together in one package in the order listed.
a. The HUD-9887/A Fact Sheet.
b. Form HUD-9887.
c. Form HUD-9887-A.
d. Relevant verifications (HUD Handbook 4350.3 Rev. 1 ).
2. Verbally inform applicants and tenants that
a. They may take these forms home with them to read or to discuss with a third party of their choice and to return to sign them on a date they have worked out with you, and
b. If they have a disability that prevents them from reading and/or signing any consent, that you, the Owner, are required to provide reasonable accommodations.
3. Owners are required to give each household a copy of the HUD 9887/A Fact Sheet, form HUD-9887, and form HUD-9887-A after obtaining the required applicants/tenants signature(s). Also, owners must give the applicants/tenants a copy of the signed individual verification forms upon their request.
Instructions to Applicants and Tenants
This Form HUD-9887-A contains customer information and protections concerning the HUD-required verifications that Owners must perform.
1. Read this material which explains:
* HUD's requirements concerning the release of information,
* Other customer protections.
2. Sign on the last page that:
* you have read this form, or
* the Owner or a third party of your choice has explained it to you, and
* you consent to the release of information for the purposes and uses described.
Authority for Requiring Applicant's/Tenant's Consent to the
Release of Information Section 904 of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988, as amended by section 903 of the Housing and Community Development Act of 1992. This law is found at 42 U.S.C. 3544.
In part, this law requires you to sign a consent form authorizing the Owner to request current or previous employers to verify salary and wage information pertinent to your eligibility or level of benefits.
In addition, HUD regulations (24 CFR 5.659, Family Information and Verification) require as a condition of receiving housing assistance that you must sign a HUD-approved release and consent authorizing any depository or private source of income to furnish such information that is necessary in determining your eligibility or level of benefits. This includes information that you have provided which will affect the amount of rent you pay. The information includes income and assets, such as salary, welfare benefits, and interest earned on savings accounts. They also include certain adjustments to your income, such as the allowances for dependents and for households whose heads or spouses are elderly handicapped, or disabled; and allowances for child care expenses, medical expenses, and handicap assistance expenses.
Purpose of Requiring Consent to the Release of Information
In signing this consent form, you are authorizing the Owner of the housing project to which you are applying for assistance to request information from a third party about you. HUD requires the housing owner to verify all of the information you provide that affect your eligibility and level of benefits to ensure that you are eligible for assisted housing benefits and that these benefits are set at the correct levels. Upon the request of the HUD office or the PHA (as Contract Administrator) the housing Owner may provide HUD or the PHA with the information you have submitted and the information the Owner receives under this consent.
Uses of Information to be Obtained
The individual listed on the verification form may request and receive the information requested by the verification, subject to the limitations of this form. HUD is required to protect the income information it obtains in accordance with the Privacy Act of 1974, 5 U.S.C. 552a. The PHA and the Owner are also required to protect the income information they obtain in accordance with any applicable state privacy law. Should the Owner receive information from a third party that is inconsistent with the information you have provided, the Owner is required to notify you in writing identifying the information believed to be incorrect. If this should occur, you will have the opportunity to meet with the Owner to discuss any discrepancies.
Who Must Sign the Consent Form
Each member of your household who is 18 years ofage or older must sign the relevant consent forms at the initial certification, at each recertification and at each interim certification, if applicable. In addition, when new adult members join the household and when members of the household become 18 years of age they must also sign the relevant consent forms.
Persons who apply for or receive assistance under the following programs must sign the relevant consent forms:
Rental Assistance Program (RAP)
Section 8 Housing Assistance Payments Programs (administered by the Office of Housing)
Sections 202 and 811 PRAC
Section 202/162 PAC
Section 22l(d)(3) Below Market Interest Rate
HOPE 2 Home Ownership of Multifamily Units
Failure to Sign the Consent Form
Failure to sign any required consent form may result in the denial of assistance or termination of assisted housing benefits. If an applicant
is denied assistance for this reason, the Owner must follow the notification procedures in Handbook 4350.3 Rev. I. If a tenant is denied assistance for this reason, the 0/ A must follow the procedures set out in the lease.
No action can be taken to terminate, deny, suspend or reduce the assistance your household receives based on information obtained about you under this consent until the 0/ A has independently I) verified the information you have provided with respect to your eligibility and level of benefits and 2) with respect to income (including both earned and unearned income), the O/A has verified whether you have actually have ( or had) access to such income for your own use, and verified the period or periods when, or with respect to which you actually received such income, wages, or benefits.
A photocopy of the signed consent may be used to request the information authorized by your signature on the individual consent forms. This would occur if the O/A does not have another individual verification consent with an original signature and the 0/ A is required to send out another request for verification (for example, the third party fails to respond). If this happens, the O/A may attach a photocopy of this consent to a photocopy of the individual verification form that you sign. To avoid the use of photocopies, the 0/ A and the individual may agree to sign more than one consent for each type of verification that is needed.
The 0/ A shall inform you, or a third party which you designate,
of the findings made on the basis ofinformation verified under this consent and shall give you an opportunity to contest such findings in accordance with Handbook 4350.3 Rev. I.
The Owner must provide you with information obtained under this consent in accordance with State privacy laws.
If an adult member of the household, due to extenuating circumstances, is unable to sign the required forms on time, the 0/ A may document the file as to the reason for the delay and the specific plans
Penalties for Misusing this Consent:
to obtain the proper signature as soon as possible.
Individual consents to the release of information expire 15 months after they are signed. The 0/ A may use these individual consent forms during the 120 days preceding the certification period. The Owner may also use these forms during the certification period, but only in cases where the O/A receives information indicating that the information you have provided may be incorrect. Other uses are prohibited. The 0/ A may not make inquiries into information that is older than
12 months unless he/she has received inconsistent information and has reason to believe that the information that you have supplied is incorrect. If this occurs, the 0/ A may obtain information within the last 5 years when you have received assistance.
I have read this information on the purposes and uses of information that is verified and/or it has been explained to me and consent to the release of information for these purposes and uses.
Original is retained by the requesting organization.