Housing Tools

SECTION 3 WORKER CERTIFICATION FORM-To be completed by worker - Instructions: This form
must be completed and signed by the worker to verify Section 3 eligibility for projects funded under HUD's
Housing and Community Development programs

SECTION E-WORKER CERTIFICATION -I certify that the information provided above is true andcomplete to the best of my knowledge. I understand that providing falseinformation may result indisqualification from Section 3 consideration. Section3 workers' and Targeted Section 3 workers'labor hours may be counted for five yearsfrom when their status as a Section 3 worker or TargetedSection 3 worker is established pursuant to § 75.31.

2

By submitting this form, my business certifies that the statements and information contained on this form are true and accurate, and meet the HUD Section 3 business self-certification requirements in accordance with 24 CFR Part 75. By signing below, I certify under penalty of perjury under the Laws of the State of California that I am fully authorized to execute this document and that all the information provided herein is true and correct.

Section 3 Count-Based on the worker section 3 documents please answer the following questions.

The undersigned declares that the above information is complete and correct.