SECTION 3 WORKER CERTIFICATION FORM

SECTION 3 WORKER CERTIFICATION FORM
Section 3 Worker is a public housing resident or a low - or very low - income person who lives in the City/County of Sacramento and who has an individual income that does not exceed HUD's income limits for family size, as described below.
Any current employee, potential new hire, i.e. Section 3 Worker claiming eligibility must complete this form in order to comply with Section 3 reporting requirements of the Housing and Urban Development Act of 1968.
Name:
Address:

Street Address Line 2

CityState / Province

Postal / Zip Code
Public Housing Site of Residence:
Phone Number:
Format: (000) 000-0000.
Check all that apply:

Other
Email Address:
Registered apprentice: (Attach the Department of Labor Issued Apprentice Certificate)

If yes, what level:
PART II: INCOME INFORMATION (to be completed by the eligible Section 3 Worker)
Find the column that corresponds to the number of people in your household. If your individual annual income is within or below the range shown for the number of people in your household, you qualify as a Section 3 Worker. Circle the column accordingly. The Agency's public housing, Section 8 (HCV) and YouthBuild residents qualify as Section 3 Workers regardless of if they meet the below income requirements.
Income Limits 2025 (If applies to you)
Employee Worker Signature:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Section 3 (Sacramento)
Should be Empty: