The
following list of HOME forms and checklists available through this
module is organized by the subject area in which the form would
be used.
This
index is most useful to individuals who know the type of program
or activity for which they are seeking helpful forms.
The
description of each form in the list below is made up of the following
components:
- The
name of the form;
- A
brief description of the use of the form;
- A
link to information relevant to the use of the form; and
- Links
that allow the form to be viewed, printed, and/or downloaded in
Adobe PDF or TEXT Formats.
ADMINISTRATION
Annual
Performance Report (HUD-40107)
This
form is used to meet the data collection and reporting requirements
of the HOME statute. It collects information on program income,
as well as Minority Business Enterprises and Women Business Enterprises,
to be aggregated nationally. This form should be completed by the
PJ and submitted to HUD before December 31 of each year. In order
to ensure that you view, print, and/or download the most recent
version of this form, use the link below to go to the forms portion
of HUD Clips where you will have access to this HUD form and other
official forms.
Application
for Federal Assistance (SF-424)
This
form is used by applicants as a required face sheet for pre-applications
and applications submitted for Federal assistance, including HOME
funds. The form accompanies the annual Action Plan submitted to
HUD by each PJ. (The Action Plan is an annual update of the PJs
Consolidated
Plan describing the specific planned uses of the covered HUD
programs, including HOME, as well as other program requirements.)
In order to ensure that you view, print, and/or download the most
recent version of this form, use the link below to go to the forms
portion of HUD Clips where you will have access to this Standard
Form and other official forms.
Consolidated
Plan
The Consolidated Plan is a plan of up to five years in length
that is submitted to HUD by each PJ in order to describe the communitys
needs, resources, priorities, and proposed activities to be undertaken
with the HOME, Community Development Block Grant, Emergency Shelter
Grant, and Housing Opportunities for Persons with AIDs Programs.
For more information about the Consolidated Plan, use the link below
to go to HUDs Consolidated Planning web site.
Funding
Approval and HOME Investment Partnership Agreement (HUD-40093)
This form is an agreement between HUD and the PJ that identifies
the previous HOME obligation, the current transaction, and the revised
HOME obligation. It outlines the provisions by which HUD will make
the funds available to the PJ upon execution of the form by both
parties. A copy of this form should be maintained by the PJ. In
order to ensure that you view, print, and/or download the most recent
version of this form, use the link below to go to the forms portion
of HUD Clips where you will have access to this HUD form and other
official forms.
HOME
Match Report (HUD-40107-A)
This form is completed by the PJ to report match contributions
for the past Federal fiscal year. It should be submitted to HUD
before December 31 of each year as part of the Annual Performance
Report. A PJ may not be required to submit this report, either because
it did not incur any match or because it had a full match reduction,
but may submit a HOME Match Report if it wishes. For more information
about the use of this form, click here to learn about HOME
match. In order to ensure that you view, print, and/or download
the most recent version of this form, use the link below to go to
the forms portion of HUD Clips where you will have access to this
HUD form and other official forms.
Match
Log - PDF
- Word
This form is a spreadsheet used to track HOME expenditures,
the amount of match liability incurred, and the value of match contributions
on an ongoing basis. For information about the use of this form,
click here to learn about HOME
match.
HOMEOWNER REHABILITATION
Bid
Form - PDF
- Word
This form is completed by the contractor as an official bid
to perform the work described in a Housing Quality Standards (HQS)
Inspection Form. The contractor is asked to provide a cost estimate
and time frame for the work to be completed. This form should be
placed in the project file by the PJ. For more information about
the use of this form, click here to learn about homeowner
rehabilitation.
Certificate
and Release - PDF
- Word
This form is completed by the contractor following the completion
of work to certify that the work was performed in accordance with
the contract and to receive final payment(s). A copy of this form
should be placed in the project file by the PJ. For more information
about the use of this form, click here to learn about homeowner
rehabilitation.
Certificate
of Final Inspection - PDF
- Word
This form is completed by the PJ to document that the work on
the identified property was performed in accordance with the property
evaluation form and the approved contractors proposal for
the case. This form should be placed in the project file by the
PJ. For more information about the use of this form, click here
to learn about homeowner rehabilitation.
Change
Order - PDF
- Word
This form is completed by the homeowner and contractor to authorize
change(s) to the original rehabilitation contract. A copy of this
form should be placed in the project file by the PJ. For more information
about the use of this form, click here to learn about homeowner
rehabilitation.
Contractors
Data Sheet - PDF
- Word
This form is completed by the contractor to provide essential
information to the PJ and homeowner regarding the corporation and
its business references, recent customers, and creditors. This form
should be placed in the project file by the PJ. For more information
about the use of this form, click here to learn about homeowner
rehabilitation.
Contractor
Instructions - PDF
- Word
This form is provided by the PJ to the contractor in order to
provide written instructions on submitting a complete bid package
to the homeowner. For more information about the use of this form,
click here to learn about homeowner rehabilitation.
Contractor
Payment Request - PDF
- Word
This is a form completed by the contractor to request payment
for his/her work. It must be signed by the homeowner and the PJs
construction advisor before any payment is released to the contractor.
This form should be placed in the project file by the PJ. For more
information about the use of this form, click here to learn about
homeowner rehabilitation.
Contractors
Proposal Form - PDF
- Word
This form is completed by the contractor to specify the work
to be performed and the bid price for each work specification. It
is based upon the Housing Quality Standards (HQS) Inspection Form.
This form should be placed in the project file by the PJ. For more
information about the use of this form, click here to learn about
homeowner rehabilitation.
Homeowner/Contractor
Provisions - PDF
- Word
This form provides sample language for provisions that should
be included in the contract between the homeowner and the contractor.
For more information about the use of this form, click here to learn
about homeowner rehabilitation.
Housing
Quality Standards (HQS) Inspection Form - PDF
- Word
This is a checklist that can be used to ensure that a property
meets HUDs Housing Quality Standards. The use of HQS is required
for HOME tenant-based rental assistance only, but a PJ may choose
to use HQS as its property standard. For more information about
the use of this checklist, click here to learn about property
standards.
Rehabilitation
Tracking Sheet - PDF
- Word
This checklist is used to document completion of HOME requirements
related to presettlement activities, construction and close-out,
and loan settlement. It should be completed by the PJ and placed
in the project file. For more information about the use of this
form, click here to learn about homeowner rehabilitation.
Verification
of Mortgage or Deed of Trust - PDF
- Word
This form gives authorization for the HOME PJ to verify the
status of existing mortgages for all the members of the household
applying for participation in the HOME Program. For more information
about the use of this form, click here to learn about homeowner
rehabilitation.
INCOME DETERMINATION
IRS
Forms
In order to provide the most up to date forms possible, the
HOME Front is providing a link to the IRS web site where you
can download any IRS Form and its relevant instructions. For more
information about the use of this form, click here to learn about
the IRS
Form 1040 definition of annual income.
Program
Eligibility Release Form - PDF
- Word
This form gives authorization for the named organization to
obtain information from a third party relative to his/her eligibility
in a HOME TBRA, homebuyer, rental rehabilitation, or homeowner rehabilitation
program. It may also be used to determine continued eligibility
or rent charged in a HOME TBRA program or HOME-assisted rental housing.
For more information about the use of this form, click here to learn
about verifying
income.
Recertification
of Annual Income by Government Programs - PDF
- Word
This form is used to certify the amount of funding a household
receives through a government program. A government administrator
completes this form for the PJ to use when recertifying the income
of rental housing tenants. For more information about the
use of this form, click here to learn about income
recertification for rental housing tenants.
Recertification
of Annual Income by Tenant Family - PDF
- Word
This form is completed by the tenant family to certify the household
size and annual income. The tenant family returns this form to the
PJ for use when recertifying the income of rental housing tenants.
For more information about the use of this form, click here to learn
about income recertification for rental housing tenants.
Sample
Format for Calculating Adjusted Income - PDF
- Word
This form provides a format that can be used to calculate adjusted
income for HOME Program purposes. For more information about the
use of this form, click here to learn about calculating
adjusted income.
Sample
Format for Calculating Part 5 Annual Income - PDF
- Word
This form provides a format that can be used to assess assets
and anticipated income and calculate Part 5 annual income. For more
information about the use of this form, click here to learn about
the Part
5 definition of annual income.
Sample
Format for Computing Census Long Form Annual Income - PDF
- Word
This form provides a format that can be used to assess and compute
the anticipated annual income defined by the Census Long Form. For
more information about the use of this form, click here to learn
about the Census
Long Form definition of annual income.
Sample
Format for Computing IRS Form 1040 Series Adjusted Gross Income
- PDF
- Word
This form provides a format that can be used to compute the
IRS Form 1040 series adjusted gross income. For more information
about the use of this form, click here to learn about the IRS
Form 1040 definition of annual income.
Sample
Format for Computing Total Tenant Payment and PJ Subsidy: Rental
Certificate Model - PDF
- Word
This form provides a format that can be used to compute the
total payment and PJ subsidy for a rental certificate model. This
form is used with the Sample Format for Calculating Part 5 Adjusted
Income. For more information about the use of this form, click here
to learn about calculating
assistance amounts.
Sample
Format for Computing Total Tenant Payment and PJ Subsidy: Rental
Voucher Model - PDF
- Word
This form provides a format that can be used to compute the
total payment and PJ subsidy for a rental voucher model. This form
is used with the Sample Format for Calculating Part 5 Adjusted Income.
For more information about the use of this form, click here to learn
about calculating
assistance amounts.
Verification
of Alimony and Separation - PDF
- Word
This form gives authorization for the HOME PJ to verify alimony
and separation payments made to all members of the household applying
for participation in the HOME Program. For more information about
the use of this form, click here to learn about verifying
income.
Verification
of Assets on Deposit - PDF
- Word
This
form gives authorization for the HOME PJ to verify assets on deposit
for all members of the household applying for participation in the
HOME Program. For more information about the use of this form, click
here to learn about verifying
income.
Verification
of Child Support Payments - PDF
- Word
This form gives authorization for the HOME PJ to verify child
support payments made to all members of the household applying for
participation in the HOME Program on all or none. For more information
about the use of this form, click here to learn about verifying
income.
Verification
of Employment - PDF
- Word
This form gives authorization for the HOME PJ to verify employment
income of all the members of the household applying for participation
in the HOME Program. For more information about the use of this
form, click here to learn about verifying
income.
Verification
of Income from Military - PDF
- Word
This form gives authorization for the HOME PJ to verify military
service income of all the members of the household applying for
participation in the HOME Program. For more information about the
use of this form, click here to learn about verifying income.
Verification
of Income from Business - PDF
- Word
This form gives authorization for the HOME PJ to verify business
income of all the members of the household applying for participation
in the HOME Program. For more information about the use of this
form, click here to learn about verifying
income.
Verification
of Pensions and Annuities - PDF
- Word
This form gives authorization for the HOME PJ to verify pension
and annuity income of all the members of the household applying
for participation in the HOME Program. For more information about
the use of this form, click here to learn about verifying income.
Verification
of Public Assistance Program - PDF
- Word
This form gives authorization for the HOME PJ to verify public
assistance income for all the members of the household applying
for participation in the HOME Program. For more information about
the use of this form, click here to learn about verifying
income.
Verification
of Recurring Cash Contributions - PDF
- Word
This form gives authorization for the HOME PJ to verify recurring
cash contributions made to all members of the household applying
for participation in the HOME Program. For more information about
the use of this form, click here to learn about verifying income.
Verification
of Social Security Benefits - PDF
- Word
This form gives authorization for the HOME PJ to verify Social
Security benefit income for all the members of the household applying
for participation in the HOME Program. For more information about
the use of this form, click here to learn about verifying
income.
Verification
of Unemployment Benefits - PDF
- Word
This form gives authorization for the HOME PJ to verify information
about unemployment benefits income for all members of the household
applying for participation in the HOME Program. For more information
about the use of this form, click here to learn about verifying
income.
Verification
of Veterans Administrative Benefits - PDF
- Word
This form gives authorization for the HOME PJ to verify Veterans
Administrative Benefits income for all the members of the household
applying for participation in the HOME Program. For more information
about the use of this form, click here to learn about verifying
income.
RENTAL HOUSING
Affirmative
Marketing, Tenant Selection, and Lease Compliance Checklist - PDF
- Word
This checklist is used to document compliance with HOME requirements
related to affirmative marketing, tenant selection, and lease compliance.
It should be completed by the PJ and placed in the project file.
For more information about the use of this form, click here to learn
about rental
housing.
Housing
Quality Standards (HQS) Inspection Form - PDF
- Word
This is a checklist that can be used to ensure that a property
meets HUDs Housing Quality Standards. The use of HQS is required
for HOME tenant-based rental assistance only, but a PJ may choose
to use HQS as its property standard. For more information about
the use of this checklist, click here to learn about property
standards.
Rent
Determination Chart 1 Low and High HOME Rents - PDF
- Word
This form is completed by the PJ and given to the owner/manager
of HOME-assisted rental housing in order to inform them of the current
fair market rents with 50% and 65% rent limits as provided by HUD.
For more information about the use of this form, click here to learn
about HOME
rent limits.
Rent
Determination Chart 2 Utility Allowance - PDF
- Word
This form is used to determine the allowance for tenant-furnished
utilities and other services. This form can be completed by the
PJ and given to the owner/manager of HOME-assisted rental housing,
or the owner/manager can complete it and submit it to the PJ for
approval. For more information about the use of this form, click
here to learn about HOME rent limits.
Rent
Determination Chart 3 Actual Maximum Rent Computation - PDF
- Word
This form is completed by the PJ and given to the owner/manager
of HOME-assisted rental housing as a tool to calculate the actual
maximum rent. For more information about the use of this form, click
here to learn about HOME
rent limits.
Rental
Housing Income Limits - PDF
- Word
This form is completed by the PJ and given to the owner/manager
in order to provide information about the income level per household
size that is eligible for the HOME program. For more information
about the use of this form, click here to learn about rental
housing income limits.
Rental
Project Compliance Report - PDF
- Word
This form is completed by the PJ and kept in the project file
to ensure that the project has met all the compliance requirements
for the HOME Program. For more information about the use of this
form, click here to learn about rental
housing.
TENANT BASED RENTAL ASSISTANCE
Housing
Quality Standards (HQS) Inspection Form - PDF
- Word
This is a checklist that can be used to ensure that a property
meets HUDs Housing Quality Standards. The use of HQS is required
for HOME tenant-based rental assistance only, but a PJ may choose
to use HQS as its property standard. For more information about
the use of this checklist, click here to learn about property
standards.
Lease
Addendum - PDF
- Word
This form is used as an addendum to a lease to include the provisions
necessary as a result of the tenants participation in a HOME
rental assistance program. For more information about the use of
this form, click here to learn about tenant-based
rental assistance.
Rent
Reasonableness Checklist and Certification - PDF
- Word
This form is used as a checklist to ensure rent reasonableness
in cases where HOME funds are used to provide rental assistance.
For more information about the use of this form, click here to learn
more about rent
reasonableness.
Rental
Assistance Contract - PDF
- Word
This form is a tenant-based rental assistance contract that
can be entered into by a participating jurisdiction and a landlord
to ensure compliance with relevant HOME and other federal requirements.
For more information about the use of this form, click here to learn
more about tenant-based
rental assistance.
Rental
Assistance Coupon - PDF
- Word
This coupon is issued by the program administrator to the tenant
who is eligible to participate in a HOME rental assistance program.
This document assumes that the payment will go to the landlord on
behalf of an eligible tenant. For more information about the use
of this form, click here to learn about tenant-based rental assistance.
Request
for Unit Approval - PDF
- Word
This form is completed by the tenant and the landlord to request
the program administrator's approval of the unit for which the tenant
has elected to receive rental assistance. For more information about
the use of this form, click here to learn about approving
TBRA units.
TBRA
Applications for Rental Assistance - PDF
- Word
These forms provide sample formats that can be used as applications
for rental assistance, including a pre-application version and a
full application version. For more information about the use of
these forms, click here to learn about tenant-based
rental assistance.
TBRA
Budget Worksheet PDF
- Word
This form provides a sample worksheet for estimating the costs
and the budget for a project. For more information about the use
of this form, click here to learn about tenant-based
rental assistance.
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