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73505919v2 <br /> <br /> <br /> B-1-3 <br /> <br />PART V. DETERMINATION OF INCOME ELIGIBILITY <br /> <br /> TOTAL ANNUAL HOUSEHOLD <br /> INCOME FROM ALL SOURCES <br /> From Item (L) on page 1 <br /> <br /> <br /> Current Maximum Income <br /> Limit per Family Size: <br /> Household Income at Move-in <br /> <br />Household Meets <br />Income Restriction <br />at: <br /> 60% 50% <br /> 40% 30% <br /> _________ <br />Current Income Limit x 140% <br /> <br />____________________________ <br />Household income exceeds 140% at <br />recertification: <br /> Yes No <br /> <br />PART VI. RENT <br /> <br />Tenant Paid Rent _________________ <br />Utility Allowance _________________ <br /> <br />GROSS RENT FOR UNIT: <br />(Tenant paid rent plus Utility <br />Allowance & other non-optional <br />Charges) <br /> <br />Maximum Rent Limit for this unit: ______________ <br /> <br />Rent Assistance: RA Type <br />Other non-optional charges: ________________ <br /> <br />Unit Meets Rent Restriction at: <br /> <br /> 60% 50% 40% <br /> <br /> 30% _______ <br /> <br />PART VII. STUDENT STATUS <br />ARE ALL OCCUPANTS FULL-TIME <br />STUDENTS? <br /> <br />If yes, choose a student explanation*(also attach <br />documentation) <br /> Yes No <br />*Student Explanation <br /> Previously in Foster Care <br /> TANF assistance Single parent/ <br /> dependent child <br /> Job Training Program Married/joint return <br /> <br /> <br /> <br /> <br />