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73505919v2 <br /> <br /> <br /> B-2-3 <br /> <br />PART VIII. HOUSEHOLD DEMOGRAPHICS <br />Please complete for each household member. See below for Ethnicity, Race, and Other codes that <br />characterize the household composition. <br /> <br />HH <br />Mbr # <br />Sex – <br />enter M or F <br /> <br />Ethnicity <br /> <br />Race <br />Enter up to 5 categories <br />Disabled <br />1 <br /> <br /> <br /> <br /> <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br /> <br />The Minnesota Housing Finance Agency is required to comply with HUD’s reporting requirements; however, <br />you are not required to provide this information. You may not be discriminated against on the basis of this <br />information, or on whether or not you choose to furnish it. If you do not wish to furnish this information, please <br />initial below. <br /> <br />RESIDENT/APPLICANT: I do not wish to furnish information regarding ethnicity, race, sex, and disability status. <br />(Initials) __________ <br /> <br /> <br />Ethnicity: Enter each household member’s ethnicity by using one of <br />the following coded definitions: <br />1. Hispanic or Latino <br />2. Not Hispanic or Latino <br />3. Tenant did not respond <br />Race: Enter each household member’s race by using, at least one, <br />of the following coded definitions (up to 5 categories may <br />be selected): <br /> <br />1. White <br />2. Black/African American <br />3. American Indian/Alaska Native <br />4. Select from the following: <br />4a Asian India <br />4b Chinese <br />4c Filipino <br />4d Japanese <br />4e Korean <br />4f Vietnamese <br />4g Other Asian <br />5. Select from the following: <br />5a Native Hawaiian <br />5b Guamanian or Chamorro <br />5c Samoan <br />5d Other Pacific Islander <br />6. Other <br />7. Tenant did not respond <br />