HUD INTERIM RECERTIFICATION CHECKLIST

HUD INTERIM RECERTIFICATION CHECKLIST

PROPERTY: UNIT: TENANT: EFFECTIVE DATE: REASON FOR RECERTIFCATION: CHANGE IN INCOME_____

CHANGE IN FAMILY COMPOSTION_____

Documents Needed for Adding Household Member If adding an adult, use HUD Move-In checklist Race and Ethnic Data Reporting Form Verification of Birth (Copy of Birth Certificate or Driver's License) Verification of Social Security Number (Copy of Social Security Card or other legal document) Supporting Verifications (All must be third party verified.) Income Sources:______________________________________________________________________________ Assets:______________________________________________________________________________________ Child/Day Care Expense: (If Applicable)____________________________________________________________ Medical Expense: (If Applicable)__________________________________________________________________

CEPCO Management, Inc. is an equal opportunity provider and employer PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343 * Phone 952-935-0359 * Fax 952-935-9612

Rev. 4/2012

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