INCOME VERIFICATION FORM

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The following questions are REQUIRED by grantors that support CDAIDE. Your answers are confidential.

Family Information

Other Adults in Household

 

Please check the box for each adult you will be adding and the data entry fields will appear below.

Income Data

Income is defined as the total of all the adult household members’ gross income that is anticipated to be received during the coming 12-month period. Income includes things such as wages, tips, social security payments, alimony, child support, and the income generated by an asset such as bank accounts or a 401(k).

NOTE: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.

Thanks for submitting!

If you plan to meet in person with any CDAIDE staff member or volunteer, please complete our COVID waiver.