Many household members get Social Security, Supplemental Security Income (SSI), or other government benefits. To certify and recertify households correctly, you must count these benefits as part of a household’s income and verify the amounts with the appropriate government agency [HUD Handbook 4350.3, par. 5-12(A)(1). Your state housing agency might let you accept the “award letter” the household gets from the government agency as proof of the household member’s benefits. If not, then the best way to verify this information is to send a form directly to the appropriate government source. But the HUD Handbook and most state housing agencies don’t offer a form for this purpose. To help you, we’ve provided a Model Form: Benefit Verification and Consent Form, below, that you can use at your tax credit site. Here’s a rundown on how the form works.

How to Use Form

Start by making photocopies of our form so you have a good supply on hand. Keep them in a separate folder that’s easily accessible.

Use a new form each time you need to ask a government agency to verify a household member’s benefit income information. Identify the household member at the top of the form. Then have the member consent to the release of her benefit information by signing at the bottom of the form. Household members are required to cooperate by signing consent forms that help you verify income information [Handbook 4350.3, par. 5-12(A)(3).

Next, mail the form or scan and email the form to the appropriate government agency. A source at the agency should complete the form by providing information about the member’s benefit income, and then return the form to you at the address or email you provide. After you get the form back, keep it in the household’s file. This way, you and other staff members can easily find the information you need, and your state housing agency will see that you properly verified benefit income information.

It may be a good idea to keep a copy of the partially completed form before you send it to the government agency, in case the source calls you with a question and you need to refer to the form.

How to Complete Form

Here’s how to complete the form:

Identify household. Fill in the household member’s name and Social Security number, and the building and unit numbers.

Explain type and amount of government benefits. The form asks the source to indicate the type of benefit the household member gets. It also asks the source to give the total amount of the benefit, including the breakdown of the gross federal and state amounts. Because the HUD Handbook requires you to calculate the amount of income a household expects to earn over the next 12 months, the form asks the source to indicate whether the benefit amount is expected to change over this period. If any further explanation is needed, the source can provide this information in the space labeled “Notes.”

Identify government agency source. The form asks the government agency source to write her name, title, and agency’s name. It also asks the source to list her phone number so you can contact her directly with any follow-up questions.

Have source sign and date form. The form asks the source to sign the form and write in the date. This way, any staff member or auditor who reviews the form will see that you verified the income information with a proper government agency source and within the time frame your state housing agency requires—usually no more than 90 or 120 days prior to the household’s certification date.

Give your email or address. Provide your email or the address of your management office or other location where you want the source to return the completed form.