Zero Income Statement

You should only complete this form if you have been contacted by your certification specialist and asked to do so and someone in your household currently has no income. If you are receiving an error when trying to submit your form, try a different browser (Google Chrome, Firefox, etc.) or using a different computer/device.

 

If NO, please stop and do not complete this form until it is requested by an AMHA staff person.

 
 

Please select the development in which you live. If you are not on this program type, select "None of the properties listed."

 
 
 
 

First and Last Name of person in household reporting zero income.

 
 
 

 

Type in $ per month.

 
 
 
 

 
 
 
 
 

 

Participant Certifications

Please review each statement and choose "Yes" that you have read and understand the statement. If you have any questions regarding the certifications, please contact your certification specialist.

 
 
 

MUST be for the person reporting zero income.

 

If no, please re-type your name on the Electronic Signature line.