Spreadsheet: b1df8d87-6f6e-48fa-a761-8acd9e6f3b74
Sheet: Property Information

SPECIAL MULTIFAMILY OCCUPANCY REPORT
COMPLETE INFORMATION REQUESTED BELOW FOR THE PROPERTY.
AFTER COMPLETING THE GENERAL PROPERTY INFORMATION USE THE "BUILDING-UNIT" WORKSHEETS TO ENTER INFORMATION ON ALL RENTAL UNITS FOR EACH BUILDING.                                                                                                                                                                                                                                                                                                                     USE A SEPARATE "Building-Unit" WORKSHEET FOR EACH BUILDING. For Properties with more than 10 buildings use additonal worksheets.
PROPERTY NAME |  | PROPERTY ADDRESS |  | CITY | STATE ABBREVIATION (Required) | ZIP CODE | HUD IDENTIFICATION NUMBER                                 (Enter identification number if applicable) |  | OTHER IDENTIFICATION NUMBER                               (Enter identification number if applicable)
 |  |  |  |  |  |  | HUD/FHA ID Number | REMS ID Number | LIHTC TCAA ID Number | Other
HUD CONTRACT NUMBER (s)                                      (Enter Subsidy Contract Identification Number or Development Code if applicable) |  | PROPERTY ADDRESS                                                      (Enter address for contact if different than above) |  | CONTRACT EXPIRATION DATE
ANSWER QUESTIONS BELOW TO DETERMINE IF PROPERTY IS ELIGIBLE FOR SELF CERTIFICATION |  |  |  | Enter                  YES or NO
[NAME]: Does the property maintain certified annual income records for all rental units  pursuant to federal requirements?
[NAME]: Are all of the certified annual income records for the rental units at the property less  than one-year old?
[NAME]: Has the property owner completed a review of all household income records and determined that 66% or more of the units ineach building at the property meet DOE income qualifications? (50% for buildings with 4 units or less.)
[NAME]: If the property received Low Income Housing Tax Credits, is the property currently in compliance with IRS requirements? (If the property has been determined to be in noncompliance with IRS regulations by the designated state housing finance agency enter NO)
TABLE OF APPLICABLE DOE INCOME ELIGIBLE THRESHOLD                                                                                       2011 HHS Federal Poverty Guidelines or other specified by State                                                                                                                                              (No data entry required on table) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2011 HHS POVERTY GUIDELINES* (200 %)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Contiguous 48 States |  |  | Alaska |  |  | Hawaii |  |  | California
[NAME] |  | 200% Federal Poverty Level
1 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 21780 |  | 1 | 27200 |  | 1 | 25080 |  | 1 | 29791.32
2 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2 | 29420 |  | 2 | 36760 |  | 2 | 33860 |  | 2 | 38957.88
3 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 3 | 37060 |  | 3 | 46320 |  | 3 | 42640 |  | 3 | 48124.44
4 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 | 44700 |  | 4 | 55880 |  | 4 | 51420 |  | 4 | 57291
5 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 5 | 52340 |  | 5 | 65440 |  | 5 | 60200 |  | 5 | 66457.56
6 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 6 | 59980 |  | 6 | 75000 |  | 6 | 68980 |  | 6 | 75624.12
7 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 7 | 67620 |  | 7 | 84560 |  | 7 | 77760 |  | 7 | 77342.85
8 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 8 | 75260 |  | 8 | 94120 |  | 8 | 86540 |  | 8 | 79061.58
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Additional person: |  |  | 3820 |  |  | 4780 |  |  | 4390
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | HUD MAY REQUIRE ADDITIONAL INFORMATION TO DETERMINE ELIGIBILITY. PLEASE COMPLETE FORM AND WORKSHEET AND SUBMIT TO [EMAIL].
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PROCEED TO BUILDING INFORMATION WORKSHEET AND ENTER INFORMATION ON EACH UNIT. COMPLETE SEPARATE WORKSHEET FOR EACH BUILDING.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | MEETS DOE INCOME REQUIREMENTS
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | BUILDING DOES NOT MEET INCOME REQUIREMENTS
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | * [Federal Register: January 20, 2011 (Volume 76, Number 13)] [Page 3637-3638]
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [Notices]