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200109053 Column (D) Enter the annual amount of alimony, child support, unemployment benefits, or any other income regularly received by the household. Row (E) Add the totals from columns (A) through (D), above. Enter this amount. Part IV — Income from Assets See HUD Handbook 4350.3 for complete instructions on verifying and calculating income from assets, including acceptable forms of verification. From the third -party verification forms obtained form each asset source, list the gross amount anticipated to be received during the twelve months from the effective date of the certification. List the respective household member number from Part II and complete a separate line for each member. Column (F) List the type of asset (i.e., checking account, savings account, etc.). Column (G) Enter C (for current, if the family currently owns or holds the asset), or I (for imputed, if the family has disposed of the asset for less than fair market value within two years of the effective date of (re)certification). Column (H) Enter the cash value of the respective asset. Column (I) Enter the anticipated annual income from the asset (i.e., savings account balance multiplied by the annual interest rate). TOTALS Add the total of Column (H) and Column (I), respectively. If the total in Column (H) is greater than $5,000, you must do an imputed calculation of asset income. Enter the Total Cash Value, multiply by 2% and enter the amount in (J), Imputed Income. Row (K) Enter the greater of the total in Column (I) or (J). Row (L) Total Annual Household Income From all Sources. Add (E) and (K) and enter the total. HOUSEHOLD CERTIFICATION AND SIGNATURES After all verifications of income and or assets have been received and calculated, each household member age 18 or older must sign and date the Tenant Income Certification. For move -in, it is recommended that the Tenant Income Certification be signed no earlier than 5 days prior to the effective date of the certification. Total Annual Household Income from all Sources Current Income Limit per Family Size Household income at move -in Household size at move -in Part V — Determination of Income Eligibility Enter the number from item (L). Enter the Current Move -in Income Limit for the household size. For recertification only. Enter the household income from the move -in certification. On the adjacent line, enter the number of household members from the move -in certification. Household Meets Income Check the appropriate box for the income restriction that the household meets Restriction according to what is required by the set - aside(s) for the project. Current Income Limit x 140% For recertifications only. Multiply the Current Maximum Move -in Income Limit by 140% and enter the total. Below, indicate whether the household income exceeds that total. If the Gross Annual Income at recertification is greater than 140% of the current income limit, then the available unit rule must be followed. 01- 351904.01 B -5