Form Hud-40201 - Instructions For Completing Part 13 Housing Resident Worksheet

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Instructions for Completing Part 13
Housing Resident Worksheet
This form must be completed on all Youthbuild properties completed and occupied during
8. Race of Head of Household. Use the key presented below the table. Enter one
number only based on the following definitions:
the 30 month grant period. Retain this worksheet for your files.
Address, City, State and Zip Code.
Enter the full address of the property where
(1) White, not Hispanic Origin. A person having origins in any of the original peoples
Youthbuild on-site training and work took place.
of Europe, North America, or the Middle East, but not of Hispanic origin.
(2) Black, not Hispanic Origin. A person having origins in any of the black racial groups
Total Number of Units. Enter the total number of residential units for the property.
of Africa, but not of Hispanic origin.
Characteristics of Property and Occupants. Provide a brief description of the property
(3) Native American. A person having origins in any of the original peoples of the North
as well as any occupants. Complete items 1 - 11 for each residential unit contained in the
American Continent, and who maintains cultural identification through tribal affiliations or
property.
community recognition.
1. Unit Number. Enter the unit number, if applicable, for the unit.
(4) Asian or Pacific Islander. A person having origins in any of the peoples of the Far
2. Number of Bedrooms. Enter the number of bedrooms.
East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes,
If the unit is an Efficiency, enter "0".
for example, China, India, Japan, Korea, the Philippines Islands, and Samoa.
3. Type. Enter "T" for Transitional; "O" for Homeownership; or "R" for Residential rental.
(5) Hispanic. A person of Mexican, Puerto Rican, Cuban, Central or South American
or other Spanish culture or origin, regardless of race.
4. Previously Homeless. Enter "Yes" if the occupant was previously homeless.
9. Size of Household. Enter the number of persons in the household.
5. Total Rent. Enter the total of the Tenant’s monthly rent including any rental assistance
such as Section 8.
10. Type of Household. Enter one number based on the following definitions:
6. Monthly Gross Income. Enter the monthly gross household income.
(1) Single/Non-Elderly. One person household in which the person is not elderly.
7. Percent of Median Income. Enter one number based on the following definitions:
(2) Elderly. One or two person households containing a person at least 62 years of age.
(1) 0 - 30 Percent of Area Median means a household whose adjusted income is at or
(3) Related/Single Parent. A single parent household with dependent minor (18 or
below 30% of the median family income for the area, as determined by HUD with
under) children.
adjustments for smaller and larger families.
(4) Related/Two Parents. A two parent household with dependent (18 or under)
(2) 31 - 50 Percent of Area Median means a household whose adjusted income exceeds
children.
30% and does not exceed 50% of the median family income for the area, as determined
by HUD with adjustments for smaller and larger families.
(5) Other. Any household that is not included in the above 4 definitions, including two
or more unrelated individuals.
(3) 51 - 60 Percent of Area Median means a household whose adjusted income exceeds
11. Rental Assistance. Use the key presented below the table. Enter one number based
51% and does not exceed 60% of the median family income for the area, as determined
on the following definitions:
by HUD with adjustments for smaller and larger families.
(1) Tenant receives Section 8 assistance.
(4) 61 - 80 Percent of Area Median means a household whose adjusted income exceeds
61% and does not exceed 80% of the median family income for the area, as determined
(2) Tenant receives HOME Tenant-Based Assistance.
by HUD with adjustments for smaller and larger families.
(3) Tenant receives other assistance.
(5) Above 80% of the area median means a household whose adjusted income exceeds
80% of the median family income for the area, as determined by HUD with adjustments for
(4) Tenant receives no assistance.
smaller and larger families.
Previous editions are obsolete
form HUD-40201 (7/97)

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