Form Hud-40094 - Rental/homebuyer/homeowner Rehab Set-Up Report Page 2
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5Part C: Household Characteristics Complete one line for each unit assisted with HOME funds. Enter one code only in each block. If
the activity is a 1-4 unit owner occupied rental activity, also provide tenant characteristics. For activities which include multiple
addresses, complete a separate Household Characteristics (Part C) for each address. Do not complete for new construction activities.
Activity Address
Activity Number
Unit
No. of
Occupancy
Tenant
Subsidy
Total Rent
% of
Hisp
Race of
Size of
Head of
Rental
No.
Bedrooms
Contribution
Amount
Area
Head of
Household
Household
Assistance
Median
Household
(1 to 8)
No. of Bedrooms Code
% of Area Median Code
Race of Head of Household Code
Head of Household Code
1 – 1 Bedroom
1 – 0 – 30%
11 – White
1 – Single/non-Elderly
2 – 2 Bedrooms
2 – 30 – 50%
12 – Black or African American
2 - Elderly
3 – 3 Bedrooms
3 – 50 – 60%
13 – Asian
3 – Related/Single Parent
4 – 4 Bedrooms
4 – 60 – 80%
14 – American Indian or Alaska Native
4 – Related/Parent
5 – 5 or more Bedrooms
15 – Native Hawaiian or Other Pacific Islander
5 - Other
Hispanic
16 – American Indian/Alaska Native & White
Occupancy Code
y – yes
17 – Asian & White
Rental Assistance Code
1 – Tenant
n – no
18 – Black or African American & White
1 – Section 8
2 – Owner
19 – American Indian or Alaska Native &
2 – HOME TBRA
9 – Vacant
Black or African American
3 – Other
20 – Other Multi Racial
4 – No Assistance
Page 2 of 5
form HUD-40094 (02/2003)
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