Pbv Application Packet - Housing Authority Of Snohomish County Page 14
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38E. DEDUCTIONS
1. Do you pay out of pocket for childcare for any family member under 13 years old?
If yes, please complete the table below: You must provide supporting documentation.
Name of Child
Name, Address & Phone of Childcare Provider
Amount of Payment
$
$
$
2. Is any family member 18 or older attending college? You must provide supporting documentation.
Full/Part-
Family Member Name
Name and Address of School
School Phone Number
time?
3. Are you, your spouse / co-head 62 years or older?
Yes
No
4. Are you, your spouse / co-head disabled? “Disabled” is defined by HUD as “any Person
who has a physical or mental impairment that substantially limits one or more major life
Yes
No
activities; has a record of such impairment; or is regarded as having such an impairment.”
IF YOU ANSWERED “NO” TO BOTH QUESTIONS, PLEASE SKIP TO SECTION F
If yes, please complete the table below:
Family Member Name
Name and Address of Doctor or Diagnostician
5
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