Form 56 - Income Certification Form Categorical Projects (Page 2 of 2) in pdf

Form 56 - Income Certification Form Categorical Projects Page 2

Income Certification Form

An “Income Certification Form” must be completed on each and every person applying for a

job that results from the project, funded in whole or part, with ACEDP Economic Development

Set-Aside funds. For all jobs created, at least 51 percent of all positions must be either filled by

or made available to persons who qualify as low or moderate income at the time they are hired

by the company. The Grantee or the referring agency must maintain this documentation to verify

the low and moderate income status of all persons benefiting from the project funded with

ACEDP funds.

SECTION I

Identifying Information: Complete all blanks identifying the business and applicant as

requested.

SECTION II

Column A: How many persons are in the applicant’s family? Circle the appropriate

number based on the response of the applicant.

Column B:

List the income limits by family size, which are provided in the grant

agreement, in the appropriate lines of this column.

Column C: Check either the above or below box in this column based in the response of the

applicant.

In the certifying statement, type the name and Social Security number of the applicant in the

spaces provided. Have the applicant sign the form.

SECTION III

The demographic information listed in this section is information requested by HUD. Check

all the spaces that apply based on applicant responses.

Form 56 – Page 2

June 2007

Form 56 - Income Certification Form Categorical Projects Page 2