This checklist and worksheet is to be completed for all families whose total tenant payment equal the minimum rent, or, for PHAs without minimum rents, for all families reporting less than $100 per month in total income.The form should be completed prior to admission and at each recertification (which may be monthly or quarterly depending on the PHA's policy on re-examination of tenets with minimum rents or zero income). The form first lists all the cash and non-cash contributions the family is receiving and then assists PHA staff to compute the annual value of such contributions. This form should be completed after the home visit to an applicant or a home inspection of a resident. The family is required to submit documentation of amount claimed.