Zero Income Checklist
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.
1. Food Expenses
Note: Food contributed by rood banks, received from the surplus commodity program, the wIc program, or consumed at publicly or non-profit funded meal programs does not count as income. Food or cash for food contributed by private persons does count as income.
Verification: The family should bring in at least one month’s worth of grocery receipts. Check the receipts to make sure a family of that size could manage on the amount of rood documented.
2. Cleaning, Grooming, and Paper Products Expenses
Verification: Most families buy cleaning supplies, grooming products, and paper products at the grocery store. Review the families grocery receipts to help verify amount spent.
3. Transportation Expenses
If the family owns a car outright (no payments are due), what are the average monthly amounts the family pays for the following:
Verification: The family should bring in one months gas receipts, proof of insurance, and proof of car payment (if applicable).
Note: Uninsured automobiles cannot be parked on PHA property.
4. Entertainment Expenses
What are the average weekly cost of other types of entertainment to the family? Include the following:
Verification: The family should bring in two monthly bills for cable TV, plus receipts for other entertainment costs
5. Clothing Expenses
Note: clothing acquire from clothing banks or given to the family second hand is not counted as income.
Verification: The family should provide a schedule that shows when clothing and shoes are purchased and the amount spent. Remember that children will need more clothing and shoes than adults because they are growing.
6. Smoking Expenses
Verification: The family should document the brand of cigarettes/cigars smoked and staff will document the least expensive price of that brand in the locality to impute cost.
7. Communications Expenses
Verification: The family should bring in at least two month’s worth of bills ror telephone, beeper/2ager, and Internet services, as applicable. Review the bills carefully to determine the average monthly cost for communications services.
8. Shelter Expenses
Verification: Family should bring in documentation for their actual cost for housing and utilities
9. Medical Expenses
10. Pet Expenses
Is the family has a pet, list the monthly expenses for:
11. Miscellaneous Expenses
Listed below are a series of expenses the family might have. Indicate the monthly amount the family spends on any applicable expenses and the amounts contributed toward the expenses:
Review the information provided above against the observations of staff conducting the home visit/home Inspection. Does the information appear to be consistent? If not, Insist that the applicant explain any variations. For example, if the applicant does not admit to having telephone or cable TV service but they have been observed in the home, press the point.