This form contains 322 fields organized into 89 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
401K/Keogh/Retirement Accounts Income
Yes Checkbox
Check this box if there is actual income from 401K/Keogh/Retirement Accounts.
No Checkbox
Check this box if there is no actual income from 401K/Keogh/Retirement Accounts.
N/A Checkbox
Check this box if information regarding 401K/Keogh/Retirement Accounts income is not applicable or unavailable.
Actual Income from Assets Comments
Actual Income from Assets Comments Text
Provide any additional comments or details regarding the actual income from assets.
Actual Income from Assets Headers
Income Received Status Header Text
Provide a header for the column indicating whether income was received from assets.
Actual Income Header Text
Provide a header for the column specifying the actual income from assets.
Cash Value Header Text
Provide a header for the column indicating the cash value of assets.
Additional Charges Paid by Tenant
Yes Checkbox
Check this box if additional charges were paid by the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
No Checkbox
Check this box if no additional charges were paid by the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
N/A Checkbox
Check this box if the question about additional charges paid by the tenant is not applicable. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Additional Charges Comment Text
Provide any additional comments regarding charges paid by the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Ages of Occupants Verification
Ages of Occupants Verified: Yes Checkbox
Check this box if the ages of all occupants have been properly verified.
Ages of Occupants Verified: No Checkbox
Check this box if the ages of all occupants have not been properly verified.
Ages of Occupants Verified: N/A Checkbox
Check this box if the verification of occupants' ages is not applicable.
Allowances/Expenses Comments
Allowances and Expenses Comments Text
Provide any additional comments or explanations regarding the allowances and expenses listed in section 11.
Appeal Process and Notification Timeline
Yes Checkbox
Check this box if the appeal was processed and the applicant was notified of the appeal decision within five days of the meeting. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
No Checkbox
Check this box if the appeal was not processed or the applicant was not notified of the appeal decision within five days of the meeting. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
N/A Checkbox
Check this box if an appeal was not made or this question is not applicable to the current situation. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Applicant Rejection Review Comments Text
Provide any additional comments or details regarding the applicant rejection review process and notification timeline. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
Appeal Review Independence
Yes Checkbox
Check this box if the applicant appealed and the appeal was reviewed by someone other than the person who made the original decision. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
No Checkbox
Check this box if the applicant appealed but the appeal was not reviewed by someone other than the person who made the original decision. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
N/A Checkbox
Check this box if the applicant did not appeal, so this question is not applicable. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Appeal Review Independence Comments Text
Provide any additional comments or details regarding the independence of the appeal review process. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
Application Completeness
Yes Checkbox
Check this box if the application is complete, including the date and time received by the owner/agent.
No Checkbox
Check this box if the application is not complete, including the date and time received by the owner/agent.
Application Completeness Comments Text
Provide any additional comments or details regarding the completeness of the application or related household information documents.
Asset Disposal Certification
No314 CheckBox
NA131 CheckBox
ChkBox384 CheckBox
Asset Disposal Details Text
Provide detailed information regarding any assets disposed of by the household during the past two years, as certified.
Assistance Payment Agreement
Yes Checkbox
Check this box if the assistance payment requested on the monthly billing (HUD-52670-A, Part 1) agrees with the assistance payment on the applicable form HUD-50059.
No Checkbox
Check this box if the assistance payment requested on the monthly billing (HUD-52670-A, Part 1) does not agree with the assistance payment on the applicable form HUD-50059.
N/A Checkbox
Check this box if the question regarding the agreement of assistance payments is not applicable.
Assistance Payment Agreement Comments Text
Provide comments regarding whether the assistance payment requested on the monthly billing (HUD-52670-A, Part 1) agrees with the assistance payment on form HUD-50059.
Bedroom Size
0 Bedroom Checkbox
Check this box if the unit has 0 bedrooms (e.g., a studio or efficiency).
1 Bedroom Checkbox
Check this box if the unit has 1 bedroom.
2 Bedroom Checkbox
Check this box if the unit has 2 bedrooms.
3 Bedroom Checkbox
Check this box if the unit has 3 bedrooms.
4 Bedroom Checkbox
Check this box if the unit has 4 bedrooms.
5 or more Bedrooms Checkbox
Check this box if the unit has 5 or more bedrooms.
Certificates of Deposit Income
Certificates of Deposit - Yes Checkbox
Check this box if there is actual income from Certificates of Deposit.
Certificates of Deposit - No Checkbox
Check this box if there is no actual income from Certificates of Deposit.
Certificates of Deposit - N/A Checkbox
Check this box if Certificates of Deposit are not applicable for income assessment.
Certification Signing
Yes Checkbox
Check this box if the certification is signed and dated by the appropriate parties. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
No Checkbox
Check this box if the certification is not signed and dated by the appropriate parties. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Certification Signing Comments Text
Provide any relevant comments regarding whether the certification is signed and dated by the appropriate parties. Fill only if 'No' is 'No'.
Depends on: No
Certification Type
Initial Checkbox
Check this box if the certification type is an initial certification. Fill only if 'Certification/Recertification' is 'Yes'.
Depends on: Certification/Recertification
Annual Checkbox
Check this box if the certification type is an annual certification. Fill only if 'Certification/Recertification' is 'Yes'.
Depends on: Certification/Recertification
Interim Checkbox
Check this box if the certification type is an interim certification. Fill only if 'Certification/Recertification' is 'Yes'.
Depends on: Certification/Recertification
Corrections Checkbox
Check this box if the certification type is for corrections. Fill only if 'Certification/Recertification' is 'Yes'.
Depends on: Certification/Recertification
Other Checkbox
Check this box if the certification type is not initial, annual, interim, or corrections. Fill only if 'Certification/Recertification' is 'Yes'.
Depends on: Certification/Recertification
Checking Account Income
Checking Account - Yes Checkbox
Check this box if there is actual income from the checking account.
Checking Account - No Checkbox
Check this box if there is no actual income from the checking account.
Checking Account - N/A Checkbox
Check this box if income from a checking account is not applicable to this review.
Childcare Expenses
Yes Checkbox
Check this box if childcare expenses are applicable and have been accounted for.
No Checkbox
Check this box if childcare expenses are not applicable or have not been accounted for.
N/A Checkbox
Check this box if information regarding childcare expenses is not available or not applicable in this context.
Clarity of Rejection Reason
Yes Checkbox
Check this box if the reason for rejection was provided in specific terms and plain language. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
No Checkbox
Check this box if the reason for rejection was NOT provided in specific terms and plain language. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
N/A Checkbox
Check this box if this question regarding the clarity of the rejection reason is not applicable. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
Clarity of Rejection Reason Comments Text
Please provide any additional comments or details regarding the clarity and plain language of the rejection reason provided to the applicant. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
Correct Amount
Yes Checkbox
Check this box if the amount is correct. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
No Checkbox
Check this box if the amount is not correct. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
N/A Checkbox
Check this box if the question about the correct amount is not applicable. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Correct Amount Number
Please provide the correct monetary amount. Fill only if 'No' is 'No'.
Depends on: No
Correct Unit Rent Determination
Yes Checkbox
The user should check this box if the correct unit rent is being used for subsidy determination.
No Checkbox
The user should check this box if the correct unit rent is NOT being used for subsidy determination.
Unit Rent Determination Discrepancy Comment Text
Provide a comment detailing any discrepancies identified if the income information on the 50059 does not agree with the verified file information regarding unit rent determination.
Criminal and Drug Screening
Yes Checkbox
Check this box if criminal and drug screening has been performed and documented.
No Checkbox
Check this box if criminal and drug screening has not been performed or documented.
Criminal and Drug Screening Details Text
Provide any additional details or comments regarding the criminal and drug screening results or process. Fill only if 'No' is 'No'.
Depends on: No
Dependent Allowance
Dependent Allowance - Yes Checkbox
Check this box if a dependent allowance is applicable for this tenant.
Dependent Allowance - No Checkbox
Check this box if a dependent allowance is not applicable for this tenant.
Dependent Allowance - N/A Checkbox
Check this box if information regarding a dependent allowance is not available or not applicable for this assessment.
Disability Expenses
Yes Checkbox
Check this box if there are disability expenses to be considered.
No Checkbox
Check this box if there are no disability expenses to be considered.
N/A Checkbox
Check this box if the question regarding disability expenses is not applicable.
Disability Status Verification
Yes Checkbox
Check this box if disability status has been verified.
No Checkbox
Check this box if disability status has not been verified.
N/A Checkbox
Check this box if disability status verification is not applicable.
Discrepancy Documentation Comments
Discrepancy Documentation Comments Text
Provide any comments or additional details regarding the documentation to verify discrepant personal identifiers and/or subsidy paid. Fill only if 'EIV Multiple Subsidy Report Verification No', 'EIV Deceased Tenant Report - No' is 'No', any.
Depends on: EIV Multiple Subsidy Report Verification No, EIV Deceased Tenant Report - No
Effective date of certification(s) reviewed
Effective Date of Certification(s) Reviewed Date
Provide the effective date when the certification(s) were reviewed.
EIV & You Brochure Tenant Receipt
EIV & You Brochure Acknowledged - Yes Checkbox
Check this box if there is an acknowledgement or signed document in the file indicating the tenant received the EIV & You Brochure.
EIV & You Brochure Acknowledged - No Checkbox
Check this box if there is no acknowledgement or signed document in the file indicating the tenant received the EIV & You Brochure.
EIV Deceased Tenant Report Verification
EIV Deceased Tenant Report - Yes Checkbox
Check this box if the file contains documentation to verify the EIV Deceased Tenant Report.
EIV Deceased Tenant Report - No Checkbox
Check this box if the file does not contain documentation to verify the EIV Deceased Tenant Report.
EIV Deceased Tenant Report - N/A Checkbox
Check this box if an EIV Deceased Tenant Report is not applicable or not available for verification.
EIV Existing Tenant Search Results
Yes Checkbox
Check this box if the EIV Existing Tenant Search results are in the file along with contacts made as a result of the search, applicable to move-ins after January 31, 2010. Fill only if 'Move-in Date' is after January 31, 2010.
Depends on: Move-in Date
No Checkbox
Check this box if the EIV Existing Tenant Search results are not in the file or contacts were not made as a result of the search, applicable to move-ins after January 31, 2010. Fill only if 'Move-in Date' is after January 31, 2010.
Depends on: Move-in Date
N/A Checkbox
Check this box if the EIV Existing Tenant Search results are not applicable, such as for move-ins before January 31, 2010. Fill only if 'Move-in Date' is after January 31, 2010.
Depends on: Move-in Date
EIV Existing Tenant Search Results Comments Text
Provide comments regarding whether the EIV Existing Tenant Search results are in the file along with contacts made as a result of the search, applicable to move-ins after January 31, 2010. Fill only if 'Move-in Date' is after January 31, 2010.
Depends on: Move-in Date
EIV Multiple Subsidies Action
Yes Checkbox
Check this box if the tenant file indicates that the owner/agent has taken necessary steps to address any EIV reported receipt of multiple subsidies.
No Checkbox
Check this box if the tenant file does not indicate that the owner/agent has taken necessary steps to address any EIV reported receipt of multiple subsidies.
N/A Checkbox
Check this box if the question regarding necessary steps to address EIV reported receipt of multiple subsidies is not applicable to this tenant file.
Multiple Subsidies Action Details Text
Provide a detailed explanation of the steps taken to address EIV reported multiple subsidies. Fill only if 'No' is 'No'.
Depends on: No
EIV Multiple Subsidy Report Verification
EIV Multiple Subsidy Report Verification Yes Checkbox
Check this box if the file contains documentation to verify discrepant personal identifiers and/or subsidy paid as reported on an EIV Multiple Subsidy report.
EIV Multiple Subsidy Report Verification No Checkbox
Check this box if the file does not contain documentation to verify discrepant personal identifiers and/or subsidy paid as reported on an EIV Multiple Subsidy report.
EIV Multiple Subsidy Report Verification N/A Checkbox
Check this box if an EIV Multiple Subsidy report is not applicable or not relevant for verification.
EIV Summary Report for SSN Validation
EIV Summary Report in file - Yes Checkbox
Check this box if an EIV Summary Report is present in the file to validate SSNs.
EIV Summary Report in file - No Checkbox
Check this box if an EIV Summary Report is not present in the file to validate SSNs.
EIV Summary Report in file - N/A Checkbox
Check this box if the EIV Summary Report is not applicable for validating SSNs.
Elderly/Disabled Household Allowance
Elderly/Disabled Household Allowance - Yes Checkbox
Check this box if the household is eligible for the Elderly/Disabled Household Allowance.
Elderly/Disabled Household Allowance - No Checkbox
Check this box if the household is not eligible for the Elderly/Disabled Household Allowance.
Elderly/Disabled Household Allowance - N/A Checkbox
Check this box if the Elderly/Disabled Household Allowance is not applicable to this household.
Ethnicity and Racial Data Certification
Yes Checkbox
Check this box if the tenant file contains the ethnicity and racial data certification as provided to the owner/agent.
No Checkbox
Check this box if the tenant file does not contain the ethnicity and racial data certification as provided to the owner/agent.
Certification Comments Text
Provide any additional comments regarding the ethnicity and racial data certification for the tenant file.
Exemption from SSN Disclosure
Yes Checkbox
Check this box if an exemption from Social Security Number disclosure applies.
No Checkbox
Check this box if an exemption from Social Security Number disclosure does not apply.
N/A Checkbox
Check this box if the question regarding exemption from Social Security Number disclosure is not applicable.
Expense and Allowance Eligibility
Yes Checkbox
Check this box if all claimed expenses and allowances are eligible under the HUD Handbook 4350.3 REV-1.
No Checkbox
Check this box if not all claimed expenses and allowances are eligible under the HUD Handbook 4350.3 REV-1.
N/A Checkbox
Check this box if the question regarding expense and allowance eligibility is not applicable.
Expense Eligibility Explanation Text
Provide a detailed explanation regarding the eligibility of all claimed expenses and allowances under the HUD Handbook 4350.3 REV-1.
File Inspections
Move-in Inspection Yes Checkbox
Check this box if a move-in inspection, dated and signed by the tenant and owner/agent, is present in the file. Fill only if 'Type of Review' is 'Tenant Move-In'.
Depends on: Tenant Move-In
Move-in Inspection No Checkbox
Check this box if a move-in inspection, dated and signed by the tenant and owner/agent, is not present in the file. Fill only if 'Type of Review' is 'Tenant Move-In'.
Depends on: Tenant Move-In
Annual Unit Inspections Yes Checkbox
Check this box if records of annual unit inspections are present in the file. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Annual Unit Inspections No Checkbox
Check this box if records of annual unit inspections are not present in the file. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Annual Unit Inspections N/A Checkbox
Check this box if annual unit inspections are not applicable or required. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Inspection Comments Text
Enter any additional comments or details regarding the file inspections. Fill only if 'Move-in Inspection No', 'Annual Unit Inspections No' is 'No' for any.
Depends on: Move-in Inspection No, Annual Unit Inspections No
Household Member Identification
Yes Checkbox
Check this box if all household members (head, spouse, dependent, co-head, other adult(s), live-in aide, foster child, and foster adult) are identified correctly.
No Checkbox
Check this box if any household member (head, spouse, dependent, co-head, other adult(s), live-in aide, foster child, and foster adult) is not identified correctly.
Household Member Identification Comments Text
Provide any additional comments or details regarding the correct identification of household members.
HUD 9887/9887A Consent Form
Yes Checkbox
Check this box if there is a current HUD 9887/9887A Consent Form signed and dated by the head, spouse, co-head (regardless of age), and family members at least 18 years of age.
No Checkbox
Check this box if there is not a current HUD 9887/9887A Consent Form signed and dated by the head, spouse, co-head (regardless of age), and family members at least 18 years of age.
Comments for HUD 9887/9887A Consent Form Text
Provide any additional comments regarding the HUD 9887/9887A Consent Form.
HUD Model Lease Usage
No Checkbox
Check this box if the correct HUD model lease was not used for the tenant. Fill only if 'Type of Review' is 'Tenant Move-In'
Depends on: Tenant Move-In
No (Alternate) Checkbox
Check this box if the correct HUD model lease was not used, serving as an alternative or additional 'No' option for the tenant's lease. Fill only if 'Type of Review' is 'Tenant Move-In'
Depends on: Tenant Move-In
Yes Checkbox
Check this box if the correct HUD model lease was used for the tenant. Fill only if 'Type of Review' is 'Tenant Move-In'
Depends on: Tenant Move-In
HUD Model Lease Usage Comments Text
Provide any additional comments or explanations regarding the use of the correct HUD model lease. Fill only if 'No (Alternate)' is 'No'.
Depends on: No (Alternate)
HUD-92006 Form Presence
Yes Checkbox
Check this box if form HUD-92006, 'Supplement to Application for Federally Assisted Housing,' is present in the files for tenants who applied after 12/14/2009.
No Checkbox
Check this box if form HUD-92006, 'Supplement to Application for Federally Assisted Housing,' is not present in the files for tenants who applied after 12/14/2009.
N/A Checkbox
Check this box if the question regarding the presence of form HUD-92006 is not applicable.
Comments on HUD-92006 Form Presence Text
Provide any relevant comments regarding the presence or absence of the HUD-92006 form for tenants who applied after 12/14/2009.
Immigration or Citizenship Status Verification
Eligible Immigration Status Verified (Yes) Checkbox
Check this box if the eligible immigration status or citizenship status has been properly verified and documented.
Eligible Immigration Status Not Verified (No) Checkbox
Check this box if the eligible immigration status or citizenship status has NOT been properly verified and documented.
Eligible Immigration Status Not Applicable (N/A) Checkbox
Check this box if the verification of eligible immigration status or citizenship status is not applicable.
Immigration or Citizenship Status Verification Comments Text
Provide any comments or additional information regarding the verification of eligible immigration status or citizenship status. Fill only if 'Eligible Immigration Status Not Verified (No)' is 'No'.
Depends on: Eligible Immigration Status Not Verified (No)
Imputed Income Details
Imputed Income Yes Checkbox
Check this box if there is imputed income because the tenant's assets are greater than $5,000.
Imputed Income No Checkbox
Check this box if there is no imputed income because the tenant's assets are not greater than $5,000, or for other reasons.
Imputed Income N/A Checkbox
Check this box if the question regarding imputed income when assets are greater than $5,000 is not applicable.
Imputed Income Amount Number
Please provide the imputed income amount when assets are greater than $5,000. Fill only if 'Imputed Income Yes' is 'Yes'.
Depends on: Imputed Income Yes
Additional Imputed Income Amount Number
Please provide any additional imputed income amount based on assets greater than $5,000.
Income Discrepancy Report Details
Yes Checkbox
Check this box if income discrepancies reported on the EIV Income Discrepancy Report were investigated, resolved, and file documented.
No Checkbox
Check this box if income discrepancies reported on the EIV Income Discrepancy Report were not investigated, resolved, or file documented.
N/A Checkbox
Check this box if the question regarding income discrepancies reported on the EIV Income Discrepancy Report is not applicable.
Income Discrepancy Comments Text
Provide comments on any discrepancies identified if the income information on the 50059 did not agree with the verified file information.
Income Ineligibility Exception
Yes Checkbox
Check this box if an exception or waiver was granted for a household that was not income eligible at move-in. Fill only if 'Income Eligible at Move-in - No' is 'Yes'.
Depends on: Income Eligible at Move-in - No
No Checkbox
Check this box if an exception or waiver was not granted for a household that was not income eligible at move-in. Fill only if 'Income Eligible at Move-in - No' is 'Yes'.
Depends on: Income Eligible at Move-in - No
N/A Checkbox
Check this box if the household was income eligible at move-in, making an exception or waiver unnecessary. Fill only if 'Income Eligible at Move-in - No' is 'Yes'.
Depends on: Income Eligible at Move-in - No
Income Ineligibility Exception Details Text
Provide details regarding the exception or waiver granted if the household was not income eligible at move-in. Fill only if 'Income Eligible at Move-in - No' is 'Yes'.
Depends on: Income Eligible at Move-in - No
Itemized List of Damages and Charges
Yes Checkbox
Check this box if an itemized list of damages and charges was provided to the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
No Checkbox
Check this box if an itemized list of damages and charges was NOT provided to the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
N/A Checkbox
Check this box if the question regarding an itemized list of damages and charges is not applicable. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Itemized List Comments Text
Please provide any comments or additional details regarding the itemized list of damages and charges provided to the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Lead Based Paint Tenant Receipt
Lead-Based Paint Acknowledged (Yes) Checkbox
Check this box if there is an acknowledgement and/or signed document in the file indicating the tenant received the Lead-Based Paint disclosure.
Lead-Based Paint Acknowledged (No) Checkbox
Check this box if there is no acknowledgement and/or signed document in the file indicating the tenant received the Lead-Based Paint disclosure.
Lead-Based Paint Acknowledged (N/A) Checkbox
Check this box if the Lead-Based Paint disclosure is not applicable to this tenant or property.
Lease Attachments Verification
Yes Checkbox
Check this box if all applicable attachments, such as house rules, pet rules, and unit inspection report, are attached to the lease. Fill only if 'Type of Review' is 'Tenant Move-In'
Depends on: Tenant Move-In
No Checkbox
Check this box if all applicable attachments, such as house rules, pet rules, and unit inspection report, are NOT attached to the lease. Fill only if 'Type of Review' is 'Tenant Move-In'
Depends on: Tenant Move-In
Lease Attachments Comments Text
Provide any additional comments or explanations regarding the verification of applicable attachments attached to the lease, such as house rules, pet rules, or unit inspection reports. Fill only if 'No' is 'No'.
Depends on: No
Lease Signature Verification
Yes Checkbox
Check this box if the original lease and any subsequent leases or addenda are signed and dated by the owner/agent, head, spouse, co-head, and all other adult members of the household. Fill only if 'Type of Review' is 'Tenant Move-In'
Depends on: Tenant Move-In
No Checkbox
Check this box if the original lease and any subsequent leases or addenda are NOT signed and dated by the owner/agent, head, spouse, co-head, and all other adult members of the household. Fill only if 'Type of Review' is 'Tenant Move-In'
Depends on: Tenant Move-In
Lease Signature Verification Comments Text
Provide any relevant comments regarding whether the original lease and subsequent leases or addenda are signed and dated by the owner/agent, head, spouse, co-head, and all other adult members of the household. Fill only if 'No' is 'No'.
Depends on: No
Medical Expenses
Medical Expenses Yes Checkbox
Check this box if there are medical expenses to be considered for allowances.
Medical Expenses No Checkbox
Check this box if there are no medical expenses to be considered for allowances.
Medical Expenses N/A Checkbox
Check this box if medical expenses are not applicable for allowances.
Monthly Billing Adjustments
Yes Checkbox
Check this box if adjustments were required and have been made to the monthly billing.
No Checkbox
Check this box if adjustments were required but have not been made to the monthly billing.
N/A Checkbox
Check this box if adjustments to the monthly billing were not required.
Comments on Adjustments Text
Provide details and explanations regarding any adjustments made to the monthly billing.
Move-in Income Eligibility
Income Eligible at Move-in - Yes Checkbox
Check this box if the household's income was eligible at the time of move-in. Fill only if 'Tenant Move-In' is 'Yes'.
Depends on: Tenant Move-In
Income Eligible at Move-in - No Checkbox
Check this box if the household's income was not eligible at the time of move-in. Fill only if 'Tenant Move-In' is 'Yes'.
Depends on: Tenant Move-In
Income Eligible at Move-in - N/A Checkbox
Check this box if income eligibility for the household is not applicable for this move-in review. Fill only if 'Tenant Move-In' is 'Yes'.
Depends on: Tenant Move-In
Income Eligibility Comments (Over/Very Low) Text
Enter comments explaining why the household was over income or classified as very low income at move-in. Fill only if the 'Was this household’s income eligible at move-in?' is 'No'.
Income Eligibility Comments (Low/Extremely Low) Text
Enter comments explaining why the household was low income or classified as extremely low income at move-in. Fill only if the 'Was this household’s income eligible at move-in?' is 'No'.
Over income Checkbox
Check this box if the household's income was determined to be over the income limits for eligibility. Fill only if 'Income Eligible at Move-in - No' is 'Yes'.
Depends on: Income Eligible at Move-in - No
Low income Checkbox
Check this box if the household's income was determined to be within the low income limits for eligibility. Fill only if 'Income Eligible at Move-in - Yes' is 'Yes'.
Depends on: Income Eligible at Move-in - Yes
Very low income Checkbox
Check this box if the household's income was determined to be within the very low income limits for eligibility. Fill only if 'Income Eligible at Move-in - Yes' is 'Yes'.
Depends on: Income Eligible at Move-in - Yes
Extremely low income Checkbox
Check this box if the household's income was determined to be within the extremely low income limits for eligibility. Fill only if 'Income Eligible at Move-in - Yes' is 'Yes'.
Depends on: Income Eligible at Move-in - Yes
Move-Out Date Verification
Yes Checkbox
Check this box if the tenant move-out date on the voucher matches the date the tenant vacated. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
No Checkbox
Check this box if the tenant move-out date on the voucher does not match the date the tenant vacated. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Move-Out Date Voucher Match Comments Text
Provide any comments regarding whether the tenant move-out date on the voucher matches the date the tenant vacated. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Move-Out Inspection
Inspection Performed - Yes Checkbox
Check this box if a move-out inspection was performed for the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Inspection Performed - No Checkbox
Check this box if a move-out inspection was not performed for the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Move-Out Inspection Comments Text
Provide any additional comments or details regarding the move-out inspection. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Move-Out Inspection Date Date
Please provide the date when the move-out inspection occurred. Fill only if 'Inspection Performed - Yes' is 'Yes'.
Depends on: Inspection Performed - Yes
Date of Inspection Entered - Yes Checkbox
If a move-out inspection was performed, check this box if the date of the inspection has been entered in the corresponding field. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Date of Inspection Entered - No Checkbox
If a move-out inspection was performed, check this box if the date of the inspection has not been entered in the corresponding field. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Move-Out Notice
Yes Checkbox
Check this box if there is a move-out notice from the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
No Checkbox
Check this box if there is no move-out notice from the tenant. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Move-Out Notice Comments Text
Provide any additional comments or details regarding the tenant's move-out notice. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Move-Out Date Date
Enter the date the tenant moved out. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Date of Notice Date
Enter the date the move-out notice was provided by the tenant. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Name of Reviewer
Reviewer Name Text
Provide the full name of the individual who conducted the review.
Other Asset Description
Other Asset Description Text
Provide a detailed description for any asset not listed in the categories above.
Other Income Details
Welfare/Public Assistance/TANF Yes Checkbox
Check this box if Welfare/Public Assistance/TANF income has been verified and calculated correctly. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Welfare/Public Assistance/TANF No Checkbox
Check this box if Welfare/Public Assistance/TANF income has not been verified or calculated correctly. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Welfare/Public Assistance/TANF N/A Checkbox
Check this box if Welfare/Public Assistance/TANF income is not applicable. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Child Support Yes Checkbox
Check this box if Child Support income has been verified and calculated correctly. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Child Support No Checkbox
Check this box if Child Support income has not been verified or calculated correctly. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Child Support N/A Checkbox
Check this box if Child Support income is not applicable. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Pensions Yes Checkbox
Check this box if Pensions income has been verified and calculated correctly. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Pensions No Checkbox
Check this box if Pensions income has not been verified or calculated correctly. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Pensions N/A Checkbox
Check this box if Pensions income is not applicable. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Other Income Yes Checkbox
Check this box if other specified income has been verified and calculated correctly. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Other Income No Checkbox
Check this box if other specified income has not been verified or calculated correctly. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Other Income N/A Checkbox
Check this box if other specified income is not applicable. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Other Income Discrepancy Comments Text
Provide a detailed explanation if the other income information reported on form 50059 does not match the verified file information. Fill only if 'Welfare/Public Assistance/TANF Yes', 'Child Support Yes', 'Pensions Yes', 'Other Income Yes' is 'Yes' for any.
Depends on: Welfare/Public Assistance/TANF Yes, Child Support Yes, Pensions Yes, Other Income Yes
Other Screening as per Tenant Selection Plan
Yes Checkbox
Check this box if other screening as disclosed in the Tenant Selection Plan was conducted.
No Checkbox
Check this box if other screening as disclosed in the Tenant Selection Plan was not conducted.
N/A Checkbox
Check this box if other screening as disclosed in the Tenant Selection Plan is not applicable.
Other Screening Comments Text
Please provide any comments or details related to other screenings conducted as disclosed in the Tenant Selection Plan. Fill only if 'No' is 'No'.
Depends on: No
Pet Deposit Amount
Yes Checkbox
Check this box if the required pet deposit is in the correct amount.
No Checkbox
Check this box if the required pet deposit is not in the correct amount.
N/A Checkbox
Check this box if a pet deposit is not required for the tenant.
Required Pet Deposit Amount Number
Please provide the required pet deposit amount. Fill only if 'No' is 'No'.
Depends on: No
Pet Deposit Installments
Yes Checkbox
Check this box if the pet deposit was paid in installments and the payment schedule was in accordance with pet regulations.
No Checkbox
Check this box if the pet deposit was paid in installments, but the payment schedule was not in accordance with pet regulations.
N/A Checkbox
Check this box if the pet deposit was not paid in installments, making the question about payment schedule compliance not applicable.
Installment Payment Schedule Comments Text
Provide additional comments or details regarding the pet deposit installment payment schedule and its compliance with regulations. Fill only if 'No' is 'No'.
Depends on: No
Re-certification Completion
Yes Checkbox
Check this box if re-certifications were completed on time. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
No Checkbox
Check this box if re-certifications were not completed on time. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Re-certification Completion Comments Text
Provide any additional comments or details regarding the timely completion of re-certifications. Fill only if 'No' is 'No'.
Depends on: No
Re-certification Due to New Employment
Re-certification Due to New Employment - Yes Checkbox
Check this box if the tenant's file contains a re-certification that was initiated as a result of new employment reported on the EIV New Hires Report.
Re-certification Due to New Employment - No Checkbox
Check this box if the tenant's file does not contain a re-certification that was initiated as a result of new employment reported on the EIV New Hires Report.
Re-certification Due to New Employment - N/A Checkbox
Check this box if the question regarding re-certification due to new employment is not applicable to the tenant's file.
New Employment Income Included - Yes Checkbox
Check this box if the new employment income is included in the tenant's reported annual income, assuming a re-certification due to new employment was present. Fill only if 'Re-certification Due to New Employment - Yes' is 'Yes'.
Depends on: Re-certification Due to New Employment - Yes
New Employment Income Included - No Checkbox
Check this box if the new employment income is not included in the tenant's reported annual income, assuming a re-certification due to new employment was present. Fill only if 'Re-certification Due to New Employment - Yes' is 'Yes'.
Depends on: Re-certification Due to New Employment - Yes
New Employment Income Included - N/A Checkbox
Check this box if the question about new employment income being included in reported annual income is not applicable. Fill only if 'Re-certification Due to New Employment - Yes' is 'Yes'.
Depends on: Re-certification Due to New Employment - Yes
Re-certification Comments Text
Provide any additional comments related to the re-certification due to new employment or new employment income.
Re-certification Notices
Yes Checkbox
Check this box if re-certification notices were provided within the required timeframes. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
No Checkbox
Check this box if re-certification notices were not provided within the required timeframes. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Re-certification Notices Provision Comment Text
Provide any additional comments or details regarding whether re-certification notices were provided within the required timeframes. Fill only if 'No' is 'No'.
Depends on: No
Real Estate Income
Real Estate Income - Yes Checkbox
Check this box if there is actual income from real estate assets.
Real Estate Income - No Checkbox
Check this box if there is no actual income from real estate assets.
Real Estate Income - N/A Checkbox
Check this box if information regarding actual income from real estate assets is not applicable.
Reason for Denial Consistency
Yes Checkbox
Check this box if the reason the applicant was denied admittance was in accordance with the Tenant Selection Plan. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
No Checkbox
Check this box if the reason the applicant was denied admittance was not in accordance with the Tenant Selection Plan. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
Reason for Denial Comments Text
Please provide any additional comments related to the reason for denial consistency during the applicant rejection review. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
Rent Determination Fact Sheet Tenant Receipt
Yes Checkbox
Check this box if there is an acknowledgement and/or signed document in the file indicating the tenant received the 'Fact Sheet on How Your Rent is Determined'.
No Checkbox
Check this box if there is no acknowledgement and/or signed document in the file indicating the tenant received the 'Fact Sheet on How Your Rent is Determined'.
Rent Increase Notice
Notice Provided (Yes) Checkbox
Check this box if a 30-day notice of rent increase has been provided to the tenant. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Notice Provided (No) Checkbox
Check this box if a 30-day notice of rent increase has not been provided to the tenant. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Notice Provided (N/A) Checkbox
Check this box if a 30-day notice of rent increase is not applicable to the tenant's situation. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Rent Increase Notice Comments Text
Provide any additional comments regarding the 30-day notice of increase in rent. Fill only if 'Notice Provided (No)' is 'No'.
Depends on: Notice Provided (No)
Repayment Agreement Details
Repayment Agreement Exists Yes Checkbox
Check this box if the tenant HAS entered into a written repayment agreement for monies due to the project.
Repayment Agreement Exists No Checkbox
Check this box if the tenant HAS NOT entered into a written repayment agreement for monies due to the project.
Repayment Agreement Exists N/A Checkbox
Check this box if the question about a tenant entering into a written repayment agreement is not applicable.
Plan Has Required Info Yes Checkbox
Check this box if a repayment agreement was entered, and the plan contains the required information. Fill only if 'Repayment Agreement Exists Yes' is 'Yes'.
Depends on: Repayment Agreement Exists Yes
Plan Has Required Info No Checkbox
Check this box if a repayment agreement was entered, but the plan does not contain the required information. Fill only if 'Repayment Agreement Exists Yes' is 'Yes'.
Depends on: Repayment Agreement Exists Yes
Plan Has Required Info N/A Checkbox
Check this box if the question about whether the repayment agreement plan contains the required information is not applicable. Fill only if 'Repayment Agreement Exists Yes' is 'Yes'.
Depends on: Repayment Agreement Exists Yes
Income Discrepancy Comments Text
Provide comments on any discrepancies identified between the income information on the 50059 and the verified file information. Fill only if 'Repayment Agreement Exists Yes' is 'Yes'.
Depends on: Repayment Agreement Exists Yes
Resident Rights Brochure Tenant Receipt
Resident Rights Brochure Received - Yes Checkbox
Check this box if there is an acknowledgement and/or signed document in the file indicating the tenant received the Resident Rights and Responsibilities Brochure.
Resident Rights Brochure Received - No Checkbox
Check this box if there is no acknowledgement and/or signed document in the file indicating the tenant received the Resident Rights and Responsibilities Brochure.
Right to Appeal Information
Yes Checkbox
Check this box if the rejection letter provided the applicant the right to appeal. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
No Checkbox
Check this box if the rejection letter did not provide the applicant the right to appeal. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
Rejection Letter Appeal Right Comments Text
Provide any additional comments or details regarding whether the rejection letter provided the applicant the right to appeal. Fill only if 'Type of Review' is 'Applicant Rejection'.
Depends on: Applicant Rejection
Savings Account Income
Savings Account Yes Checkbox
Check this box if there is actual income from a savings account.
Savings Account No Checkbox
Check this box if there is no actual income from a savings account.
Savings Account N/A Checkbox
Check this box if a savings account is not applicable for income assessment.
Security Deposit Refund
Yes Checkbox
Check this box if the security deposit was refunded to the tenant within 30 days, or in accordance with state or local laws, whichever is shorter. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
No Checkbox
Check this box if the security deposit was not refunded to the tenant within 30 days, or in accordance with state or local laws, whichever is shorter. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
N/A Checkbox
Check this box if the question regarding the security deposit refund is not applicable. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Security Deposit Refund Comments Text
Please provide any additional comments or details regarding whether the security deposit was refunded to the tenant within the specified timeframe or in accordance with applicable laws. Fill only if 'Type of Review' is 'Tenant Move-Out'.
Depends on: Tenant Move-Out
Social Security Benefits Verification
Social Security Benefits Third Party Verification Details Text
Provide additional details regarding the third-party verification for social security benefits. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
EIV Income Report Checkbox
Check this box if Social Security benefits were verified using the EIV (Enterprise Income Verification) Income Report. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Traditional 3rd party Checkbox
Check this box if Social Security benefits were verified through a traditional third-party source. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Other Checkbox
Check this box if Social Security benefits were verified by an other third-party source not explicitly listed. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Not verified Checkbox
Check this box if Social Security benefits could not be verified. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
N/A Checkbox
Check this box if verification of Social Security benefits is not applicable. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Social Security Benefits Amount on 50059 Number
Enter the amount of social security benefits reported on form 50059. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Social Security Benefits Discrepancy Comments Text
Provide comments on any discrepancies identified between the social security benefits income information on form 50059 and verified file information. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Social Security Number Verification
Yes Checkbox
Check this box if Social Security numbers have been properly verified and documented (except for those exempted by 24 CFR 5.216).
No Checkbox
Check this box if Social Security numbers have not been properly verified and documented (except for those exempted by 24 CFR 5.216).
SSN Verification Comments
SSN Verification Comments Text
Provide any relevant comments regarding the verification of Social Security numbers, including any exemptions or issues encountered. Fill only if 'No', 'EIV Summary Report in file - No', 'No' is 'No', any.
Depends on: No, EIV Summary Report in file - No, No
State Lifetime Sex Offender Registration Check
Yes Checkbox
Check this box if a state lifetime sex offender registration check has been conducted for all household members in every state they resided, using a database that checks against all state registries.
No Checkbox
Check this box if a state lifetime sex offender registration check has not been conducted for all household members as required.
Comments on Sex Offender Registration Check Text
Provide any additional comments or details regarding the state lifetime sex offender registration check. Fill only if 'No' is 'No'.
Depends on: No
Status Verification Comments
Status Verification Comments Text
Provide any necessary comments or additional details regarding the verification of disability status, student status, or ages of occupants. Fill only if 'No', 'No', 'Ages of Occupants Verified: No' is 'No', any.
Depends on: No, No, Ages of Occupants Verified: No
Student Status Verification
Yes Checkbox
Check this box if the student status has been verified.
No Checkbox
Check this box if the student status has not been verified.
N/A Checkbox
Check this box if student status verification is not applicable.
Tenant File Review Continued Header
Continuation Page Identifier Text
Enter the identifier for this continued section of the tenant file review.
Tenant Information
Family Name Text
Please enter the family name of the tenant.
Unit Number Text
Please provide the unit number assigned to the tenant.
Move-in Date Date
Please enter the date the tenant moved into the unit.
Tenant Minimum Rent and Hardship Exception
Is the tenant paying minimum rent? - Yes Checkbox
Check this box if the tenant is currently paying minimum rent.
Is the tenant paying minimum rent? - No Checkbox
Check this box if the tenant is not currently paying minimum rent.
Is the tenant paying minimum rent? - N/A Checkbox
Check this box if the question about the tenant paying minimum rent is not applicable.
Hardship Exception Details Text
Provide details if a hardship exception was granted for the tenant's minimum rent. Fill only if 'Is the tenant paying minimum rent? - Yes' is 'Yes'.
Depends on: Is the tenant paying minimum rent? - Yes
Hardship exception granted? - Yes Checkbox
Check this box if a hardship exception was granted for the minimum rent. Fill only if 'Is the tenant paying minimum rent? - Yes' is 'Yes'.
Depends on: Is the tenant paying minimum rent? - Yes
Hardship exception granted? - No Checkbox
Check this box if a hardship exception was not granted for the minimum rent. Fill only if 'Is the tenant paying minimum rent? - Yes' is 'Yes'.
Depends on: Is the tenant paying minimum rent? - Yes
Hardship exception granted? - N/A Checkbox
Check this box if the question about a hardship exception being granted is not applicable, or if the tenant is not paying minimum rent. Fill only if 'Is the tenant paying minimum rent? - Yes' is 'Yes'.
Depends on: Is the tenant paying minimum rent? - Yes
Tenant Receipt Comments
Tenant Receipt Comments Text
Provide any additional comments or details regarding the tenant's acknowledgment and signed documents for receipt of various materials. Fill only if 'Lead-Based Paint Acknowledged (No)', 'Resident Rights Brochure Received - No', 'EIV & You Brochure Acknowledged - No', 'No' is 'No', any.
Depends on: Lead-Based Paint Acknowledged (No), Resident Rights Brochure Received - No, EIV & You Brochure Acknowledged - No, No
Type of Review
Applicant Rejection Checkbox
Check this box if the review type is for an applicant rejection.
Tenant Move-In Checkbox
Check this box if the review type is for a tenant move-in.
Tenant Move-Out Checkbox
Check this box if the review type is for a tenant move-out.
Certification/Recertification Checkbox
Check this box if the review type is for a tenant's certification or recertification.
Unemployment Benefits Verification
Unemployment Benefits Other Verification Method Text
Please provide the specific method used for verifying unemployment benefits if it is not EIV Income Report or Traditional 3rd party. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
EIV Income Report Checkbox
Check this box if unemployment benefits were verified using the Enterprise Income Verification (EIV) Income Report. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Traditional 3rd Party Checkbox
Check this box if unemployment benefits were verified through a traditional third-party source. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Other Checkbox
Check this box if unemployment benefits were verified using a method other than EIV Income Report or traditional third-party verification. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Not Verified Checkbox
Check this box if unemployment benefits could not be verified. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
N/A (Unemployment Benefits) Checkbox
Check this box if the unemployment benefits verification is not applicable. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Unemployment Benefits Reported Amount Number
Enter the total amount of unemployment benefits reported on form 50059. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Unemployment Benefits Verification Comments Text
Provide comments on whether the unemployment benefits income information on form 50059 agreed with verified file information, and note any discrepancies. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Unit Size Appropriateness
Unit Size Appropriate Checkbox
Check this box if the unit size is appropriate for the household.
Unit Size Not Appropriate Checkbox
Check this box if the unit size is not appropriate for the household.
Unit Size Appropriateness Comments Text
Provide any relevant comments or details regarding the appropriateness of the unit size for the household.
Unlabeled Asset Income
Checking Account - Yes Checkbox
Check this box if there is actual income from a checking account.
Checking Account - No Checkbox
Check this box if there is no actual income from a checking account.
Checking Account - N/A Checkbox
Check this box if a checking account is not applicable for actual income assessment.
Verified Amounts Discrepancy Comments
Discrepancy Comments Text
Provide comments on any discrepancies identified between the income information on the 50059 and the verified file information. Fill only if 'Did income information on the 50059 agree with verified file information?' is 'No'.
Depends on: No
Wages Verification
Wages Verification Details Text
Provide details on how the wages were verified and if they were calculated correctly. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
EIV Income Report Checkbox
Check this box if wages verification was performed using an EIV Income Report. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Traditional 3rd party Checkbox
Check this box if wages verification was performed using traditional third-party methods. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Other Checkbox
Check this box if wages verification was performed using an 'Other' method not listed. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Not verified Checkbox
Check this box if wages were not verified. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
N/A Checkbox
Check this box if wages verification is not applicable. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Wages Amount Reported on 50059 Number
Enter the amount of wages reported on the Form 50059. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification
Wages Discrepancy Comments Text
Provide comments on any discrepancies found between the income information on Form 50059 and the verified file information for wages. Fill only if 'Type of Review' is 'Certification/Recertification'.
Depends on: Certification/Recertification