Attachment 4-5: Sample Income and Resident Rent Calculation Worksheet – Completed
HOPWA Rental Assistance Guidebook 113
INCOME & RESIDENT RENT CALCULATION WORKSHEET
HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS
This worksheet will determine the Tenant Rent Payment based on the greater of 10% of Monthly Gross
Income or 30% of Monthly Adjusted Income. For income exclusions, see pages 5 and 6.
HOPWA regulations 24CFR574.310d(1)(2)(3) state: “Resident rent payment. Except for persons in short-term supported housing, each person
receiving rental assistance under this program or residing in any rental housing assisted under this program must pay as rent, including utilities, an
amount which is the higher of: (1) 30 percent of the family's monthly adjusted income (adjustment factors include the age of the individual,
medical expenses, size of family and child care expenses and are described in detail in 24CFR5.609); (2) 10 percent of the family's monthly gross
income; or (3) If the family is receiving payments for welfare assistance from a public agency and a part of the payments, adjusted in accordance
with the family’s actual housing costs, is specifically designated by the agency to meet the family’s housing costs, the portion of the payment that
is designated for housing costs.” Documentation and Verification of Income: As a condition of participation in the program, each client must
agree to supply such certification, release, information, or documentation as the agency determines to verify the client’s income.
*The total income of the household (Annual Gross Income) is from all sources anticipated to be received in the 12-month
period following the effective date of the income certification. Therefore, income must be ANNUALIZED, e.g. payment
amount X number of payment periods/yr. for all income sources.
1. The full amount, before payroll deductions, of wages and salaries, overtime pay,
commissions, fees, tips and bonuses, other compensation for personal services prior to
payroll deductions. (Applies to client and all household members 18 and older. For full-time
students 18 and over, only $480 of annual earned income should be included here.) $ 17,472
2. Periodic payments from Social Security, annuities, insurance policies, retirement
funds, pensions, disability or death benefits, excluding lump sum payments for the
delayed start of a periodic payment (Except as provided in (c)(14)). $ 7,200_
3. Payments in lieu of earnings, such as unemployment, disability, worker’s compensation,
and severance pay (Except as provided in (c)(3)). $ _0__
4. Welfare Assistance, including payments made under other programs funded,
separately or jointly, by federal, state, or local governments which are not excluded by
Federal Statutes (see Income Exclusions). $ _0___
5. Periodic allowances including alimony and child support payments, and regular
contributions or gifts received from organizations or persons not residing in the residence. $ __0__
6. Net income from operation of a business or profession. $ __0__
7. Interest, dividends, and other net income of any kind from real or personal property. Where
net family assets are less than $5000, include the actual income from asset; where net family
assets are in excess of $5,000, annual income shall include the greater of actual income
derived from net family assets or a percentage of the value of such assets based on the
current passbook savings rate, as determined by HUD. $ ____0_
8. All regular pay, special pay and allowances of a member of the Armed Forces
(Except Hostile Fire Pay). $ ____0_
9. ANNUAL GROSS INCOME* TOTAL OF LINES 1-8
Note: Annual income must be reassessed at least annually. However, if there is
substantial change in the household’s income during the year, an adjustment must be made $ 24,672_
to the resident rent to reflect the change in income.
10. MONTHLY GROSS INCOME (Line # 9 divided by 12.) $ 2,056_
Sample Form Updated: February 22, 2008