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ATTACHMENT 9-B
Applicant: Co Applicant:
WORKSHEET FOR DOCUMENTING ELIGIBLE HOUSEHOLD AND REPAYMENT INCOME
Lender Instructions: Determine eligible household income for the Single-Family Housing Guaranteed Loan Program (SFHGLP) by documenting all sources/types of income for all household members. Qualify the loan by documenting all sources/types of income that is stable and dependable, utilized to repay the loan.
Identify all Household Members Age Full-time Student Y/N?
Disabled
Receive Income Y/N?
Source of Income
Y/N?
ANNUAL INCOME CALCULATION (Consider anticipated income for the next 12 months for all adult household members as described in 7 CFR 3555.152(b)
and HB-1-3555, Chapter 9. Website for instructions: https://www.rd.usda.gov/resources/directives)
1. Applicant (Wages, salary, self-employed, commission, overtime, bonus, tips, alimony, child support, pension/retirement, social security, disability, trust income, etc.). Calculate and record how the calculation of each income source/type was determined in the space below.
2. Co-Applicant (Wages, salary, self-employed, commission, overtime, bonus, tips, alimony, child support, pension/retirement, social security, disability, trust income, etc.) Calculate and record how the calculation of each income source/type was determined in the space below.
3. Additional Income to Primary Income (Automobile Allowance, Mortgage Differential, Military, Secondary Employment, Seasonal Employment, Unemployment, etc.). Calculate and record how the calculation of each income source/type was determined in the space below.
4. Additional Adult Household Member (s) who are not a party to the note (Primary Employment from Wages, Salary, Self- Employed, Additional Income to Primary Employment, Other Income, etc.). Calculate and record how the calculation of each income source/type was determined in the space below.
5. Income from Assets (Income from household assets as described in HB-1-3555, Chapter 9). Calculate and record how the calculation of each income source/type was determined in the space below.
6. Annual Household Income (Total 1 through 5)
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Applicant: Co Applicant:
ADJUSTED ANNUAL INCOME CALCULATION (Consider qualifying deductions as described in 7 CFR 3555.152(c) and HB-1-3555 Chapter 9)
7. Dependent Deduction ($480 for each child under age 18, full-time student, or disabled family member over the age of 18) - # x $480
8. Annual Child Care Expenses (Reasonable expenses for children 12 and under) Calculate and record the calculation of the deduction in the space below.
9. Elderly/Disabled Household (1 household deduction of $400 if 62 years of age or older, or disabled and a party to the note)
10. Disability (Unreimbursed expenses in excess of 3% of annual income per 7 CFR 3555.152(c) and HB-1-3555 Chapter 9) Calculate and record the calculation of the deduction in the space below.
11. Medical Expenses (Elderly/Disabled households only. Unreimbursed medical expenses in excess of 3% of annual income per 7 CFR 3555.152(c) and HB-1-3555 Chapter 9) Calculate and record the calculation of the deduction in the space below.
12. Total Household Deductions (Total 7 through 11)
13. Adjusted Annual Income (Item 6 minus item 12)
Income cannot exceed Moderate Income Limit to be eligible for SFHGLP
Moderate Income Limit State: County:
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Applicant: ___________________________________________ Co Applicant: ______________________________________________
MONTHLY REPAYMENT INCOME CALCULATION (Consider stable and dependable income of parties to the note as described in 7 CFR 3555.152(a) and HBͲ1Ͳ3555 Chapter 9. Non-occupant borrowers or co-signers are not allowed.)
14. Stable Dependable Monthly Income (Parties to note only). Calculate and record how the calculation of each income source/type was determined in the space below. Identify income type by party to note.
Applicant Co-Applicant Total
Base Income Calculation of Base Income:
Calculation of Base Income:
Other Income
Calculation of Other Income:
Calculation of Other Income:
Total Income
15. Monthly Repayment Income (Total of 14)
Preparer’s Signature:
Name (Print):
Title:
Date: ___________________