House & Apartment
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Interim Recertification Information Form - No Documents Blank form
Tenants in public housing are required to report all changes in household income to the public housing authority in writing within 10 calendar days of the change. Tenants must fill out and sign this form if they want to file an interim recertification but don't have documents to prove their change in income.
Learn more about how to complete this form.
Can I use this form?
You must be a tenant in public housing who has had one of the following:
- Decreased income due to loss of employment, reduction in number of hours worked by an employed family member, or loss or reduction of welfare income,
- Increased medical expenses, high childcare costs, and
- Other changes affecting the family's annual income.
What do I need first?
To complete this form, you will need your:
- Name,
- Address,
- Tenant number (if any),
- Email,
- Source of weekly income, and
- Amount of weekly income.
Last full review by a subject matter expert
June 30, 2023
Last revised by staff
July 03, 2023
Worried about doing this on your own? You may be able to get free legal help.
