Transcription of HUD LIHTC Tenant Data Collection Form
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HUD LIHTC Tenant Data Collection Form
OMB Approval No. 2528-0165 (Exp. 05/31/2019) Department of Housing and Urban Development Page 1 of 5 HUD LIHTC Tenant Data Collection Form Previous editions unusable Revised May 2016 Form HUD 52697 HUD LIHTC Tenant Data Collection FormCertification Type: _____ (1=Initial Certification ; 2=Recertification; 3=Other)Effective Date of Certification:_____If other, specify: _____ LIHTC Qualification Date: _____ (YYYY-MM-DD) Part I: Development Data Compliance Agency Name: _____ Property Name: _____ PIN: _____ BIN: _____ Building Address:_____ Unit Number: _____ # Bedrooms: _____ Part II: Household Composition Was Unit Vacant on December 31, 2015? Yes; No (If Yes, no other Tenant -specific information required.) HH Mbr # Last Name First Name Middle Initial Relationship to Head of HouseholdRace EthnicityDisabled?
OMB Approval No. 2528-0165 (Exp. 05/31/2019) U.S. Department of Housing and Urban Development Page 2 of 5 HUD LIHTC Tenant Data Collection Form
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