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WORKSHEET FOR DOCUMENTING ELIGIBLE HOUSEHOLD …

HB-1-3555 Attachment 9-B Page 1 of 3 Applicant: _____ Co Applicant: _____ WORKSHEET FOR DOCUMENTING ELIGIBLE HOUSEHOLD AND REPAYMENT INCOME Identify all HOUSEHOLD Members Age Full-time Student Y/N? Disabled Y/N? Receive Income Y/N? Source of Income ANNUAL INCOME CALCULATION (Consider anticipated income for the next 12 months for all adult HOUSEHOLD members as described in 7 CFR (b) and HB-1-3555 Chapter 9. Website for instructions/administrative notices: guidelines (Wages, salary, self-employed, commission, overtime, bonus, tips, alimony, child support, pension/retirement, socialsecurity, disability, trust income, etc.). Calculate and record how the calculation of each income source/type was determined inthe space Co-Applicant (Wages, salary, self-employed, commission, overtime, bonus, tips, alimony, child support, pension/retirement, socialsecurity, disability, trust income, etc.))

by documenting all sources/types of income for all household members. Qualify the loan by documenting all sources/type of income that is stable and dependable utilized to repay the loan. HB-1-3555 Attachment 9-B Page 2 of 3

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