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Resident Request for Interim Recertification SK …

Resident Request for Interim Recertification SK management company , LLC. Tenant Name: _____ Unit #: _____. Tenant's Phone Number: _____. Property Name: _____. Please carefully read the instructions and provide all requested information. IF YOU HAVE ANY QUESTIONS. REGARDING ANYTHING ON THIS FORM, PLEASE ASK THE MANAGER FOR CLARIFICATION. 1. I am requesting a change in my household composition. Yes No If no, skip to question 2. A. HOUSEHOLD COMPOSITION (Removing Household Member(s)). Household member(s) have moved out of my unit. Name of household member(s) moving out: _____. Move-out date: _____. If move-out member was the Head of Household, please provide the name of the NEW Head of Household: _____.

Resident Request for Interim Recertification SK Management Company, LLC. SK-160 (Rev. 8/18/2016) 3 B. LOSS OF INCOME Household member lost his/her employment.

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Transcription of Resident Request for Interim Recertification SK …

1 Resident Request for Interim Recertification SK management company , LLC. Tenant Name: _____ Unit #: _____. Tenant's Phone Number: _____. Property Name: _____. Please carefully read the instructions and provide all requested information. IF YOU HAVE ANY QUESTIONS. REGARDING ANYTHING ON THIS FORM, PLEASE ASK THE MANAGER FOR CLARIFICATION. 1. I am requesting a change in my household composition. Yes No If no, skip to question 2. A. HOUSEHOLD COMPOSITION (Removing Household Member(s)). Household member(s) have moved out of my unit. Name of household member(s) moving out: _____. Move-out date: _____. If move-out member was the Head of Household, please provide the name of the NEW Head of Household: _____.

2 Note: You MUST complete the Removal of Household Member(s) Release Form. B. HOUSEHOLD COMPOSITION (Prospective New Household Member(s)). I want to add a household member to my unit. Name of prospective household member(s): _____. Note: Any member moving into the unit must be FULLY screened and APPROVED by management PRIOR to moving into the unit. Submit the Request to management to start the screening process. 2. Did your household income increase since the last Recertification ? Yes No If no, skip to question 3. A. NEW EMPLOYMENT/NEW INCOME. Household member has new employment/new income or changed employment/income type. Type of income source (Example: AFDC, SS/SSI, Wages, Dual Entitlement, Unemployment, Pension, Self- Employment, Worker's Compensation/Disability Benefits, Child Support, Family Support).

3 Please specify if retirement benefits are received as periodic payments. _____. Name of household member: _____. Employer Name/Source Name, Address, Phone Number and Direct Supervisor's Name: _____. _____. _____. Date employment/other earned income started or will start: _____. Estimated Wages/Earned Income per month: $ _____. Provide copies of six (4-6) current and consecutive pay stubs/other earned income stubs, if available. If six (4-6) pay stubs are not available due to recently being hired, provide stubs that you have available. For other earned income, provide supporting document and/or Award Letter. SK-160 (Rev. 8/18/2016) 1. Resident Request for Interim Recertification SK management company , LLC.

4 B. INCREASE IN HOUSEHOLD INCOME. My combined household income for all adult members increased by $ or more per month. (Example: $150. for member 1 and $50 for member 2). Yes No My household income did not increase by $200; but it increased by $_____. Type of income source (Example: AFDC, SS/SSI, Wages, Unemployment, Pension, Self-Employment, Worker's Compensation/Disability Benefits, Child Support, Family Support): _____. Name of household member(s):_____. Amount of increase: $_____ Date of increase: _____. Name, Address, Phone Number and Contact Person: _____. _____. _____. Cause for income increase? (Example: Pay rate increase, additional job, increase of financial assistance: _____. _____.)

5 Provide copies of six (4-6) current and consecutive pay stubs/other earned income stubs, if available. If six (4-6) pay stubs are not available due to recently being hired, provide stubs that you have available. For other earned income, provide supporting document and/or Award Letter. 3. Did your household income decrease since the last Recertification ? Yes c No If no, skip to question 4. If yes, review A-D before selection. A. DECREASE IN INCOME. My household income has decreased. Name of household member: _____. Type of income (Example: AFDC, SS/SSI, Wages, Child Support, Family Support): _____. _____. Amount of decrease: $_____ Date of decrease: _____. Name, Address, Phone Number and Contact Person: _____.

6 _____. _____. Cause for income decrease? (Example: Work hours have been decreased, decrease in financial assistance, EDD. benefits were decreased, etc.). _____. _____. How do you plan to supplement this decrease in income?_____. _____. Provide Award Letter, Court Letter or notarized letter showing decrease in income, if available. SK-160 (Rev. 8/18/2016) 2. Resident Request for Interim Recertification SK management company , LLC. B. LOSS OF INCOME. Household member lost his/her employment. Name of household member: _____. Former Employer Name, Address, Phone Number and Direct Supervisor's Name: _____. _____. _____. Date employment ended: _____. Provide termination letter, if available. Average amount of earned Wages per month: $ _____.

7 Do you anticipate your income to be partially or fully restored within 60 days? Yes No If Yes, please check the appropriate box Cash Aid Monetary Support Unemployment New Employment Other _____. If No, What are your plans to meet your living expenses? _____. _____. _____. _____. C. LOSS OF INCOME WITH RETURN DATE (for School Teachers). Name of household member: _____. Employer Name, Address, Phone Number and Contact Person: _____. _____. _____. I am off for summer break and am not paid for this time Last day worked before summer break _____. I will return to work on _____. My compensation will _____ will not _____ change when I return. If compensation will change, what will be the amount of new compensation?

8 $_____. I will be receiving money from other sources during this time off. Source Name and amount _____. Provide copies of six (4-6) current and consecutive pay stubs once school begins. D. LOSS OF INCOME WITH RETURN DATE (for Seasonal Workers). Name of household member: _____. Employer Name, Address, Phone Number and Contact Person: _____. _____. _____. SK-160 (Rev. 8/18/2016) 3. Resident Request for Interim Recertification SK management company , LLC. I have been temporarily laid off from my job, but will return to the same employment. I expect to return to work on _____. I will be receiving money from other sources during this time off. Source Name and amount _____. 4. Did your household allowance increase since the last Recertification ?

9 (Example: number of dependents, childcare, an increase in medical expenses, insurance premium plan). Yes No If no, skip to question 5. A. HOUSEHOLD ALLOWANCE INCREASE. My household allowances have increased. Name of household member: _____. Amount of increase per month: $_____. Effective Date of Increase: _____. Name, Address, Phone Number and Contact Person: _____. _____. Provide day care receipts, medical receipts showing increase in expenses. 5. Did your household assets change since the last Recertification ? (Example: Checking and savings account, Money Market, IRA, Certificate of Deposit, Retirement Accounts, Whole Life Insurance, Stocks, Bonds, Mutual Funds, Real Estate). Yes No If no, skip to question 6.

10 A. CHANGE IN ASSETS. My household assets increased/decreased. Name of household member: _____. Type of Asset, Institution Name, Address, Account Number: _____. _____. Date asset change occurred: _____. Reason for Change: _____. If applicable, provide six (6) months of bank statements for Checking account and current bank statement for Savings and retirement accounts. If account is new, provide any statements available. 6. Did your household citizenship/eligible immigration status change since the last Recertification ? Yes No If no, skip to question 7. A. CITIZENSHIP STATUS. My household has a change in citizenship or eligible immigration status. Name of household member(s): _____. Status changed from _____ to _____.


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