HOME Forms

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The following list of HOME forms and checklists available through this module is organized by the subject area in which the form would be used.

This index is most useful to individuals who know the type of program or activity for which they are seeking helpful forms.

The description of each form in the list below is made up of the following components:

ADMINISTRATION

Annual Performance Report (HUD-40107)
This form is used to meet the data collection and reporting requirements of the HOME statute. It collects information on program income, as well as Minority Business Enterprises and Women Business Enterprises, to be aggregated nationally. This form should be completed by the PJ and submitted to HUD before December 31 of each year. In order to ensure that you view, print, and/or download the most recent version of this form, use the link below to go to the forms portion of HUD Clips where you will have access to this HUD form and other official forms.

Application for Federal Assistance (SF-424)
This form is used by applicants as a required face sheet for pre-applications and applications submitted for Federal assistance, including HOME funds. The form accompanies the annual Action Plan submitted to HUD by each PJ. (The Action Plan is an annual update of the PJ’s Consolidated Plan describing the specific planned uses of the covered HUD programs, including HOME, as well as other program requirements.) In order to ensure that you view, print, and/or download the most recent version of this form, use the link below to go to the forms portion of HUD Clips where you will have access to this Standard Form and other official forms.

Consolidated Plan
The Consolidated Plan is a plan of up to five years in length that is submitted to HUD by each PJ in order to describe the community’s needs, resources, priorities, and proposed activities to be undertaken with the HOME, Community Development Block Grant, Emergency Shelter Grant, and Housing Opportunities for Persons with AIDs Programs. For more information about the Consolidated Plan, use the link below to go to HUD’s Consolidated Planning web site.

Funding Approval and HOME Investment Partnership Agreement (HUD-40093)
This form is an agreement between HUD and the PJ that identifies the previous HOME obligation, the current transaction, and the revised HOME obligation. It outlines the provisions by which HUD will make the funds available to the PJ upon execution of the form by both parties. A copy of this form should be maintained by the PJ. In order to ensure that you view, print, and/or download the most recent version of this form, use the link below to go to the forms portion of HUD Clips where you will have access to this HUD form and other official forms.

HOME Match Report (HUD-40107-A)
This form is completed by the PJ to report match contributions for the past Federal fiscal year. It should be submitted to HUD before December 31 of each year as part of the Annual Performance Report. A PJ may not be required to submit this report, either because it did not incur any match or because it had a full match reduction, but may submit a HOME Match Report if it wishes. For more information about the use of this form, click here to learn about HOME match. In order to ensure that you view, print, and/or download the most recent version of this form, use the link below to go to the forms portion of HUD Clips where you will have access to this HUD form and other official forms.

Match Log - PDF - Word
This form is a spreadsheet used to track HOME expenditures, the amount of match liability incurred, and the value of match contributions on an ongoing basis. For information about the use of this form, click here to learn about HOME match.

HOMEOWNER REHABILITATION

Bid Form - PDF - Word
This form is completed by the contractor as an official bid to perform the work described in a Housing Quality Standards (HQS) Inspection Form. The contractor is asked to provide a cost estimate and time frame for the work to be completed. This form should be placed in the project file by the PJ. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Certificate and Release - PDF - Word
This form is completed by the contractor following the completion of work to certify that the work was performed in accordance with the contract and to receive final payment(s). A copy of this form should be placed in the project file by the PJ. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Certificate of Final Inspection - PDF - Word
This form is completed by the PJ to document that the work on the identified property was performed in accordance with the property evaluation form and the approved contractor’s proposal for the case. This form should be placed in the project file by the PJ. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Change Order - PDF - Word
This form is completed by the homeowner and contractor to authorize change(s) to the original rehabilitation contract. A copy of this form should be placed in the project file by the PJ. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Contractor’s Data Sheet - PDF - Word
This form is completed by the contractor to provide essential information to the PJ and homeowner regarding the corporation and its business references, recent customers, and creditors. This form should be placed in the project file by the PJ. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Contractor Instructions - PDF - Word
This form is provided by the PJ to the contractor in order to provide written instructions on submitting a complete bid package to the homeowner. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Contractor Payment Request - PDF - Word
This is a form completed by the contractor to request payment for his/her work. It must be signed by the homeowner and the PJ’s construction advisor before any payment is released to the contractor. This form should be placed in the project file by the PJ. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Contractor’s Proposal Form - PDF - Word
This form is completed by the contractor to specify the work to be performed and the bid price for each work specification. It is based upon the Housing Quality Standards (HQS) Inspection Form. This form should be placed in the project file by the PJ. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Homeowner/Contractor Provisions - PDF - Word
This form provides sample language for provisions that should be included in the contract between the homeowner and the contractor. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Housing Quality Standards (HQS) Inspection Form - PDF - Word
This is a checklist that can be used to ensure that a property meets HUD’s Housing Quality Standards. The use of HQS is required for HOME tenant-based rental assistance only, but a PJ may choose to use HQS as its property standard. For more information about the use of this checklist, click here to learn about property standards.

Rehabilitation Tracking Sheet - PDF - Word
This checklist is used to document completion of HOME requirements related to presettlement activities, construction and close-out, and loan settlement. It should be completed by the PJ and placed in the project file. For more information about the use of this form, click here to learn about homeowner rehabilitation.

Verification of Mortgage or Deed of Trust - PDF - Word
This form gives authorization for the HOME PJ to verify the status of existing mortgages for all the members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about homeowner rehabilitation.

INCOME DETERMINATION

IRS Forms
In order to provide the most up to date forms possible, the HOME Front is providing a link to the IRS web site where you can download any IRS Form and its relevant instructions. For more information about the use of this form, click here to learn about the IRS Form 1040 definition of annual income.

Program Eligibility Release Form - PDF - Word
This form gives authorization for the named organization to obtain information from a third party relative to his/her eligibility in a HOME TBRA, homebuyer, rental rehabilitation, or homeowner rehabilitation program. It may also be used to determine continued eligibility or rent charged in a HOME TBRA program or HOME-assisted rental housing. For more information about the use of this form, click here to learn about verifying income.

Recertification of Annual Income by Government Programs - PDF - Word
This form is used to certify the amount of funding a household receives through a government program. A government administrator completes this form for the PJ to use when recertifying the income of rental housing tenants. For more information about the use of this form, click here to learn about income recertification for rental housing tenants.

Recertification of Annual Income by Tenant Family - PDF - Word
This form is completed by the tenant family to certify the household size and annual income. The tenant family returns this form to the PJ for use when recertifying the income of rental housing tenants. For more information about the use of this form, click here to learn about income recertification for rental housing tenants.

Sample Format for Calculating Adjusted Income - PDF - Word
This form provides a format that can be used to calculate adjusted income for HOME Program purposes. For more information about the use of this form, click here to learn about calculating adjusted income.

Sample Format for Calculating Part 5 Annual Income - PDF - Word
This form provides a format that can be used to assess assets and anticipated income and calculate Part 5 annual income. For more information about the use of this form, click here to learn about the Part 5 definition of annual income.

Sample Format for Computing Census Long Form Annual Income - PDF - Word
This form provides a format that can be used to assess and compute the anticipated annual income defined by the Census Long Form. For more information about the use of this form, click here to learn about the Census Long Form definition of annual income.

Sample Format for Computing IRS Form 1040 Series Adjusted Gross Income - PDF - Word
This form provides a format that can be used to compute the IRS Form 1040 series adjusted gross income. For more information about the use of this form, click here to learn about the IRS Form 1040 definition of annual income.

Sample Format for Computing Total Tenant Payment and PJ Subsidy: Rental Certificate Model - PDF - Word
This form provides a format that can be used to compute the total payment and PJ subsidy for a rental certificate model. This form is used with the Sample Format for Calculating Part 5 Adjusted Income. For more information about the use of this form, click here to learn about calculating assistance amounts.

Sample Format for Computing Total Tenant Payment and PJ Subsidy: Rental Voucher Model - PDF - Word
This form provides a format that can be used to compute the total payment and PJ subsidy for a rental voucher model. This form is used with the Sample Format for Calculating Part 5 Adjusted Income. For more information about the use of this form, click here to learn about calculating assistance amounts.

Verification of Alimony and Separation - PDF - Word
This form gives authorization for the HOME PJ to verify alimony and separation payments made to all members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Assets on Deposit - PDF - Word
This form gives authorization for the HOME PJ to verify assets on deposit for all members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Child Support Payments - PDF - Word
This form gives authorization for the HOME PJ to verify child support payments made to all members of the household applying for participation in the HOME Program on all or none. For more information about the use of this form, click here to learn about verifying income.

Verification of Employment - PDF - Word
This form gives authorization for the HOME PJ to verify employment income of all the members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Income from Military - PDF - Word
This form gives authorization for the HOME PJ to verify military service income of all the members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Income from Business - PDF - Word
This form gives authorization for the HOME PJ to verify business income of all the members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Pensions and Annuities - PDF - Word
This form gives authorization for the HOME PJ to verify pension and annuity income of all the members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Public Assistance Program - PDF - Word
This form gives authorization for the HOME PJ to verify public assistance income for all the members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Recurring Cash Contributions - PDF - Word
This form gives authorization for the HOME PJ to verify recurring cash contributions made to all members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Social Security Benefits - PDF - Word
This form gives authorization for the HOME PJ to verify Social Security benefit income for all the members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Unemployment Benefits - PDF - Word
This form gives authorization for the HOME PJ to verify information about unemployment benefits income for all members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

Verification of Veterans Administrative Benefits - PDF - Word
This form gives authorization for the HOME PJ to verify Veterans Administrative Benefits income for all the members of the household applying for participation in the HOME Program. For more information about the use of this form, click here to learn about verifying income.

RENTAL HOUSING

Affirmative Marketing, Tenant Selection, and Lease Compliance Checklist - PDF - Word
This checklist is used to document compliance with HOME requirements related to affirmative marketing, tenant selection, and lease compliance. It should be completed by the PJ and placed in the project file. For more information about the use of this form, click here to learn about rental housing.

Housing Quality Standards (HQS) Inspection Form - PDF - Word
This is a checklist that can be used to ensure that a property meets HUD’s Housing Quality Standards. The use of HQS is required for HOME tenant-based rental assistance only, but a PJ may choose to use HQS as its property standard. For more information about the use of this checklist, click here to learn about property standards.

Rent Determination Chart 1 — Low and High HOME Rents - PDF - Word
This form is completed by the PJ and given to the owner/manager of HOME-assisted rental housing in order to inform them of the current fair market rents with 50% and 65% rent limits as provided by HUD. For more information about the use of this form, click here to learn about HOME rent limits.

Rent Determination Chart 2 — Utility Allowance - PDF - Word
This form is used to determine the allowance for tenant-furnished utilities and other services. This form can be completed by the PJ and given to the owner/manager of HOME-assisted rental housing, or the owner/manager can complete it and submit it to the PJ for approval. For more information about the use of this form, click here to learn about HOME rent limits.

Rent Determination Chart 3 — Actual Maximum Rent Computation - PDF - Word
This form is completed by the PJ and given to the owner/manager of HOME-assisted rental housing as a tool to calculate the actual maximum rent. For more information about the use of this form, click here to learn about HOME rent limits.

Rental Housing Income Limits - PDF - Word
This form is completed by the PJ and given to the owner/manager in order to provide information about the income level per household size that is eligible for the HOME program. For more information about the use of this form, click here to learn about rental housing income limits.

Rental Project Compliance Report - PDF - Word
This form is completed by the PJ and kept in the project file to ensure that the project has met all the compliance requirements for the HOME Program. For more information about the use of this form, click here to learn about rental housing.

TENANT BASED RENTAL ASSISTANCE

Housing Quality Standards (HQS) Inspection Form - PDF - Word
This is a checklist that can be used to ensure that a property meets HUD’s Housing Quality Standards. The use of HQS is required for HOME tenant-based rental assistance only, but a PJ may choose to use HQS as its property standard. For more information about the use of this checklist, click here to learn about property standards.

Lease Addendum - PDF - Word
This form is used as an addendum to a lease to include the provisions necessary as a result of the tenant’s participation in a HOME rental assistance program. For more information about the use of this form, click here to learn about tenant-based rental assistance.

Rent Reasonableness Checklist and Certification - PDF - Word
This form is used as a checklist to ensure rent reasonableness in cases where HOME funds are used to provide rental assistance. For more information about the use of this form, click here to learn more about rent reasonableness.

Rental Assistance Contract - PDF - Word
This form is a tenant-based rental assistance contract that can be entered into by a participating jurisdiction and a landlord to ensure compliance with relevant HOME and other federal requirements. For more information about the use of this form, click here to learn more about tenant-based rental assistance.

Rental Assistance Coupon - PDF - Word
This coupon is issued by the program administrator to the tenant who is eligible to participate in a HOME rental assistance program. This document assumes that the payment will go to the landlord on behalf of an eligible tenant. For more information about the use of this form, click here to learn about tenant-based rental assistance.

Request for Unit Approval - PDF - Word
This form is completed by the tenant and the landlord to request the program administrator's approval of the unit for which the tenant has elected to receive rental assistance. For more information about the use of this form, click here to learn about approving TBRA units.

TBRA Applications for Rental Assistance - PDF - Word
These forms provide sample formats that can be used as applications for rental assistance, including a pre-application version and a full application version. For more information about the use of these forms, click here to learn about tenant-based rental assistance.

TBRA Budget Worksheet PDF - Word
This form provides a sample worksheet for estimating the costs and the budget for a project. For more information about the use of this form, click here to learn about tenant-based rental assistance.