TENANT:

1. Annual Income $0.00

2. DEPENDENTS (do not include HEAD OR SPOUSE) DO NOT ENTER ANYTHING HERE!!
Family members that are either: 1) Scroll down to start at income
A. Under 18 years of age 0 2) Only enter information in yellow
B. Disabled or Handicapped - 18 years 0 3) Cells with a red mark have a note
4) Everything in green will be calculated for you
C. Full time students - 18 years/older 0
5) Click on
INSERT TOTAL NUMBER 0 Calculatin Worksheet tab to complete
Times $480.00 $0.00

3. Childcare Expenses: $0

ELDERLY HOUSEHOLDS ONLY:

(Head or Spouse is 62, Diabled or Handicapped)
4. Total Medical Expenses $0.00

5. Annual Income (Line 1) x .03 $0.00

6. Total Allowable Medical Expenses $0.00

7. Insert $400 per Elderly household . $0.00

8. Total Adjustments (2,3,6 & 7) $0.00

9. Adjusted Income (1 minus 8) $0.00

10. Monthly Income (1 divided 12) $0.00

11. 10% of Monthly Income (10 times .1) $0.00

12. Monthly Adjusted Income (9 divided by 12) $0.00

13. Line 12 x .30 $0.00

Anyone 18 an
sign criminal h
14. Computed Total Tenant Payment (TTP) $25 Personal Decla
the greatest of lines 11 & 13, or a minimum of $25.00 $25.00 Authorization
and family res
form

PREPARED BY: enter 1 if sourc

Date: May 23, 2023 (ex: SSI, TANF
 sign criminal h
Personal Decla
Authorization
and family res
form

enter 1 if sourc
(ex: SSI, TANF
Enter Tenant Name
How
FAMILY INCOME (list each person Hrs per pay often
receiving income) Relationship DOB Age Source Rate of pay period paid Gross Income
0 $0.00 weekly = 5
0 $0.00 biweekly =
2 x a mont
0 $0.00 monthly =
0 $0.00
0 $0.00
IS HOUSEHOLD RECEIVING FOOD STAMPS? YES NO AMOUNT PER MONTH ► $0.00
TOTAL ANNUAL INCOME $0.00
example:
checking, sav
stocks,bonds
ASSETS: (List each person Interest Imputed Income greater of actual Real Property
receiving asset) Source Amount Rate Actual Income Passbook Rate (over $5,000) or imputed
$0.00 2.50% $0.00 $0.00
$0.00 2.50% $0.00 $0.00
$0.00 2.50% $0.00 $0.00
$0.00 2.50% $0.00 $0.00
$0.00 2.50% $0.00 $0.00
Total Asset Income $0.00

DEPENDENTS
Name DOB Age Social Security Relationship UNDER 18
0 0
0
OVER 18 REMEMBER
0 DISABLED time studen
0 0 working on
$480 for th
0
OVER 18 FULL
0 TIME STUDENT
0 0

weekly = 52
MEDICAL EXPENSES biweekly = 26
Name Source Amount How often paid 2x a month =
monthly = 12
$0
$0
$0
$0
$0
Enter $400 in blue box if head of household
or spouse is 62 or disabled. Total Medical Expenses $0
Enter $400 if head or spouse
weekly = 52
is 62 or disabled
biweekly = 26
CHILDCARE EXPENSES 2x a month =
Child’s Name Source Amount How often paid monthly = 1

$0
$0
$0
$0
$0
Total Child Care $0
Make sure tenant is not
receiving assistance from
another person or agency
Make sure tenant is not
receiving assistance from
another person or agency
 nyone 18 and older must
gn criminal history,
ersonal Declaration,
uthorization for release
nd family responsibilities
orm

nter 1 if source is monthly

x: SSI, TANF)
 gn criminal history,
ersonal Declaration,
uthorization for release
nd family responsibilities
orm

nter 1 if source is monthly

x: SSI, TANF)

weekly = 52
biweekly = 26
2 x a month = 24
monthly = 12

example:
checking, savings,
stocks,bonds, CD, IRA,
Real Property

REMEMBER! If full
time student is
working only count
$480 for the year

weekly = 52
biweekly = 26
2x a month = 24
monthly = 12

weekly = 52
biweekly = 26
2x a month = 24
monthly = 12
 CALCULATION WORKSHEET
WORKSHEET FOR HOUSING CHOICE VOUCHER PROGRAM COMPUTATIONS
✘ HOUSING CHOICE VOUCHER (use lesser of PS or GR on line 1)
PRE-MERGER VOUCHER: Interim on/after 10/1/99 prior to 1st annual reexam (Use old PS on line 1)
1st annual reexam on/after 10/1/99 (Use greater of current or old PS on line 1) # OF BEDROOMS TENANT
Interim between 1st & 2nd reexam (Use PS used at last annual on line 1) IS ACTUALLY ELIGIBLE
2nd annual reexam (Use lesser of PS or GR on line 1) FOR
FAMILY NAME
ACTUAL BEDROOM SIZE
0 #BR per PHA #BR LEASED OF UNIT
MAXIMUM HOUSING VOUCHER SUBSIDY
IF ABOVE AMOUNTS ARE DIFF
1) Applicable Payment Standard: Gross Rent $0 Enter lesser of:
Effective Date 1) $0 Voucher size
2) TTP 2) $25 Unit leased
3) Maximum Subsidy: 3) $0
Applicable payment Standard (#1) - TTP (#2)

TOTAL FAMILIY CONTRIBUTION (TFC) & TOTAL SUBSIDY DON'T FORGET TO DO

4) Rent to Owner 4) AFFORDABILITY CHECK
5) Utility Allowance (for utilities not included) 5) FOR NEW TENANTS OR
CHANGE OF UNITS ONLY
6) Gross Rent: Rent to Owner (# 4) + UA (# 5) 6) $0

7) Total Family Contribution:

Gross Rent (# 6): $0
Minus Maximum Subsidy(# 3): $0 7) $0

8) Total Voucher Subsidy:

Gross Rent(# 6): $0
Minus TFC (# 7) $0 OR (# 3)
LESSER OF $0 $0 8) $0

HOUSING ASSISTANCE PAYMENT AND UTILITY REIMBURSEMENT

9) Housing Assistance Payment (HAP) to Owner:
Lesser of:
Total Voucher subsidy (# 8) $0 TDHCA PORTION
Rent to Owner (# 4) $0 9) $0

10) Utility Reimbursement to Family

Total voucher subsidy (# 8) $0 TENANT'S UTILITY
Minus HAP (# 9) $0 10) $0 ALLOWANCE

FAMILY RENT TO OWNER TENANT'S PORTION OF

11) Rent to Owner (# 4) $0 11) $0 RENT
Minus HAP (# 9) $0

12) Accuracy Check

Family rent to Owner (#11) $0
Plus Utility Allowance (# 5) $0
Total $0
Minus URP (# 10) $0 = 12) $0

13) AFFORDABILITY CHECK NEW MOVE IN OR CHANGE OF UNIT N/A RENEWALS

Is gross rent (# 6) $0.00 greater than PS used to determine (#1) $0
YES
NO
Monthly adjusted income: $0
times 0.40 $0 (40% of MAI)
TFC (#7) $0 ◄ CANNOT BE MORE THAN 40% OF THE MAI

RENT IS AFFORDABLE YES NO

DATE OF COMPLETION: STAFF INT:

Worksheet for Prorated Rent for Citizen/NonCitizen Mixed Families

HAP for #2 = lesser of ► PS - TTP Gross Rent-TTP
$25 $0

1. Gross Rent (line 6 from Calculation worksheet) $0

2. HAP Payment $25

3. Enter total # of Family members in household

eligible Immigrant Status

5. Pro-Ration Factor #DIV/0!

6. PRORATED HAP #DIV/0!

7. Family Share #DIV/0!

HAP TO OWNER #DIV/0!

TENANT RENT TO OWNER #DIV/0!
UTILITY REIMBURSEMENT TO TENANT #DIV/0!