| a. |
Check here if Voucher:
, if Certificate or Low Rent leave unchecked.
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| b. |
Select Participant's # of family members:
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| 1. |
Current Annual Income (Enter amount on line 5 of form HUD-50058.)
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| 2. |
Applicable Lower-Income (Enter the current lower-income limit for the
in which the FSS family is living.)
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| 3. |
Current Adjusted Income (Enter amount on line 10b of form
HUD-50058.) If Line 3 is greater than line 2, this family
does not qualify for an FSS credit.
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| 4. |
Earned income included in the line 1 (Add up the income items coded
B, M, F, and W in column 3a of form HUD-50058.)
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| 5. |
Earned income included in Annual Income on effective date of the
FSS Contract of Participation. (Enter amount from contract of
participation.)
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| 6. |
Increase in earned income since the effective date of the FSS
Contract of Participation. (Subtract line 5 from line 4. If negative
enter 0.)
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| 7. |
Current annual Income less increases in earned income since the effective
date of the FSS Contract of Participation. (Subtract line 6 from line 1.)
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| 8. |
Thirty percent of current monthly Adjusted Income (Line 3 divided by 40.
The calculated amount should equal the amount on line 11 of form
HUD-50058.)
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| 9. |
Current Adjusted Income less increase in earned income since the effective
date of the FSS Contract of Participation
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| 10. |
30% of current Adjusted Income less increase in earned income since the
effective date of the FSS Contract of Participation. (Line 9 divided by 40.)
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| 11. |
10% of current monthly Annual Income less increase in earned income since the
effective date of the FSS Contract of Participation. (Line 7 divided by 120.)
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| 12. |
If applicable, welfare rent (enter amount on line 13 of form HUD-50058) or
public housing ceiling rent (enter amount on line 16a of form HUD-50058)
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| 13. |
TTP based on current annual Income less increase in earned income since effective
date of FSS Contract of Participant. (If rental vouchers, enter the amount on
line 10, otherwise, enter the greater of line 10, 11, or 12.)
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| 14. |
Difference between 30% of current monthly Adjusted income and TTP adjusted for
increases in earned income. (Subtract line 13 from line 8. Enter 0 if negative
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| 15. |
Current TTP (Enter the amount on line 16b of form HUD-50058 or, in the case of
rental vouchers, enter the amount on line 8 of this form
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| 16. |
TTP on the effective date of the FSS Contract of Participation or, in the case of
rental vouchers, 30% of the monthly Adjusted Income on the effective date of the
Contract of Participation. (Enter amount from contract of participation.)
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| 17. |
Difference between current TTP and TTP on effective date of the FSS Contract of
Participation. (Subtract line 16 from line 15. Enter 0 if negative.)
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| 18. |
Enter the lesser of line 14 or line 17.
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| 19. |
Applicable Very Low-Income Limit (Enter the current very low-income limit for the
jurisdiction in which the FSS family is living.)
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| 20. |
Amount by which Adjusted Income exceeds the Very Low-Income Limit (Subtract
line 19 from line 3.)
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| 21. |
30% of the the amount by which Adjusted Income exceeds the Very Low-Income
Limit (Line 20 divided by 40)
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| 22. |
Escrow credit (Subtract line 21 from line 18.)
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