Form 14.14 - Verification of Child Support Payments - Download as DOC

							                        TEXAS D EPARTMENT OF HOUSING AND COMMUNITY AFFAIRS
                                              Housing Trust Fund Program




                            VERIFICATION OF CHILD SUPPORT PAYMENTS

Contract Administrator Name:                                                          Contract Number:
Address:

Phone:                                     Fax:                                       Email:

Applicant Name:
RELEASE: Applicant’s signature here or on attached “Housing Trust Fund (HTF) Program Eligibility Release
Form” (Form 914.21) authorizes the release and/or verification of the requested Child Support Payment
information.


______________________________________________                            ____________________
Signature of Applicant                                                    Date

                  State regulations require verification of emp loyment and inco me of all members for any household
Authorization who applies for HTF Program funds. Emp loy ment and income must be re-examined and
and           re-verified periodically. We ask your cooperation in providing this informat ion to the above- referenced
Verification: Contract Administrator. The informat ion you provide will be used only to determine the elig ibility status
                  and level of benefit available to the applicant household..

Name of person paying child support:
Address of person paying child support:


Support is for:       his children        her children
Amount of support payment: $ ____________________ Per                       Week       Month        Year
Signature of Authorized Representative: ______________________________________________
Title:                                     Date:                                     Phone:

WARNING: Ti tle 18, Section 1001 of the U.S. Code states that a person is guilty of a fel ony for knowi ngly and
         willingly making false or fraudulent statements to any department of the United States Government .




TDHCA – Housing Trust Fund Program                                                                               Page 1 of 1
Form 914.14 – Verification of Ch ild Support Payments                                                            March 2008