Date of Income

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					                                              Calculation of Income Worksheet
                                    This worksheet must be used to calculate the annual gross household income of each assisted
                                    household. Please refer to the instructions for further guidance on completing the worksheet.

Applicant's Name:
Date of Application:
Household Size:                                  County or MSA:
   Payroll Frequency and Code            Payroll Factor                          Hourly Payroll Factor Calculation Chart
            Hourly (H)                See Calculation Chart            Number of hours worked per week:
            Weekly (W)                         52                      Multiplied by 52:                                 x   52
        Bi-weekly (BiW)                        26                      Equals Hourly Payroll Factor:
        Bi-monthly (BiM)                       24                      NOTE: Enter applicable Payroll Frequency Code next to
           Monthly (M)                         12                      any gross rate of pay entered below in Section I.


                               Section I: Calculation of Gross Annual Wage Income
Household Member #1 Name:
Year-to-Date Income                                                    Gross Rate of Pay:                                       Code
Dividied by # of months included in YTD:                        OR     Multiplied by Payroll Factor: x
Multiplied by 12 Equals Gross Wage Income:                             Equals Gross Wage Income:

Household Member #2 Name:

Year-to-Date Income                                                    Gross Rate of Pay:                                       Code
Dividied by # of months included in YTD:                        OR     Multiplied by Payroll Factor: x
Multiplied by 12 Equals Gross Wage Income:                             Equals Gross Wage Income:

Total Household Gross Annual Wage Income:

                                  Section II: Calculation of Other Annual Income
        Commission/Overtime/Bonus Income                                   Seasonal Income, including Unemployment
  Amount                   Calculation Notes                              Amount                    Calculation Notes
        x                                                                       x
    Total                                                                   Total

   Social Security/Supplemental Security Income                                      Pension/Retirement Income
  Amount                     Calculation Notes                            Amount                            Calculation Notes
        x                                                                       x
    Total                                                                   Total

                 Child Support Income                                                        Alimony Income
  Amount                          Calculation Notes                       Amount                            Calculation Notes
        x                                                                       x
    Total                                                                   Total

                Self-employment Income                                                        Other Income
  Amount                          Calculation Notes                       Amount                            Calculation Notes
        x                                                                       x
    Total                                                                   Total

Total Other Annual Income:


TOTAL HOUSEHOLD GROSS ANNUAL INCOME:
Applicable Income Limit, Adjusted for Family Size:                                                   Income Qualified?


Member/Sponsor signature, certifying he/she completed/reviewed this income calculation              Date


Homeowner/Homebuyer signature, certifying this income calculation is correct                        Date
                                                                                                                                       Revised February 2005

				
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posted:1/19/2011
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Description: Date of Income document sample