RBD FASTForms Individual Forms

Agreement EIV Privacy

Agreement EIV Privacy Auditors

This document is NOT required by HUD but may be referenced in your EIV Policy.  If so, both documents should be consistent.  Keep in mind that the EIV rules of Behavior must be signed by people conducting any HUD audit where the auditor would have access to EIV reports.  

Agreement Repayment (Pre-HOTMA)

Residents who have received improper subsidy payments due to failure to report, must return any improper payment to HUD.  This sample agreement outlines the requirements, payment plan and penalties for failure to meet the terms of the agreement. This Pre-HOTMA version requires the resident to report if income changes by $200/month.

Agreement Repayment HOTMA

Updated for HOTMA and/or TRACS 2.0.3.A
Residents who have received improper subsidy payments due to failure to report, must return any improper payment to HUD.  This sample agreement outlines the requirements, payment plan and penalties for failure to meet the terms of the agreement. This HOTMA version requires residents to report if Annual Adjusted Income changes by 10% or more per month.

Agreement Repayment Policy (Pre-HOTMA)

If you want to establish a policy to reduce the number of repayment agreements for a single family, it is best to make sure you can prove that you have explained the policy.  Use this Memorandum of Understanding to document conversations with your residents.  This Pre-HOTMA version requires the resident to report if income changes by $200/month.

Agreement Repayment Policy HOTMA

Updated for HOTMA and/or TRACS 2.0.3.A
If you want to establish a policy to reduce the number of repayment agreements for a single family, it is best to make sure you can prove that you have explained the policy.  Use this Memorandum of Understanding to document conversations with your residents.  This HOTMA version requires residents to report if Annual Adjusted Income changes by 10% or more per month.

Agreement Repayment Unpaid Rent (Pre-HOTMA)

Owner/agents may use this repayment agreement to establish a payment plan for unpaid rent.  This is for the tenant portion of the rent and should not be confused with repayment agreements for improper subsidy payments created when a resident fails to fully and accurately report income.  This Pre-HOTMA version requires the resident to report if income changes by $200/month. 

Agreement Repayment Unpaid Rent HOTMA

Updated for HOTMA and/or TRACS 2.0.3.A 
Owner/agents may use this repayment agreement to establish a payment plan for unpaid rent.  This is for the tenant portion of the rent and should not be confused with repayment agreements for improper subsidy payments created when a resident fails to fully and accurately report income.  This HOTMA version requires residents to report if Annual Adjusted Income changes by 10% or more per month. 

Agreement Repayment Zero Income

Residents who have received an improper payment, due to failure to fully and accurately report, must return that improper payment to HUD.  This sample agreement outlines the requirements when a person has zero income and explains penalties for failure to meet the terms of the agreement.  There is no need for a HOTMA version of this Zero Income Repayment Agreement because residents are required to report any new income. 

Checklist EIV 120 Day Post Move In HOTMA

Updated for HOTMA and/or TRACS 2.0.3.A
Owner/agents must not implement HOTMA EIV Changes until HOTMA compliant site software is available and implemented.  Use this checklist to document review of EIV reports 120 days after the submission of a Move-in or an IR adding a new member.  Review of the Income Discrepancy Report has been removed.  Previous to implementation of HOTMA, the requirement is to review these reports, including the Discrepancy Report, within 90 days of submitting a Move-in Certification/Initial Certification or an IR adding a new member. 

Checklist EIV 90 Day Post Move In (Pre-HOTMA)

Previous to implementation of HOTMA, the requirement is to review EIV Income Reports within 90 days of submission of a Move-in/IC or an IR adding a new member.  Use this checklist to document review of EIV reports within 90 days of submitting a Move-in/IC or an IR adding a new member.  Owner/agents must review the Income Report and the Income Discrepancy Report.

Checklist EIV AR/IR (Pre-HOTMA)

Pre-HOTMA, review of the EIV Income Reports is required at AR and IR, regardless of the reason for the IR.  Owner/agents are required to review the EIV Income Discrepancy Reports.  This checklist includes the EIV Discrepancy Workbook. 

Checklist EIV for the Deceased Tenant Report

Checklist EIV for the Failed Pre-Screening Report

Checklist EIV for the Failed Verification Report

Checklist EIV Monthly Quarterly Reporting (Pre-HOTMA)

These reporting logs assist with monitoring compliance with current EIV requirements.  Property managers can use these logs to document that EIV reports have been run in compliance with HUD requirements and the property’s EIV Use Policy.  This checklist calls for monthly review of Income Reports and the EIV Identity Verification Reports, and calls for quarterly review of the Multiple Subsidy Report, the New Hires Report and the Deceased Tenant Report.  For OAs performing quarterly income review for zero income families, there is also a call to review the No Income on 50059 and No Income from SSA/HHS.  If you change reporting requirements in the EIV Use Policy and you plan to use reporting logs, you must change the reporting logs to coincide. 

Checklist EIV Monthly Quarterly Reporting HOTMA

Updated for HOTMA and/or TRACS 2.0.3.A 
Owner/agents must not implement HOTMA EIV Changes until HOTMA compliant site software is available and implemented.  These reporting logs assist with monitoring compliance with EIV requirements after implementation of HOTMA.  Property managers can use these logs to document that EIV reports are run in compliance with HUD requirements and the property’s EIV Use Policy.  This HOTMA version removes the requirement to review the EIV Income Discrepancy Report when creating the AR or IR, adds the requirement to review the New Hires Report at AR and changes the requirement to review EIV Income Reports from 90 days after MI/IC/IR to 120 days after MI/IC/IR.  We have also removed reports reviewed for zero income families.   If you change reporting requirements in the sample use policy and you plan to use reporting logs, you must change the reporting logs to coincide.  

Checklist EIV Monthly Reporting (Pre-HOTMA)

These reporting logs assist with monitoring compliance with current EIV requirements.  Property managers can use these logs to document that EIV reports have been run in compliance with HUD requirements and the property’s EIV Use Policy.  This checklist calls for monthly review of all reports.  For OAs performing quarterly income review for zero income families, this checklist calls for quarterly review of the No Income on 50059 and No Income from SSA/HHS.  If you change reporting requirements in the EIV Use Policy and you plan to use reporting logs, you must change the reporting logs to coincide. 

Checklist EIV Monthly Reporting HOTMA

Updated for HOTMA and/or TRACS 2.0.3.A 
Owner/agents must not implement HOTMA EIV Changes until HOTMA compliant site software is available and implemented.  These reporting logs assist with monitoring compliance with EIV requirements.  Property managers can use these logs to document that EIV reports are run in compliance with HUD requirements and the property’s EIV Use Policy.  This HOTMA version removes the requirement to review the EIV Income Discrepancy Report, adds the requirement to review the New Hires Report at AR and changes the requirement to review EIV Income Reports from 90 days after MI to 120 days after MI.  We have also removed reports reviewed for zero income families.   If you change reporting requirements in the EIV Policy Template and you plan to use reporting logs, you must change the reporting logs to coincide.  

Checklist EIV Multiple Subsidy

Checklist EIV New Hires

Checklist EIV Recertification

Checklist EIV Recertification HOTMA

Updated for HOTMA and/or TRACS 2.0.3.A
Owner/agents must not implement HOTMA EIV Changes until HOTMA compliant site software is available and implemented.  With the implementation of HOTMA, use of EIV Income Reports at IR will be optional. In addition, use of the EIV Income Discrepancy Report is not required until HUD updates the algorithm used to identify a discrepancy.  Use this checklist to document review of EIV reports at AR.

Consent HUD Disclosure of EIV Information

In HUD Notice 13-06, HUD clarified that EIV information can only be disclosed 1) to people participating in the certification process 2) only with written permission.  HUD added a sample form with the release of the HUD Notice 11-21.  Subsequently, this form was added to HH 4350.3 Exhibit 9-4 in December 2013.  This requirement applies to adult household members.  We have taken the PDF version in the notice and converted it to Microsoft Word.  Please note that this version is available for free on our RBD EIV Resource Page.

Notice App Existing Tenant Search Conflict

Notice EIV Disability Conflict

Notice EIV Failed SSA Verification

Notice EIV Multiple Subsidy Conflict

Notice Extermination

Notice HUD Housing Counseling Agency

Notice Lease Violation Failure to Report a Change Employment or Income

Notice Lease Violation Multiple Repayments

Some owner/agents limit the number of repayment agreements.  Use this notice when there is a second or subsequent improper payment and the owner/agent requires full repayment or eviction.

Notice Repayment Requirement to Sign

Notice Requirement to Sign 9887

Notice Term Assistance Deceased Tenant

When a resident does not respond to requests for information related to the EIV Deceased Tenant Report, the owner agent must terminate assistance for all programs except PRAC.  For PRAC, the penalty is termination of tenancy.  This form provides the required notice of termination of assistance.  Do not use for PRAC.  There is no termination of assistance for PRAC.

Notice Term Assistance Fail to Respond

Use this form when a resident has been notified of a requirement to report but the resident does not respond in the required timeframe.  See HH 4350.3 Paragraph 7-12.  The penalty is termination of assistance.  Do not use for PRAC.  There is no termination of assistance for PRAC.

Notice Term Ten Deceased Tenant

Notice Term Ten Multiple Repayments

Notice Term Tenancy Lease Violation Material

Use this notice when a resident commits a material lease violation.  Resident has been notified of the requirement to correct but has failed to do so. 

Notice to HUD Resident Failed Report/Repay Improper Payment

NTF No 3rd Party Other HUD Residence

Note to File.  This document is used when a resident shows up on the EIV Existing Tenant Search or the Multiple Subsidy Report, but the other property will not respond to inquiries related to Dual Subsidy.

NTF SSA No EIV

Note to File.  Use this form document why EIV was not used as part of SS Income Verification.

Policy EIV Reporting Summary Template (Pre-HOTMA)

This document provides staff with a summary of your EIV reporting process.  It must be modified to match your policy before implementing.

Policy EIV Use Template HOTMA

Updated for HOTMA and/or TRACS 2.0.3.A
Please note, this is the HOTMA version of the EIV Policy.  This version of the EIV Policy may not be implemented prior to implementation of HOTMA compliant site software.  This is a comprehensive EIV Use and Security Policy which incorporates sample policies based on HUD instruction provided in HUD HSG Notice 2023-10, HUD HSG Notice 13-06, HH 4350.3, and other HUD guidance.  Multiple options are provided, and owner/agents MUST edit this template before finalizing policies. 

Policy EIV Use Template (Pre-HOTMA)

Please note, this is not the HOTMA version of the EIV Policy.  This is a comprehensive EIV Use and Security Policy which incorporates sample policies based on HUD instruction provided in HUD HSG Notice 13-06, HH 4350.3 Chapter 9, and other HUD guidance.  Multiple options are provided, and owner/agents MUST edit this template before finalizing policies. 

Policy Repayment Agreement Template

Screening Rental History Questionnaire

Security Data File Destruction Log

Security EIV Owner Authorization

Security Employee Forms Checklist WASS

Self Certification EIV Income Verification

New Form To Be Implemented When HOTMA is Implemented.
This form is used at AR as self-certification in combination with the EIV Income Report.  Resident is self-certifying that the income information in EIV is representative of the income that will be earned in the upcoming year.  Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed but HSG Notice 2023-10 indicates that witness signatures are not required in this case

Self Certification EIV New Hire

The form is used to document residents' response when there is new employment, the employer will not respond to verification requests and the resident does not have proper documentation (not enough pay stubs).  This advises the resident that the owner/agent will not delay IR.  Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed.

Self Certification Income

Self Certification Joint Custody

Self Certification of EIV Employment Discrepancy

Self-certification EIV Employment/Income Accuracy

This form is used when the EIV Income Report includes unknown information about Employment.  Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed.

Self-certification EIV Existing Tenant Search

The form is used to document applicant’s response to inquiries about subsidy indicated on the Existing Tenant Search or Multiple Subsidy Report.   Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed.

Self-certification EIV Multiple Subsidy

Use this form to document resident’s response to inquiries about dual/multiple subsidy indicated in EIV.  Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed.

Self-certification EIV SS Income Accuracy

The form is used to document residents' response to inquiries about Social Security income listed on various EIV income reports.  This can also be used as self-certification of income when investigating income discrepancies.  Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed.

Self-certification EIV SSN

Because SSA information is not perfect, sometimes EIV returns an error for an SSN and the error is invalid.  Use this form to document discussions with residents regarding EIV SSN errors.  Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed.

Self-certification No SSN (Pre-HOTMA)

Anytime a member cannot provide an SSN or adequate documentation to verify the SSN, owner/agents should advise the member of the requirements.  This form can be used to communicate HUD's rule.  This is very important when a minor under the age of six is added to a household because the family has 90 days to provide the SSN and adequate documentation to verify the SSN.  Failure to do so will result in termination.  Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed. This Pre-HOTMA version calls for termination of tenancy when required SSNs are not produced.

Self-certification No SSN HOTMA

Updated for HOTMA and/or TRACS 2.0.3.A
Anytime a member cannot provide an SSN or adequate documentation to verify the SSN, owner/agents should advise the member of the requirements.  This includes the new requirement for owner/agents to accept self-certification with accompanying documents.  This form can be used to communicate HUD's rule.  This is very important when a minor under the age of six is added to a household because the family has 90 days to provide the SSN and adequate documentation to verify the SSN.  Failure to do so will result in termination of assistance for all programs except PRAC and termination of tenancy for the PRAC program.  Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed. 

Self-certification Unexplained SS Deductions

In some cases, EIV will not provide enough detail to explain the difference between Gross SSA awards and Net SSA awards.  Use this form when the resident must provide additional information about unexplained SSA deductions.   Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed.

Self-certification Use of Funds – Representative Payee

Owner/agents may use this form when a resident receives benefits, but those benefits are paid to a Representative Payee.  The income must be associated with the recipient (not the Representative Payee) and the asset where the money is deposited is essentially owned by the recipient (not the Representative Payee).  When a minor is part of a joint custody arrangement, the income and the asset are associated with the family taking advantage of the $480 Dependent Deduction.  Per HH 4350.3 Paragraph 5-13, family self-certifications must be notarized or witnessed

Verification Eligibility HUD Assistance

Verification Employment Income Dispute EIV

Verification Move-out

Some owner/agents are struggling to keep new residents compliant with single subsidy requirements.  This document may help assist with the effort.  If an applicant is currently receiving assistance in another HUD assisted residence, owner/agents may want to verify move-out before allowing the resident to move into the new unit.  This will help ensure compliance with the single subsidy rule and may assist in resolving disputes that may come up in the future. 

Worksheet - EIV Income Discrepancy Calculation

Worksheet Repayment Calc