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SECTION 3 RESIDENT INFORMATION SHEET This form will be used in support of Newport News Redevelopment and Housing Authority’s (NNRHA) Section 3 efforts for providing economic opportunities to low and moderate income persons, particularly persons receiving federal assistance for housing. Providing the requested information is strictly voluntary and highly confidential. The information you provide will help NNRHA provide preference to persons that qualify under HUD regulations as Section 3 residents. Section 3 Resident(s) must be: e ~=©Aresident of public housing or « A low income person wha lives in a metropolitan area of a HUD assistance project or other low income residents APPLICANT INFORMATION Part I: Full Name: Last First ME Address: Street Address ApvUnit# City State Zip Code Part II: 1. Ido. do not, reside in public housing. If you do, please give the name of your housing community. 2. Ido do not, receive assistance from a Housing Choice Voucher (Section 8). If you do, please give the name of the agency that issued you the Housing Choice Voucher. HOUSEHOLD INCOME INFORMATION If you do not receive federal assistance, you may qualify for Section 3 based on household income and family size. Section 3 guidelines are based on Family Size (all persons living in your household) and household annual Income (all persons earning @ salary or income). On the chart below, find your family size and annual income and fill in the blanks below. If you have 2 people living in your household and your combined income totals $46,750 and you reside in the Metropolitan area or Non-metropolitan County in which the Section 3 covered assistance is expended, you qualify as a Section 3 resident. Family Size 1 2 3 4 5 6 7 3 Annual Household $49,550 $56,650 $63,700 $70,800 $76,450 $82,150 $87,800 $93,450 Income My Family Size is My Annual Household Income is $ | understand that the information above relating to the size and annual income of my family may require verification. Upon request, | agree to provide documents verifying this information. | also authorize my employer to release this information for the United States Department of Housing and Urban Development, the Newport News Redevelopment and Housing Authority and the prime and / or sub-contractors to verify my status as a “Section 3 Resident.” I declare and affirm under penalty of prosecution for perjury that the statements made herein are true and accurate to the best of my knowledge. | understand that falsifying information and incomplete statements may be cause to disqualify this certification. Signature Date Marshall Courts Phase VII Demolition LFB #MCP7D-09-24 ATTACHMENT “J” Page 2 of 4

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