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SECTION 3 BUSINESSES SELF -CERTIFICATION FORM
(In compliance with Section 3 of the HUD Act of 1968)
This purpose of this form is to comply with Section 3 of the HUD Act of 1968 Business Certification
requirements. To count as a Section 3 Business your company must meet one of the listed categories below.
Each category will require additional documentation to support the election. You must provide that supporting
documentation with this form to be properly and completely confirmed as a Section 3 business. If this form is
submitted without the required supplemental data, your certification will not be processed.
Please fill this portion out and mark your election; additional documentation may be required.
Over 75 percent of the labor
hours performed for the
business over the prior three-
month period are performed by
Section 3 workers; or
Provide the last 90 days fall
payrolls for the entire company,
make a list of the names from the
payrolls of the Sections 3 workers,
and provide a completed Section 3
individual Self-Certification form
for all low-and very low-income
workers listed.
Are you a Section 3 Business? (Circle one) YES NO
Company Name: Title:
Print Name: Date Signed:
Address: Email:
Telephone Number: Fax Number:
Type of Business: (circle One) Corporation. Partnership Sole Proprietorship Other
Please List All Owners of The Business:
Marshall Courts Phase VII Demolition
IFB&MCP7D-09-24
ATTACHMENT “J”
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