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SECTION 3 INDIVIDUAL LOW-INCOME PERSON SELF-CERTIFICATION FORM.
(In compliance with Section 3 of the HUD Act of 1968)
The purpose of this form is to comply with Section 3 of the HUD Act of 1968 self-certification income requirements. To
count as a Section 3 individual, any legal resident of the United States annual income must not exceed the HUD income
limits for the year before they were hired, or, the individual’s current year annualized for the year you are being confirmed
as low-income.
Printed Name:
Street Address: (No P.O. Box) Apt# City State Zip
Phone #: Email:
To qualify as a Section 3 person, you must meet one of the standards on the left side box and your income not exceed the
number in the right side box below,
Check only one line below that describes your situation:
____ lam Public Housing Resident or Section 8 assists me with my
rent.
___ | was a Public Housing Resident or Section 8 assisted me with
0 My individual Income does not exceed:
my rent. Ifso what year and where did you reside:
__ Ireceive no HUD support, but | am low-income because my
individual income does not exceed $52,400 and I live in the $56,400
Hampton roads Metropolitan area.
___ Are you currently or have you ever been a YouthBuild (2024)
participant; if so when and where:
For additional comments:
I hereby certify to the US Department of Housing Development (HUD) that all of the information on this
form is true and correct, J attest under penalty of perjury that my total income does not exceed the
income that is shown above, and that proof of this information may be requested. I understand if found
inaccurate, I may be disqualified as an applicant and/or a certified Section 3 individual. Finally, I
authorize including my name on a list of Section 3 Residents seeking employment and to include my
contact information so that contractors may contact me directly for any employment opportunities.
Signature Date
Marshall Courts Phase VII Demolition
IFBEMCP7D-09-24 ATTACHMENT “J”
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