Exhibit 7-5: Sample — HUD Handbook 4350.3 REV-1

Name of Tenant: ____________________________________________

Address/Unit No.: ___________________________________________

Date Initial Letter Mailed to Tenant to Arrange Recertification Interview: //___
Date and Type of Action Required to Follow Up Initial Letter to Arrange Recertification Interview:

Date

Type of Action

///___ ____________________________________________ (M D y) ///___ ____________________________________________ ///___ ____________________________________________

Date Recertification Interview Completed //___. If interview not completed, give
Member #1*

For verifications not available in the EIV System:

	Verifications Sent To:	Processing Dates:
	Written	Oral
	Sent Rec’d	Sent Rec’d
a. __________________	________	________	________	________
b. __________________	________	________	________	________
c. __________________	________	________	________	________
d. __________________	________	________	________	________
e. __________________	________	________	________	________

This information should be completed for all household members. Include additional sheets as needed.

HUD Multifamily Occupancy Handbook Exhibit 7-5

8/13

4350.3 REV-1