Exhibit 9-3: EIV Income Report Information

• a. TRACS certification information

• b. Personal Identifiers: name, date of birth and SSN

• c. Employment information

  1. New Hire Information (W-4)

     • (a) Date hired

     • (b) Employer name

  2. Employer name, address and employer identification number (current and past employers)

  • 3 Quarterly earnings

• d. Quarterly unemployment compensation

• e. Social Security benefit information

  1. Social Security benefits (SS)

     • (a) Payment status code

     • (b) Date of current entitlement

     • (c) Current net monthly benefit amount (if payable)

     • (d) Gross monthly benefit history (last 8 changes in benefit amount)

     • (e) Lump sum payment amount and date

     • (f) Payee name and address

  2. Dual Entitlement (Social Security benefits under another person’s SSN)

  3. Supplemental Security Income (SSI)

     • (a) Payment status code

     • (b) Alien indicator

     • (c) Current net monthly benefit amount

     • (d) Current monthly state supplement benefit amount

     • (e) Gross monthly benefit history (last 8 changes in benefit amount)

     • (f) Payee name and address

  4. Medicare data

     • (a) Payee name and address

     • (b) Monthly hospital insurance premium amount, buy-in status and buy-in start and end dates

     • (c) Monthly supplemental medical insurance premium amount, buy-in status and buy-in start and end dates

  5. Disability status and onset date

All EIV Income Reports contain the date the report was generated and by whom and the date EIV received each type of information.

HUD Occupancy Handbook Exhibit 9-3

8/13

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Exhibit 9-4

4350.3 REV-1