SAMPLE TENANT CONSENT TO DISCLOSE EIV INCOME INFORMATION
Appendix 3: Acceptable Forms of Verification
HUD Handbook 4350.3 REV-1 — Occupancy Requirements of Subsidized Multifamily Housing Programs · 2026 edition · updated 2026-10-05 · United States
| ACCEPTABLESOURCES | ||||||
|---|---|---|---|---|---|---|
| Third Party |
**Verification Tips ** | |||||
| Factor to be Verified | Written |
Provided by Applicant~~*e**~~ | Oral |
*Provided by Applicant | Self-Declaration | |
| Medical expenses. (See Chapter 5, Paragraph 5-10.D) |
Verification by a doctor, hospital or clinic, dentist, pharmacist, etc., of estimated medical costs to be incurred or regular payments expected to be made on outstanding bills which are not covered by insurance. |
Copies of income tax forms (Schedule A, IRS Form 1040) that itemize medical expenses, when the expenses are not expected to change over the next 12 months. Receipts, or pay stubs, which indicate health insurance premium costs, or payments to a resident attendant. Receipts or ticket stubs that verify transportation expenses directly related to medical expenses. |
Telephone or in- person contact with these sources, documented in file by the owner. |
Copies of cancelled checks that verify payments on outstanding medical bills that will continue for all or part of the next 12 months. Cancelled checks which indicate health insurance premium costs, or payments to a resident attendant. |
Notarized statement or signed affidavit of transportation expenses directly related to medical treatment, if there is no other source of verification. |
Medical expenses are not allowable as deduction unless applicant is an elderly or disabled family. Status must be verified. |
| Need for an assistive animal. (See Chapter 3, Paragraph 3-29) |
Letter from appropriate third party unless the need is readily apparent or already known. |
If the owner’s policy is to verify this need, owner must implement policy consistently. |
aNOTE : Requests for verification from a third party source must be accompanied by a Consent to Release form HUD-9887-A.
bNOTE : If the original document is witnessed but is a document that should not be copied, the owner should record the type of document, any control or serial numbers, and the issuer. The owner should also initial and date this notation in the file.
cNOTE : For all oral verification, file documentation must include facts, time and date of contact, and name and title of the third party.
d*NOTE: For use of EIV Income Reports as third party verification of employment and income a current Consent for Release form HUD-9887 must be on file.* c[*] NOTE: See examples and requirements found in Paragraph 5-13.B.1
HUD Occupancy Handbook 16 Appendix 3: Acceptable Forms of Verification
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Appendix 3
4350.3 REV-1
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