Project Compliance Report: Rental Housing
Monitoring HOME Program Performance
Project Name: _________________________________________ Project Address: _________________________________________
Project ID: ____________________________________________ Reporting Period: ________________________________________
Unit
#
Size of
Household
# of
Bedrooms
Date of Last
Income
Certification
Monthly
Rent
Total
Tenant
Portion
Subsidy
Amount
Tenant’s
Annual Gross
Income
Race/
Ethnicity
of Unit
Vacant
or
Occupied
Utility
Allowance
Compliance
Y/N
(MDA only)
Section 1001 of Title 18 of the U. S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the United States as
to any matter within its jurisdiction. Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge. The
undersigned further understand(s) that providing false representations herein constitutes an act of fraud.
Reviewer: _________________________________________ Date: ____________________