Income Discrepancy Summary Report
Income Discrepancy Report
New: Note Button
Documentation of No Discrepancy Report
Income Discrepancy Example:
Peter Piper
4/10/10 Annual
6XPPDU\5HSRUW
,QFRPH5HSRUW
Contract Number
Project:
Next Re-certification Date:
Address:
Most Recent Type of Action:
,QFRPH'LVFUHSDQF\5HSRUW
Wage and Benefit Report for Household of PETER PIPER
Subsidy Type
NC12M121212
Project Number
WILLOW STREET APARTMENTS
Form 50059 as of:
04/01/2011
5C – 8888 WILLOW STREET, CHARLOTTE NC 28201
Effective Date:
AR-Annual Recertification
Head of Household: PETER PIPER
Social Security Number:
***-**-9191
Household Member:
PETER PIPER
Date of Birth:
XX/XX/1965
Employment Information
EIV received no Employment (W4) data.
Section 8
01333339
03/11/2010
04/01/2010
XX/XX/1965
Print Member Information
Date of Birth:
SSN:
Relationship:
***-**-9191
Head of Household
Wages
EIV received no income data.
Unemployment Benefits
EIV received no benefit data.
Social Security Benefits
Verification Data
Payment Status Code:
Date of Current Entitlement:
Net Monthly Benefit if Payable:
Payee Name and Address:
C - Current payment status (except
railroad payment)
12/2003
$748.00
PETER PIPER
8888 WILLOW STREET
APT 5C
CHARLOTTE NC
Benefit History
Date
Gross Benefit
12/2010
12/2009
12/2008
12/2007
12/2006
04/2006
12/2005
12/2004
$748.00
$748.00
$748.00
$707.00
$691.00
$669.00
$669.00
$643.00
Benefits paid
Benefits paid
Benefits paid
Benefits paid
Benefits paid
Benefits paid
Benefits paid
Benefits paid
Lump Sum
Date
Amount
12/01/2009
$482.00
Date Received by EIV: 12/06/2010
Dual Entitlement
Verification Data
Date Received by EIV: null
Benefit History
Medicare Data
Verification Data
Premium Buy-in Buy-in Start Buy-in Stop
Supplemental Security Income Benefits
EIV received no benefit data.
Disability
Disability:
Date Received by EIV: 12/05/2010
YES
On-set Date:
12/1/2003
Household Member:
PATTY PIPER
Date of Birth:
XX/XX/1985
Employment Information
EIV received no Employment (W4) data.
Wages
Pay
Period
Amount FEIN
Q2 of 2010
$2,167.00 23-4444444
Q1 of 2010
$1,984.00 23-4444444
Q4 of 2009
$2,068.00 23-4444444
Q3 of 2009
$2,496.00 23-4444444
Q2 of 2009
$2,763.00 23-4444444
Q1 of 2009
$2,284.00 23-4444444
Q4 of 2008
$2,191.00 23-4444444
Q3 of 2008
$2,343.00 23-4444444
SSN:
Relationship:
Employer Name and Address
CHARLOTTE'S GOLD INC
920 MARKET ST, CHARLOTTE NC
CHARLOTTE'S GOLD INC
920 MARKET ST, CHARLOTTE NC
CHARLOTTE'S GOLD INC
920 MARKET ST, CHARLOTTE NC
CHARLOTTE'S GOLD INC
920 MARKET ST, CHARLOTTE NC
CHARLOTTE'S GOLD INC
920 MARKET ST, CHARLOTTE NC
CHARLOTTE'S GOLD INC
920 MARKET ST, CHARLOTTE NC
CHARLOTTE'S GOLD INC
920 MARKET ST, CHARLOTTE NC
CHARLOTTE'S GOLD INC
920 MARKET ST, CHARLOTTE NC
Print Member Information
***-**-5680
Head of Household
Date Received by EIV
08/23/2010
06/20/2010
02/19/2010
11/21/2009
09/17/2009
09/17/2009
03/20/2009
12/21/2008
Unemployment Benefits
EIV received no benefit data.
Social Security Benefits
EIV received no benefit data.
Dual Entitlement
EIV received no benefit data.
Medicare Data
EIV received no benefit data.
Supplemental Security Income Benefits
EIV received no benefit data.
Disability
Disability:
No
On-set Date:
Report Date: 1/03/2011
* The difference between the gross and net benefit may include the Medicare premium and/or additional deductions, such as garnishments, which are not listed
on this report.
Confidential Privacy Act Data. Civil and Criminal penalties apply to misuse of this data.
Report Generated By – PMCS
Income Discrepancy Example:
Brock Lee
U. S. Department of Housing
And Urban Development
Owner's Certification of Compliance
with HUD's Tenant Eligibility
and Rent Procedures
For Personal Records ONLY - not for
Submission to the Federal Government
Office of Housing
Federal Housing Commissioner
Record for Landlords
Section B. Summary Information
1. Project Name
Ironwood Apartments
2. Subsidy Type
3. Secondary Subsidy Type
4. Property ID
5. Project Number
6. Contract Number
7. Telecom Address
8. Plan of Action Code
9. HUD-Owned Project?
10. FIPS County Code
11. Previous Housing Code
12. Displacement Status
1 - Section 8
03-555555
NY43M123123
NO
2-Without Housing
4-Not Displaced
13. Effective Date
14. Anticipated Voucher Date
15. Next Recertification Date
04/01/2010
04/2010
04/01/2011
16.
17.
18.
19.
20.
21.
22.
04/07/2003
Project Move-In Date
Unit Move-In Date
Certification Type
Action Processed
Correction Type
Cert. Correction Date
Prev.Subsidy Type
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
AR
Unit Number
No of Bedrooms
Building ID
Unit Transfer Code
Previous Unit No.
Security Deposit
Basic Rent
Market Rent
Contract Rent
Utility Allowance
Gross Rent
8C
1
256
0
0
740
0
586
Section C. Household Information
34.
No.
01
02
03
04
05
06
07
08
35.
Last Name
Lee
36.
First Name
Brock
50. Family is Mobility Impaired?
51. Family is Hearing Impaired?
52. Family is Visually Impaired?
N
N
N
53.
54.
55.
56.
37. 38. 39.
MI Rel. Sex
40.
Race
H
B
M
41.
Eth.
42.
Birth Date
2 02/01/1980
Number of Family Members
Number of Non-Family Members
Number of Dependents
Number of Eligible Members
60. Previous Head Last Name
61. Previous Head First Name
62. Previous Head Middle Initial
01
67.
Income Type Code
W-Non-Federal Wage
70.
71.
72.
73.
74.
45.
ID Code
(SSN)
222-44-5678
1
0
0
1
46.
Elig
Code
47. Alien
Reg.
Number
EC
48.
49.
Age at Work
Cert Codes
30
57. Expected Family Addition - Adoption
58. Expected Family Addition - Pregnacy
59. Expected Family Addition - Foster Children
0
0
0
63. Previous Effective Date
64. Previous Head ID / SSN
65. Previous Head Birth Date
Section D. Income Information
66.
Mbr.
No.
43.
44.
Special Student
Status Status
Section E. Asset Information
68.
Amount
69.
SSN Benefits
Claim No.
23,452
*Future
Total Employment Income
Total Pension Income
Total Public Assistance Income
Total Other Income
Total Non-Asset Income
75.
Mbr.
No.
76.
Description
77.
Status
78.
Cash Value
79. Actual
Yearly
Income
80. Date
Divested
01
0
0
0
12,738
0
81.
82.
83.
84.
85.
Cash Value of Assets
Actual Income from Assets
HUD Passbook Rate
Imputed Income from Assets
Asset Income
0
0
2.00 %
0
0
Section F. Allowances and Rent Calculations
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
Total Annual Income
22,920
Low Income Limit
59,400
Very Low Income Limit
37,150
Extremely Low Income Limit
22,300
Current Income Status
Extremely Low
Eligibility Universe Code
2
Section 8 Assist.1984 Indicator
N
Income Exception Code
Police / Security Tenant?
N
Survivor of Qualifier?
Household Assistance Status
E
Previous versions of this form are obsolete.
This form also replaces HUD-50059-D, -E, -F, & -G
97. Deduction for Dependents
98. Child Care Expense (work)
99 Child Care Expense (school)
100. 3% Income
101. Disability Expense
102. Disability Deduction
103. Medical Expense
104. Medical Deduction
105. Elderly Family Deduction
106. Total Deductions
107. Adjusted Annual Income
Page 2 of 3
0
0
0
382
0
0
0
0
0
0
12,738
108. Total Tenant Payment
109. Tenant Rent
110. Utility Reimbursement
111. Assistance Payment
112. Welfare Rent
113. Hardship Exemption
114. Waiver Type Code
573
573
0
167
0
HUD-50059 (09/2008)
HB 4350.3 Rev 1
U. S. Department of Housing
And Urban Development
Owner's Certification of Compliance
with HUD's Tenant Eligibility
and Rent Procedures
For Personal Records ONLY - not for
Submission to the Federal Government
Office of Housing
Federal Housing Commissioner
Record for Landlords
Section B. Summary Information
1. Project Name
Ironwood Apartments
2. Subsidy Type
3. Secondary Subsidy Type
4. Property ID
5. Project Number
6. Contract Number
7. Telecom Address
8. Plan of Action Code
9. HUD-Owned Project?
10. FIPS County Code
11. Previous Housing Code
12. Displacement Status
1 - Section 8
03-555555
NY43M123123
NO
2-Without Housing
4-Not Displaced
13. Effective Date
14. Anticipated Voucher Date
15. Next Recertification Date
05/01/2010
05/2010
04/01/2011
16.
17.
18.
19.
20.
21.
22.
04/07/2003
Project Move-In Date
Unit Move-In Date
Certification Type
Action Processed
Correction Type
Cert. Correction Date
Prev.Subsidy Type
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
IR
Unit Number
No of Bedrooms
Building ID
Unit Transfer Code
Previous Unit No.
Security Deposit
Basic Rent
Market Rent
Contract Rent
Utility Allowance
Gross Rent
8C
1
256
0
0
740
0
321
Section C. Household Information
34.
No.
01
02
03
04
05
06
07
08
35.
Last Name
Lee
36.
First Name
Brock
50. Family is Mobility Impaired?
51. Family is Hearing Impaired?
52. Family is Visually Impaired?
N
N
N
53.
54.
55.
56.
37. 38. 39.
MI Rel. Sex
40.
Race
H
B
M
41.
Eth.
42.
Birth Date
2 02/01/1980
Number of Family Members
Number of Non-Family Members
Number of Dependents
Number of Eligible Members
60. Previous Head Last Name
61. Previous Head First Name
62. Previous Head Middle Initial
01
67.
Income Type Code
U-Unemployment
70.
71.
72.
73.
74.
45.
ID Code
(SSN)
222-44-5678
1
0
0
1
46.
Elig
Code
47. Alien
Reg.
Number
EC
48.
49.
Age at Work
Cert Codes
30
57. Expected Family Addition - Adoption
58. Expected Family Addition - Pregnacy
59. Expected Family Addition - Foster Children
0
0
0
63. Previous Effective Date
64. Previous Head ID / SSN
65. Previous Head Birth Date
Section D. Income Information
66.
Mbr.
No.
43.
44.
Special Student
Status Status
Section E. Asset Information
68.
Amount
69.
SSN Benefits
Claim No.
12,840
*Future
Total Employment Income
Total Pension Income
Total Public Assistance Income
Total Other Income
Total Non-Asset Income
75.
Mbr.
No.
76.
Description
77.
Status
78.
Cash Value
79. Actual
Yearly
Income
80. Date
Divested
01
0
0
0
12,840
0
81.
82.
83.
84.
85.
Cash Value of Assets
Actual Income from Assets
HUD Passbook Rate
Imputed Income from Assets
Asset Income
0
0
2.00 %
0
0
Section F. Allowances and Rent Calculations
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
Total Annual Income
12,840
Low Income Limit
59,400
Very Low Income Limit
37,150
Extremely Low Income Limit
22,300
Current Income Status
Extremely Low
Eligibility Universe Code
2
Section 8 Assist.1984 Indicator
N
Income Exception Code
Police / Security Tenant?
N
Survivor of Qualifier?
Household Assistance Status
E
Previous versions of this form are obsolete.
This form also replaces HUD-50059-D, -E, -F, & -G
97. Deduction for Dependents
98. Child Care Expense (work)
99 Child Care Expense (school)
100. 3% Income
101. Disability Expense
102. Disability Deduction
103. Medical Expense
104. Medical Deduction
105. Elderly Family Deduction
106. Total Deductions
107. Adjusted Annual Income
Page 2 of 3
0
0
0
385
0
0
0
0
0
0
12,840
108. Total Tenant Payment
109. Tenant Rent
110. Utility Reimbursement
111. Assistance Payment
112. Welfare Rent
113. Hardship Exemption
114. Waiver Type Code
321
321
0
419
0
HUD-50059 (09/2008)
HB 4350.3 Rev 1
Summary Report
Income Report
Contract Number
Project:
Next Re-certification Date
Address:
Most Recent Type of Action:
Wage and Benefit Report for Household of BROCK LEE
Subsidy Type
NY43M123123
Project Number
IRONWOOD APTS
Form 50059 as of:
04/01/2011
122 SECOND ST APT 8C BINGHAMTON NY
Effective Date:
IR – Interim Recertication
Head of Household: BROCK LEE
Social Security Number:
***-**-5678
Household Member:
BROCK LEE
Date of Birth:
XX/XX/1980
Employment Information
EIV received no Employment (W4) data.
Wages
Pay Period Amount
FEIN
Q1 of 2010
$4,722.00
22-1234567
Q4 of 2009
$5,863.00
22-1234567
Q3 of 2009
$5,568.00
22-1234567
Q2 of 2009
$4,930.00
22-1234567
Q1 of 2009
$5,128.00
22-1234567
Q4 of 2008
$5,730.00
22-1234567
Q3 of 2008
$5,407.00
22-1234567
Unemployment Benefits
Pay Period
Q3 of 2010
Q2 of 2010
Income Discrepancy Report
XX/XX/1980
SSN:
Relationship:
Print Member Information
***-**-5678
Head of Household
RESPOND INC
532 STATE ST, BINGHAMTON NY
RESPOND INC
532 STATE ST, BINGHAMTON NY
RESPOND INC
532 STATE ST, BINGHAMTON NY
RESPOND INC
532 STATE ST, BINGHAMTON NY
RESPOND INC
532 STATE ST, BINGHAMTON NY
RESPOND INC
532 STATE ST, BINGHAMTON NY
RESPOND INC
532 STATE ST, BINGHAMTON NY
Amount
Date Received by EIV
$3,210
$3,159
12/17/2010
08/23/2010
Date Received by EIV
05/23/2010
03/23/2010
11/19/2009
08/26/2009
05/25/2009
02/20/2008
12/16/2008
Social Security Benefits
EIV received no benefit data.
Dual Entitlement
EIV received no benefit data.
Medicare Data
EIV received no benefit data.
Supplemental Security Income Benefits
EIV received no benefit data.
Disability
Date Received by EIV: Not Available
05/01/2010
Date of Birth:
Employer Name and Address
Disability:
Section 8
03555555
05/01/2010
No
On-set Date:
Income Discrepancy Report:
Carrie Oakey
U. S. Department of Housing
And Urban Development
Owner's Certification of Compliance
with HUD's Tenant Eligibility
and Rent Procedures
For Personal Records ONLY - not for
Submission to the Federal Government
Office of Housing
Federal Housing Commissioner
Record for Landlords
Section B. Summary Information
1. Project Name
Crabtree Apartments
2. Subsidy Type
3. Secondary Subsidy Type
4. Property ID
5. Project Number
6. Contract Number
7. Telecom Address
8. Plan of Action Code
9. HUD-Owned Project?
10. FIPS County Code
11. Previous Housing Code
12. Displacement Status
1 - Section 8
13. Effective Date
14. Anticipated Voucher Date
15. Next Recertification Date
02-111222 16. Project Move-In Date
NJ12M345678 17. Unit Move-In Date
18. Certification Type
NO 19. Action Processed
20. Correction Type
2-Without Housing 21. Cert. Correction Date
4-Not Displaced 22. Prev.Subsidy Type
04/01/2010
04/2010
04/01/2011
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
04/06/2008
AR
Unit Number
No of Bedrooms
Building ID
Unit Transfer Code
Previous Unit No.
Security Deposit
Basic Rent
Market Rent
Contract Rent
Utility Allowance
Gross Rent
2B
1
452
0
0
700
0
324
Section C. Household Information
34.
No.
01
02
03
04
05
06
07
08
35.
Last Name
Oakey
36.
First Name
Carrie
50. Family is Mobility Impaired?
51. Family is Hearing Impaired?
52. Family is Visually Impaired?
N
N
N
53.
54.
55.
56.
37. 38. 39.
MI Rel. Sex
40.
Race
H
W
F
41.
Eth.
42.
Birth Date
2 06/01/1987
Number of Family Members
Number of Non-Family Members
Number of Dependents
Number of Eligible Members
60. Previous Head Last Name
61. Previous Head First Name
62. Previous Head Middle Initial
01
67.
Income Type Code
W-Non-Federal Wage
70.
71.
72.
73.
74.
45.
ID Code
(SSN)
222-33-2255
1
0
0
1
46.
Elig
Code
47. Alien
Reg.
Number
EC
48.
49.
Age at Work
Cert Codes
22
57. Expected Family Addition - Adoption
58. Expected Family Addition - Pregnacy
59. Expected Family Addition - Foster Children
0
0
0
63. Previous Effective Date
64. Previous Head ID / SSN
65. Previous Head Birth Date
Section D. Income Information
66.
Mbr.
No.
43.
44.
Special Student
Status Status
Section E. Asset Information
68.
Amount
69.
SSN Benefits
Claim No.
12,948
*Future
Total Employment Income
Total Pension Income
Total Public Assistance Income
Total Other Income
Total Non-Asset Income
75.
Mbr.
No.
76.
Description
77.
Status
78.
Cash Value
79. Actual
Yearly
Income
80. Date
Divested
01
0
0
0
17,291
0
81.
82.
83.
84.
85.
Cash Value of Assets
Actual Income from Assets
HUD Passbook Rate
Imputed Income from Assets
Asset Income
0
0
2.00 %
0
0
Section F. Allowances and Rent Calculations
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
Total Annual Income
12,948
Low Income Limit
59,400
Very Low Income Limit
37,150
Extremely Low Income Limit
22,300
Current Income Status
Extremely Low
Eligibility Universe Code
2
Section 8 Assist.1984 Indicator
N
Income Exception Code
Police / Security Tenant?
N
Survivor of Qualifier?
Household Assistance Status
E
Previous versions of this form are obsolete.
This form also replaces HUD-50059-D, -E, -F, & -G
97. Deduction for Dependents
98. Child Care Expense (work)
99 Child Care Expense (school)
100. 3% Income
101. Disability Expense
102. Disability Deduction
103. Medical Expense
104. Medical Deduction
105. Elderly Family Deduction
106. Total Deductions
107. Adjusted Annual Income
Page 2 of 3
0
0
0
388
0
0
0
0
0
0
12,948
108. Total Tenant Payment
109. Tenant Rent
110. Utility Reimbursement
111. Assistance Payment
112. Welfare Rent
113. Hardship Exemption
114. Waiver Type Code
324
324
0
376
0
HUD-50059 (09/2008)
HB 4350.3 Rev 1