HUD9887 Document Package for Applicant's/Tenant's Consent to the

U.S. Department of Housing and Urban Development (HUD)

Document Package for

Applicant’s/Tenant’s Consent

to the Release of Information

This Package contains the following documents:

1. Fact Sheet

2. Form HUD–9887 (to be signed by the Applicant or Tenant)

3. Form HUD–9887–A (to be signed by the Applicant or Tenant and Owner or Management Agent)

4. Individual Verifications (to be signed by the Applicant or Tenant)

5. Revocation of Consent (to be signed by the Applicant or Tenant and Owner or Management Agent)

Each household must receive a copy of the 9887/A Fact Sheet, form HUD-9887, and form HUD-9887-A.

What Verification Involves

To receive housing assistance, applicants and tenants who are at least 18 years of age and each family head, spouse, or co-head, regardless of age, must provide the owner or management agent (O/A) or public housing agency (PHA) with certain information specified by HUD.

Federal laws and regulations require that the information you provide must be verified. This information is verified in two ways:

1. HUD and PHAs may verify the information you provide by checking with the records kept by certain public agencies (e.g., Social Security Administration (SSA), state agencies that keep wage and unemployment compensation claim information, and the Department of Health and Human Services’ (HHS) National Directory of New Hires (NDNH) database that stores wage, new hires, and unemployment compensation). HUD (only) may verify information covered in your tax returns from the U.S. Internal Revenue Service (IRS). You give your consent to the release of this information by signing form HUD-9887. Only HUD and PHAs can receive the information authorized by form HUD-9887.

2. The O/A must verify the information that is used to determine your eligibility and the amount of rent you pay. You give your consent to the release of this information by signing the form HUD-9887, the form HUD-9887-A, and the individual verification and consent forms that apply to you. Federal laws limit the kinds of information the O/A can receive about you. The amount of income you receive helps to determine the amount of rent you will pay. The O/A will verify all the sources of income that you report. There are certain mandatory deductions that reduce the income used in determining tenant rents. The O/A will verify your family’s expenses if you are eligible to have certain expenses deducted from your annual income.

Example: Mrs. Anderson is 62 years old. Her age qualifies her for a health and medical care expenses deduction. Her annual income may be adjusted because of this deduction. Because Mrs. Anderson’s health and medical care expenses will help determine the amount of rent she pays, the O/A is required to verify any medical expenses that she reports.

Example: Mr. Harris is 53 years old. Mr. Harris does not qualify for the health and medical care expenses deduction, because he is not at least 62 years of age and he is not disabled. Because he is not eligible for the deduction, the amount of his health and medical care expenses does not change the amount of rent he pays. Therefore, the O/A cannot ask Mr. Harris anything about his health and medical care expenses and cannot verify with a third party about any health and medical care expenses that Mr. Harris reports.

Consumer Protections

Information received by HUD and/or the PHA is protected by the Federal Privacy Act. Information received by the O/A or PHA is subject to State privacy laws. Employees of HUD, the PHA, and the O/A are subject to penalties for using these consent forms improperly. You do not have to sign the form HUD-9887, the form HUD-9887-A, or the individual verification consent forms when they are given to you at your certification or recertification interview. You may take them home with you to read or to discuss with a third party of your choice. The O/A will give you another date when you can return to sign these forms.

NOTE: These forms have been translated into languages other than English and those translations must be provided if needed. If you cannot read and/or sign a consent form due to a disability, the O/A shall make a reasonable accommodation in accordance with Section 504 of the Rehabilitation Act of 1973. Such accommodations may include, depending on the circumstances, the following: home visits when the applicant's or tenant's disability prevents them from coming to the office to complete the forms; the applicant or tenant authorizing another person to sign on their behalf; and for persons with visual impairments, accommodations may include providing the forms in large script or braille or providing readers.

The O/A must tell you, or a third party which you choose, of the findings made as a result of the O/A’s verifications authorized by your consent. The O/A must give you the opportunity to contest such findings in accordance with HUD Handbook 4350.3 Rev. 1. However, for information received under the form HUD-9887 or form HUD-9887/A, HUD or the O/A may inform you of these findings.

O/As must keep tenant files in a location that ensures confidentiality. Any employee of the O/A who fails to keep tenant information confidential is subject to the enforcement provisions of the State Privacy Act and is subject to enforcement actions by HUD. Any applicant or tenant affected by negligent disclosure or improper use of information may bring civil action for damages, and seek other relief, as may be appropriate, against the employee.

The O/A is required to give each household a copy of form HUD-9887/A Fact Sheet, form HUD-9887, and HUD-9887-A along with appropriate individual consent forms and the revocation of consent form. The package you will receive will include the following documents:

1. Fact Sheet: Describes verification requirements and the verification process. This fact sheet also describes consumer protections under the verification process.

2. Form HUD–9887: Allows the release of applicant/tenant information between government agencies.

3. Form HUD–9887–A: Describes the requirement of third-party verification along with consumer protections.

4. Individual Verification Forms: Used to verify the relevant information provided by applicants/tenants to determine their eligibility and level of benefits.

5. Revocation of Consent: Allows the applicant/tenant to revoke their consent of the 9887 and 9887-A.

The public reporting burden for the HUD 9887 and the HUD 9887-A is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Comments regarding the accuracy of this burden estimate and any suggestions for reducing this burden can be sent to U.S. Department of Housing and Urban Development, Office of the Chief Data Officer, R, 451 7th St SW, Room 8210, Washington, DC 20410-5000 or email: PaperworkReductionActOffice@hud.gov. Do not send completed forms to this address. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid OMB control number

Consequences for Not Signing the Consent Forms or Revoking the Consent Forms

If you fail to sign the form HUD-9887, the form HUD-9887-A, or the individual verification forms, this may result in your assistance being denied (for applicants) or your assistance being terminated (for tenants). See further explanation on forms HUD-9887 and 9887-A.

If you revoke your consent of form HUD-9887, form HUD-9887-A, or the individual verification forms, this may result in your assistance being denied (for applicants) or your assistance being terminated (for tenants).

If you are an applicant and denied assistance for this reason, the O/A must notify you of the reason for your rejection in writing and give you an opportunity to respond to the O/A in writing or request a meeting within 14 days to dispute the rejection. The O/A must inform you that if you are a person with disabilities, you have the right to request reasonable accommodations to participate in the informal hearing process.

If you are a tenant and your assistance is terminated for this reason, the O/A must follow the procedures set out in the lease. This includes the opportunity for you to meet with the O/A.

Programs Covered by this Fact Sheet

A. Section 8 Project-Based Rental Assistance (PBRA)

1. New Construction

2. State Housing Agencies Program

3. Substantial Rehabilitation

4. Section 202/8

5. Rural Housing Services Section 515/8

6. Loan Management Set-Aside (LMSA)

7. Property Disposition Set-Aside (PDSA)

8. Rental Assistance Demonstration (RAD)

B. Section 202/162 Project Assistance Contract (PAC)

C. Section 202 Project Rental Assistance Contract (PRAC)

D. Section 202 Senior Preservation Rental Assistance (SPRAC)

E. Section 811 Project Rental Assistance Contract (PRAC)

F. Section 811 Project Rental Assistance (811 PRA)

HUD Office requesting release of information (Owner should provide the full address of the HUD Multifamily Regional Center or Satellite Office, Attention: Director, Asset Management Division.):

O/A requesting release of information (Owners should provide the full name address of the Owner or the Management Agent):

PHA requesting release of information (Owner should provide the full name and address of the PHA and the title of the director or administrator. If there is no PHA Owner or PHA Contract Administrator for this project, mark an X through this entire box):

Notice To Tenant: Do not sign this form if the space above for organizations requesting release of information is left blank. You do not have to sign this form when it is given to you. You may take the form home with you to read or discuss with a third party of your choice and return to sign the consent on a date you have agreed upon with the owner or management agent (O/A).

Authority: Section 217 of the Consolidated Appropriations Act of 2004 (Pub L. 108-199). This law is found at 42 U.S.C.653(J). This law authorizes HHS to disclose to the Department of Housing and Urban Development (HUD) information in the NDNH portion of the “Location and Collection System of Records” for the purposes of verifying employment and income of individuals participating in specified programs and, after removal of personal identifiers, to conduct analyses of the employment and income reporting of these individuals. Information may be disclosed by the Secretary of HUD to a private owner, a management agent, and a Contract Administrator in the administration of rental housing assistance.

Section 904 of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988, as amended by section 903 of the Housing and Community Development Act of 1992 and section 3003 of the Omnibus Budget Reconciliation Act of 1993. This law is found at 42 U.S.C. 3544.This law requires you to sign a consent form authorizing: (1) HUD and the PHA to request wage and unemployment compensation claim information from the state agency responsible for keeping that information; and (2) HUD and the PHA responsible for determining eligibility to verity salary and wage information pertinent to the applicant’s or participant’s eligibility or level of benefits; (3) HUD to request certain tax return information from the U.S. Social Security Administration (SSA) and the U.S. Internal Revenue Service (IRS).

Section 104 of the Housing Opportunity Through Modernization Act of 2016 (Pub. L. 114-201). This law authorizes, in part, O/As to obtain any financial record from any financial institution, as the terms financial record and financial institution are defined in the Right to Financial Privacy Act (12 U.S.C. 3401), whenever the O/A determines that the record is needed to determine an applicant’s or participant’s eligibility for assistance or level of benefits.

Purpose: By signing this consent form, you are authorizing HUD and the above-named PHA to request income information from the government agencies listed on this form. HUD and the PHA need this information to verify your household’s income to ensure that you are eligible for assisted housing benefits and that these benefits are set at the correct level. HUD may participate in computer matching programs with these sources to verify your eligibility and level of benefits. This form also authorizes HUD and the PHA to seek wage, new hire (W-4), and unemployment claim information from current or former employers to verify information obtained through computer matching.

Uses of Information to be Obtained: HUD is required to protect the income information it obtains in accordance with the Privacy Act of 1974, 5 U.S.C. 552a. The O/A and the PHA is also required to protect the income information it obtains in accordance with any applicable State privacy law. After receiving the information covered by this notice of consent, HUD, the O/A and/or the PHA may inform you that your eligibility for, or level of, assistance is uncertain and needs to be verified and nothing else.

HUD, O/A, and PHA employees may be subject to penalties for unauthorized disclosures or improper uses of the income information that is obtained based on the consent form.

Who Must Sign the Consent Form: Each member of your household who is at least 18 years of age, and each family head, spouse or co-head, regardless of age, must sign the relevant consent forms. The consent form must also be signed:

1. When any person 18 years or older becomes a member of the family;

2. When a member of the family turns 18 years of age; and

3. As required by HUD or the O/A in administrative instructions.

Persons who apply for or receive assistance under the following programs are required to sign this consent form:

A. Section 8 Project-Based Rental Assistance (PBRA)

1. New Construction

2. State Housing Agencies Program

3. Substantial Rehabilitation

4. Section 202/8

5. Rural Housing Services Section 515/8

6. Loan Management Set-Aside (LMSA)

7. Property Disposition Set-Aside (PDSA)

8. Rental Assistance Demonstration (RAD)

B. Section 202/162 Project Assistance Contract (PAC)

C. Section 202 Project Rental Assistance Contract (PRAC)

D. Section 202 Senior Preservation Rental Assistance (SPRAC)

E. Section 811 Project Rental Assistance Contract (PRAC)

F. Section 811 Project Rental Assistance Demonstration (811 PRA)

Failure to Sign Consent Form: Your failure to sign the consent form may result in the denial of assistance or termination of assistance benefits. If you are an applicant and denied assistance for this reason, the O/A must notify you of the reason for your rejection in writing and give you an opportunity to respond to the O/A in writing or request a meeting within 14 days to dispute the rejection. The O/A must inform you that if you are a person with disabilities, you have the right to request reasonable accommodations to participate in the informal hearing process. If a tenant is denied assistance for this reason, the O/A must follow the procedures set out in the lease.

Expiration: The authorization to release the information requested by the consent form will remain effective until the earliest of:

1. The rendering of a final adverse decision for an assistance applicant;

2. The cessation of a participant’s eligibility for assistance from HUD and the O/A; or

3. The express revocation by the assistance applicant or recipient (or applicable family member) of the authorization, in a written notification to HUD.

Consent: I consent to allow HUD, the O/A, or the PHA to request and obtain income information from the Federal and state agencies listed on the back of this form for the purpose of verifying my eligibility and level of benefits under HUD’s assisted housing programs.

Signatures:		Additional Signatures, if needed:
Head of Household	Date	Other Family Members 18 and Over	Date
Spouse	Date	Other Family Members 18 and Over	Date
Co-Head of Household	Date	Other Family Members 18 and Over	Date

Agencies To Provide Information

State Wage Information Collection Agencies (HUD and PHA). This consent is limited to wages and unemployment compensation you have received during period(s) when you have received assisted housing benefits.

U.S. Social Security Administration (HUD only). This consent is limited to: Social Security number verification, death indicator (when applicable), Title II (Federal Old Age, Survivors, and Disability Insurance Benefits (OASDI)), Title XVI (Supplemental Security Income (SSI) for the Aged, Blind, and Disabled), and Title VIII (Special Benefits for Certain World War II Veterans (SVB) benefit information.

National Directory of New Hires contained in the Department of Health and Human Services’ system of records. This consent is limited to wages and unemployment compensation you have received during period(s) when you have received assisted housing benefits.

U.S. Internal Revenue Service (HUD only). This consent is limited to the following information that may appear on your tax return:

1099-S Statement for Recipients of Proceeds from Real Estate Transactions

1099-B Statement for Recipients of Proceeds from Real Estate Brokers and Barters Exchange Transactions

1099-A Information Return for Acquisition or Abandonment of Secured Property

1099-G Statement for Recipients of Certain Government Payments

1099-DIV Statement for Recipients of Dividends and Distributions

1099-INT Statement for Recipients of Interest Income

1099-MISC Statement for Recipients of Miscellaneous Income

1099-OID Statement for Recipients of Original Issue Discount

1099-PATR Statement for Recipients of Taxable Distributions Received from Cooperatives

1099-R Statement for Recipients of Retirement Plans

W2-G Statement of Gambling Winnings

1065-K1 Partners Share of Income, Credits, Deductions, etc.

1041-K1 Beneficiary’s Share of Income, Credits, Deductions, etc.

1120S-K1 Shareholder’s Share of Undistributed Taxable Income, Credits, Deductions, etc.

Information may also be obtained directly from: (a) current and former employers concerning salary and wages and (b) financial institutions as defined in the Right to Financial Privacy Act (12 U.S.C. 3401), whenever the O/A determines the record is needed to determine an applicant or participant’s eligibility for assistance or level of benefits.

I understand that income information obtained from these sources will be used to verify information that I provide in determining initial or continued eligibility for assisted housing programs and the level of benefits.

No action can be taken to terminate, deny, suspend, or reduce the assistance your household receives based on information obtained about you under this consent until the HUD office, Office of Inspector General (OIG) and the O/A have independently verified: 1) the amount of the income, wages, or unemployment compensation involved, 2) whether you actually have (or had) access to such income, wages, or benefits for your own use, and 3) the period or periods when, or with respect to which you actually received such income, wages, or benefits. A photocopy of the signed consent may be used to request a third party to verify any information received under this consent (e.g., employer).

HUD or the O/A shall inform you, or a third party which you designate, of the findings made on the basis of information verified under this consent and shall give you an opportunity to contest such findings in accordance with Handbook 4350.3 Rev. 1.

If a member of the household who is required to sign the consent form is unable to sign the form on time due to extenuating circumstances, the O/A may document the file as to the reason for the delay and the specific plans to obtain the proper signature as soon as possible.

Privacy Notice: Authority: The Department of Housing and Urban Development (HUD) is authorized to collect this information by the U.S. Housing Act of 1937, as amended (42 U.S.C. 1437 et. seq.); the Housing and Urban-Rural Recovery Act of 1983 (P.L. 98-181); the Housing and Community Development Technical Amendments of 1984 (P.L. 98-479); and by the Housing and Community Development Act of 1987 (42 U.S.C. 3543). Principal Purpose: The Department of Housing and Urban Development (HUD) has developed this form to facilitate the verification and consent of release for an applicant’s eligibility, recommended unit size, and the amount tenant(s) must pay towards rent and utilities. Applicants must provide the names of all tenants who are at least 18 years old, as well as the names of each family head, spouse, or co-head, regardless of age. Disclosure: HUD may disclose this information to federal, state, and local agencies when it is relevant to civil, criminal, or regulatory investigations and prosecutions. HUD, the owner, the management agent (OA), or the public housing agency (PHA) may use computer matching to verify the information you provide. You must provide all the requested information in this form. Failure to provide any of the information may result in the delay of assistance or termination of assistance benefits.

Penalties for Misusing this Consent: HUD, the PHA, the O/A, and any Contract Administrator (or any employee of HUD, the PHA, the O/A, or the Contract Administrator) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on the form HUD-9887 is restricted to the purposes cited on the form HUD-9887. Any person who knowingly or willfully requests, obtains, or discloses any information under false pretenses concerning an applicant or tenant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or tenant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, against the officer or employee of HUD, the PHA, the O/A or the Contract Administrator responsible for the unauthorized disclosure or improper use.

Instructions to Owners

1. Give the documents listed below to the applicants/tenants to sign. Staple or clip them together in one package in the order listed.

1. Fact Sheet.

2. Form HUD-9887.

3. Form HUD-9887-A.

4. Individual Verification Forms (upon applicant/tenant request)

2. Verbally inform applicants and tenants that:

1. They may take these forms home with them to read or to discuss with a third party of their choice and to return to sign them on a date they have worked out with you, and

2. If they have a disability that prevents them from reading and/ or signing any consent, that you, the Owner, are required to provide reasonable accommodations.

3. O/As are required to give each household a copy of the HUD9887/A Fact Sheet, form HUD-9887, and form HUD-9887-A after obtaining the required applicants/tenants signature(s). Owners must also give applicants/tenants a copy of the signed individual verification forms upon their request.

Instructions to Applicants and Tenants

This form HUD-9887-A contains consumer information and protections concerning the HUD-required verifications that Owners must perform.

1. Read this material which explains:

• HUD’s requirements concerning the release of information, and

• Other consumer protections.

2. Sign on the consent forms:

• you have read this form, or

• the Owner or a third party of your choice has explained it to you, and

• you consent to the release of information for the purposes and uses described.

Authority for Requiring Applicant's/Tenant's Consent to the Release of Information and for O/As to Verify Information Provide by the Applicant/Tenant

Section 904 of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988, as amended by section 903 of the Housing and Community Development Act of 1992 and section 3003 of the Omnibus Budget Reconciliation Act of 1993. This law is found at 42 U.S.C. 3544. In part, this law requires you to sign a consent form authorizing the Owner to request current or previous employers to verify salary and wage information pertinent to your eligibility or level of benefits.

HUD’s regulations in 24 CFR part 5, subpart B require that as a condition of admission to or continued occupancy, applicants and participants must sign a HUD-approved release and consent form (including any release and consent as required under 24 CFR 5.230) authorizing any depository or private source of income, or any Federal, state or local agency, to furnish or release to the owner or HUD such information as the owner or HUD determines to be necessary. This includes information that you have provided which will affect the amount of rent you pay. The information includes income and assets, such as salary, benefit payments, and income received from assets. They also include certain adjustments to your income, such as the allowances for dependents and for households whose heads or spouses are elderly or disabled, and allowances for child care expenses, health and medical care expenses, and reasonable attendant care and auxiliary apparatus expenses.

In addition, HUD’s regulations (24 CFR 5.659, Family Information and Verification) require as a condition of receiving housing assistance that you must sign a HUD-approved release and consent authorizing any depository or private source of income to furnish such information that is necessary in determining your eligibility or level of benefits.

Failure to Sign the Consent Form

Failure to sign any required consent form may result in the denial of assistance or termination of assisted housing benefits. If you are an applicant and denied assistance for this reason, the O/A must notify you of the reason for your rejection in writing and give you an opportunity to respond to the O/A in writing or request a meeting within 14 days to dispute the rejection. The O/A must inform you that if you are a person with disabilities, you have the right to request reasonable accommodations to participate in the informal hearing process. If a tenant is denied assistance for this reason, the O/A must follow the procedures set out in the lease.

Conditions

No action can be taken to terminate, deny, suspend or reduce the assistance your family receives based on information obtained about you under this consent until the O/A has independently 1) verified the information you have provided with respect to your eligibility and level of benefits and 2) with respect to income (including both earned and unearned income), the O/A has verified whether you actually have (or had) access to such income for your own use, and verified the period or periods when, or with respect to which you actually received such income, wages, or benefits.

A photocopy of the signed consent may be used to request the information authorized by your signature on the individual consent forms. This would occur if the O/A does not have another individual verification consent with an original signature and the O/A is required to send out another request for verification (for example, the third party fails to respond). If this happens, the O/A may attach a photocopy of this consent to a photocopy of the individual verification form that you sign. To avoid the use of photocopies, the O/A and the individual may agree to sign more than one consent for each type of verification that is needed.

The O/A must provide you with information obtained under this consent in accordance with State privacy laws.

The O/A may use these individual consent forms during the 120 days preceding the certification period. The O/A may also use these forms during the certification period, but only in cases where the certification is delayed, or the O/A receives information indicating that the information you have provided may be incorrect. Other uses are prohibited.

I have read and understand this information on the purposes and uses of information that is verified and consent to the release of information for these purposes and uses.

________________________________________

Name of Applicant or Tenant (Print)

________________________________________

Signature of Applicant or Tenant & Date

I have read and understand the purpose of this consent and its uses, and I understand that misuse of this consent can lead to personal penalties to me.

________________________________________

Name of Project Owner or Owner’s representative

________________________________________

Title

________________________________________

Signature & Date

cc: Applicant/Tenant; Owner file

Revocation of Consent: I hereby revoke my consent to allow HUD, the PHA, or the O/A to use information from the Federal and state agencies listed on the back of this form or to request or obtain information from any other third party for the purpose of verifying my eligibility and level of benefits under HUD's assisted housing programs. I understand that revoking my consent may result in termination of assisted housing benefits.

If you are an applicant and denied assistance for this reason, the O/A must notify you of the reason for your rejection in writing and give you an opportunity to respond to the owner in writing or request a meeting within 14 days to dispute the rejection. The O/A must inform you that if you are a person with disabilities, you have the right to request reasonable accommodations to participate in the informal hearing process. If a tenant is denied assistance for this reason, the O/A must follow the procedures set out in the lease.

Signatures:		Additional Signatures, if needed:
Head of Household	Date	Other Family Member 18 and Over	Date
Spouse	Date	Other Family Member 18 and Over	Date
Co-Head of Household	Date	Other Family Member 18 and Over	Date

Penalties for Misusing this Consent

I/We, the undersigned, certify under penalty of perjury that the information provided above is true, correct, and accurate.. WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012, 1014; 31 U.S.C. §3729, 3802).

Instructions to Owners/Agents

You must provide a copy of the signed revocation to the applicant/tenant and retain the original in the tenant file. You must immediately notify the local HUD office of the applicant/tenant’s revocation of consent. After consent is revoked, you must not use EIV data to verify income or request information from third parties for the purpose of verifying the applicant/tenant’s eligibility and level of benefits under HUD’s assisted housing programs.

Attachment to forms HUD-9887 & 9887-A