HUD-93101a Recertification of Family Income Statistical Report

Recertification of Family Income
and Composition

OMB Approval No.2502-0583
  (exp. 02/28/2014)

U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commisioner

Statistical Report Section 235(b), (j) and (i)

Public reporting burden for this collection of information 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. This information is required to obtain
benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.
Section 235 of the National Housing Act authorizes the Secretary of the Department of Housing and Urban Development to make assistance payments to qualified
homeowners annually (or more frequently as deeded necessary) for the purpose of adjusting the amount of assistance payments. HUD uses this information to adjust
recertifications on the amount of subsidy a mortgagor is eligible to receive. If the information were not collected, HUD would not be able to prevent fraud, waste, and
abuse on overpaid assistance. The information is considered confidential. While no assurances of confidentiality are pledged to respondents, HUD generally discloses
this data only in response to a Freedom of Information request. Do not send this form to the above address. The information requested is required by P.L.479, 48
Stat, U.S.C.1701 et. seq. Failure to provide the requested information may result in loss of assistance payment.
Important: See instructions below and Privacy Act Statement on form HUD-93101 before completing this statistical report.

A. Income Adjustment

B. Assistance Computation
Income

1. Total annual income (6(o) form HUD-93101)

Payments

$

1. Current Full Monthly Mortgage Payment

(a) Less: 5% of Total Annual Income

$

2. 20% or 28% of Adjusted Monthly Income (A3) $

(b) Less: Earnings of Eligible Minors

$

3. Formula (1) for Mo. Subsidy (1 minus 2)

$

x $300 ) $

4. Monthly Payment (Principal $ Int. + MIP)

$

(c) Less Eligible Minors (

___________

2. Adjusted Annual Income

5. Minus Mo. Payment (P + 1 @

$

$

%) $

6. Formula (2) for Mo. Sub. (4 minus 5)
3. Adjusted Monthly Income (No. 2, above “ 12) $

(May be derived from Factor Tables,
HUD Handbook 4330.1, Appendix 18)

4. Date of Mortgage Insurance:
(Determines interest rate Block B, Item 5)

Sections A and B are provided for your convenience and their use is not
required. However you choose to perform the computations, you must be
prepared to support the results. A copy of this form, or the computations if
performed elsewhere, must be placed in the mortgagor's case file.

$

7. Assist. Payment Auth. (lesser of 3 or 6)

$

8. Mortgagor's Monthly Payment (1 minus 7)

$

9. Number in Household (Item 6, HUD-93101)

C. Statistical Data
1. FHA Case Number (Col. 1-14)

2. Family Type (Item 6, HUD-93101)(Col. 17)

3. Age of Head (Item 6, HUD-93101)(Col.18-19)

Husband and Wife
Female Head with Children
Single Male with Children
Female Head without Children
Other (Single Male, no children, unrelated household, etc.)
4. Sex of Head (Item 6, HUD-93101) (Col. 20) 5. New Payment is: (check ” one) (Col. 53)

Male
8. New Assistance Formula
(Col. 61)

1

Female

6. Amount of Increase or Decrease (Col. 54-56) 7. Effective Date of Payment
Change (mm / yy) (Col. 57-60)
None $

No
Increase
Decrease
Change from previous assistance.

9. How many times has this
10. Continued Eligibility
mortgagor recertified? (Col. 62-63)
(Col. 64)

2

Mail to:
Dept. of Housing and Urban Development
Subsidized Housing Programs Division
Room 3200
451 7th St., SW
Washington, D.C. 20410

1

Yes

2

11. Mortgagee Number (Col. 66-70)

No

Review and Certification: I certify that the information above is based on a recertification on form
HUD-93101, signed by at least one of the mortgagors, which is retained in our files. The information
provided by the mortgagors has been verified before being used in the assistance calculations above.
Signature & Date :

X
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/
or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Instructions

Statistical Data. (Numbering corresponds to the columns used to record each item.)

Use this form to report significant data resulting from Section 235 recertifications of income, family composition, and occupancy. Prepare an original and
one copy of this form for each mortgage for which a recertification was
processed and a confirmed change in assistance payments made (or the
requirement for continuation of the same amount of assistance verified.) Send
the original of each form as soon as processing is completed, to the address
above. Mortgagee should retain a copy of each form.

1.

Enter the complete FHA Case Number.

5-9. When dollar amounts are entered, round all figures to the nearest whole
dollar and leave any blank spaces to the left of the numbers.
10. Check "Yes" if the mortgagor remains entitled to any assistance whatsoever; "No" if either Formula One or Two produces assistance of zero or
less.
11. The Mortgagee Number must be entered since it is the only identification
of the mortgagee appearing on the report. The number is the ten-digit code
number assigned at the time of your approval as mortgagee.

Previous edition is obsolete

form HUD-93101-A (12/91)
ref. Handbook 4330.1