Preliminary Income Change Form

I certify that answers I have given are true and accurate to the best of my knowledge, and have no objection to inquiries being made to verify any statement herein.

I UNDERSTAND THAT AN INTERIM ADJUSTMENT WILL BE PROCESSED ONCE THE HOUSING AUTHORITY HAS RECEIVED THIRD PARTY VERIFICATION IF NECESSARY.

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WARNING! Title 18, Section 1001 of the U.S. Code, states that any person who knowingly and willingly make false or fraudulent statement to any Department or Agency of the U.S. or the Department of Housing and Urban Development is guilty of a felony.