HUD Zero Income Certification Form: Filing, Notarization, and Penalties

The HUD zero income certification form is a sworn statement you file with your local Public Housing Agency declaring that no one in your household earns or receives income, and your PHA uses it to set your rent at the agency’s minimum. There is no single national version of the form. HUD does not require it federally; individual PHAs decide whether to use one and design their own, so the document you receive will look different depending on where you live.¹ For most programs, rent defaults to the greater of 30 percent of monthly adjusted income or a minimum the agency sets, up to $50.² When your income is zero, the affidavit is what supports charging you only that minimum.

Where to Get the Form

Ask your PHA directly. The office managing your voucher or public housing unit issues the form, and if the agency has an online tenant portal the blank version may be available there. HUD publishes one sample template used by the Housing Opportunities for Persons with AIDS (HOPWA) program, but that is a model, not a form your PHA is required to use.³ Each PHA customizes its own version to match its Administrative Plan or Admissions and Continued Occupancy Policy.¹

Filling Out the Form

Most versions follow the same structure as the HOPWA sample. You enter your name, the date your income stopped, the date you expect income to resume if any is expected, and whether you have applied for other financial assistance. The main part of the form is a list of income categories where you confirm, by checking a box or writing zero, that no one in your household receives money from that source.³

Expect these categories:

Wages and salaries, including overtime, commissions, tips, and bonuses
Business or rental income, meaning net earnings from self-employment or property
Investment income such as interest, dividends, or returns from personal property
Government benefits including Social Security, pensions, annuities, and disability
Unemployment compensation, workers’ compensation, and severance
Public assistance or general assistance payments
Alimony and child support, whether court-ordered or informal
Military pay, regular and special, for any household member serving
Regular monetary contributions from family or friends

Go through every line, even the ones that obviously don’t apply. The point of the form is to show you reviewed each source. Leaving a line blank can prompt the agency to return the form.

Some PHAs add a section asking how your household covers basic living expenses like food, utilities, and transportation when there is no income. If yours does, be specific: name the relative who pays your electric bill, the food bank you visit, the church that helps with clothing. Vague answers like “family helps” invite follow-up questions that slow processing.

Payments That Don’t Count as Income

Before you decide whether you have “zero income,” check what HUD excludes from annual income under 24 CFR § 5.609. Some payments in your household may not count, which means you can still file the affidavit truthfully.⁴

SNAP and other food assistance
Foster care and kinship care payments⁵
Student financial aid paid to the student or the school
Money received specifically to cover a family member’s medical costs
Temporary or sporadic gifts (regular recurring gifts do count)
Earnings of any child under 18
Resident service stipends up to $200 per month
Lump-sum insurance or legal settlements for personal injury or property loss
Earnings of a live-in aide

If your only receipts are excluded items like these, you still qualify to file the zero-income affidavit. Tell your caseworker about them so the file is complete, but they will not change your rent.⁶

Assets Can Still Create Imputed Income

Zero income does not guarantee zero rent if you hold significant assets. Under 24 CFR § 5.609, when total net family assets exceed $52,787 for 2026, the PHA calculates imputed income by multiplying the cash value of those assets by HUD’s passbook savings rate, currently 0.40 percent.⁷ A $60,000 savings account, for example, generates $240 in imputed annual income that factors into your rent.

If your household’s net assets are at or below $52,787, you can self-certify their value rather than provide statements and appraisals.⁷

Signing and Notarization

Every adult household member, generally anyone 18 or older, signs the affidavit. Each signer is individually accountable for the accuracy of what the form says. Some PHAs also require a witness signature, which your caseworker can often provide during your appointment.

Notarization depends on the agency. It gives the affidavit added legal weight, but not every PHA requires it. Where required, expect a small notary fee set by state law. Call ahead so you know whether to arrive with the form already notarized or whether a notary will be on-site.

Submitting the Form

Turn the completed form in through whatever method your PHA accepts: at the front desk, through the tenant portal, by certified mail, or in a secure drop box. Keep a copy and note the date. If your recertification is due, a missing or late affidavit can suspend your subsidy, so a record of the submission date protects you if documents go missing.

HUD considers 30 days a best practice for the PHA to process an interim reexamination after receiving your request.⁸ If your new rent is going down, the agency does not have to give you advance notice before the change takes effect.

How the PHA Verifies Your Claim

Filing does not end the process. The PHA is required to verify your zero-income claim through the Enterprise Income Verification (EIV) system, which pulls employment data from the National Directory of New Hires and benefit records from the Social Security Administration.⁹ The system checks whether anyone in your household has wages, unemployment compensation, or SSA benefits you did not disclose.¹⁰

If EIV flags a discrepancy, the agency will contact the employer or benefit agency for third-party verification. The PHA may also reach out to relatives or organizations you named as sources of non-cash support. This happens with every zero-income household; it is routine.

Minimum Rent and Hardship Exemption

Even at zero income, you will owe a minimum monthly rent. Public housing and Housing Choice Voucher PHAs can set that minimum at up to $50 per month; other Section 8 programs use $25.¹¹ Your PHA chooses the exact amount within those caps.

If you cannot pay it, request a hardship exemption under 24 CFR § 5.630. The PHA must grant one when:

You have lost eligibility for, or are waiting on a decision about, a federal, state, or local assistance program
You would be evicted because you cannot pay the minimum rent
Your household income dropped because of changed circumstances, including job loss
A family member has recently died
Other circumstances that the PHA or HUD determines qualify

Once you request the exemption, the PHA must suspend the minimum rent starting the following month and cannot evict you for nonpayment of minimum rent for at least 90 days.¹² If the agency finds the hardship temporary, you will repay the suspended rent later under a reasonable repayment plan. If it is long-term, no repayment is owed and the suspension continues until your situation changes. A denial of a long-term hardship request can be appealed through an informal hearing.¹³

Recertification and Reporting New Income

One affidavit does not cover you indefinitely. Every assisted household recertifies annually, and zero-income families are often asked to resubmit more frequently. Your PHA’s Administrative Plan sets whether that means every 30, 60, or 90 days; there is no single federal schedule, so ask.⁸

If anyone in your household starts earning any income, whether from a job, Social Security, or child support, report the change within the timeframe your agency sets. Many PHAs require notice within 10 days, though some allow longer, and some waive the requirement for increases near the end of your certification period.¹⁴ Check your lease and administrative plan for the exact deadline.

Failing to report new income can trigger a retroactive rent increase covering every month you underreported. The PHA may require a lump-sum repayment or set up a repayment agreement.

Penalties for False Statements

The affidavit is a legal declaration. The HUD sample form warns applicants about the Program Fraud Civil Remedies Act, which imposes a civil penalty of up to $5,000 per false statement made when applying for federal benefits.¹⁵ Deliberately hiding income on a government form can also be prosecuted under 18 U.S.C. § 1001, carrying up to five years in prison and a fine of up to $250,000 for individuals.¹⁶

On the practical side, the PHA will terminate your housing assistance if it finds you lied on the affidavit.³ EIV will eventually catch unreported wages or benefits. Honest mistakes, like forgetting about a small support payment or misunderstanding what counts as income, are correctable. Deliberate concealment is not.

1
HUD Exchange. Is a Policy to Require a Zero-Income Statement From People Claiming No Income Consistent With HUD Regulations
2
U.S. Department of Housing and Urban Development. Housing Choice Voucher Program Guidebook – Calculating Rent and HAP Payments
3
HUD Exchange. Zero Income Affidavit Housing Opportunities for Persons With AIDS
4
eCFR. 24 CFR 5.609 – Annual Income
5
U.S. Department of Housing and Urban Development. Income Exclusion of Kinship, Kin-GAP and Other Guardianship Care Payments
6
HUD.gov. Exhibit 5-1: Income Inclusions and Exclusions
7
HUD User. 2026 HUD Inflation-Adjusted Values
8
HUD Exchange. ACOP Toolkit: Annual and Interim Reexaminations Fact Sheet
9
U.S. Department of Housing and Urban Development. Enterprise Income Verification (EIV) System
10
U.S. Department of Housing and Urban Development. PIH 2018-18 Administrative Guidance for Effective and Mandated Use of the EIV System
11
eCFR. 24 CFR 5.630 – Minimum Rent
12
HUD Exchange. Public Housing Minimum Rent and Hardship Exemptions
13
HUD Exchange. What Is the Impact of Short-Term Versus Long-Term Hardships When the Family Is Subject to the Minimum Rent
14
U.S. Department of Housing and Urban Development. PIH 2023-27 HOTMA
15
Office of the Law Revision Counsel. 31 USC Chapter 38 – Administrative Remedies for False Claims
16
Office of the Law Revision Counsel. 18 USC 3571 – Sentence of Fine