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4 <br /> 4 <br /> 9 'V <br /> Unit Number. Enter the unit number of each unit that will receive HOME 4. Two Parents. A two-parent household with a dependent child or <br /> assistance. children(18 years old or younger). <br /> 5. Other. Any household not included in the above 4 definitions, <br /> Number of Bedrooms. Enter 0 for a single room occupancy(SRO)unit or including two or more unrelated individuals. <br /> for an efficiency unit,1 for 1 bedroom,2 for 2 bedrooms,3 for 3 bedrooms, <br /> 4 for 4 bedrooms,and 5 for 5 or more bedrooms. Assistance Type. For rented units,enter one code only to indicate the type <br /> of assistance,if any,being provided to the tenant. <br /> Occupant. For homebuyer activities,one unit must be owner occupied. if 1. Section 8. Tenants receiving Section 8 assistance through the Section <br /> there are tenant occupied units,enter I for tenant or 9 for vacant. 8 Certificate Program under 24 CFR part 882 or the Section 8 <br /> Housing Voucher Program under 24 CFR part 887. <br /> Percent of Area Median Income. For each occupied residential unit, 2. HOME TBRA. Tenants receiving HOME tenant-based rental <br /> enter one code only based on the following definitions: assistance. <br /> 1. 0-30 Percent of Area Median Income refers to a household whose 3. Other federal,state or local assistance. Tenants receiving rental <br /> annual income is at or below 30 percent of the median family income assistance through other federal,state or local rental assistance <br /> for the area,as determined by HUD with adjustments for smaller and programs. <br /> larger families. 4. .No assistance. Self-explanatory. <br /> 2. 30+-50 Percent of Area Median Income refers to a household <br /> whose annual income exceeds 30 percent and does not exceed 50 Total Rent. For renters,enter the total monthly rent(tenant contribution <br /> percent of the median family income for the area,as determined by plus subsidy amount). <br /> HUD with adjustments for smaller and larger families. 1. Homebuyer Counseling. Enter the code to indicate the type of <br /> 3. 50+-60 Percent of Area Median Income refers to a household counseling received by the homebuyer,if any: <br /> whose annual income exceeds 50 percent and does not exceed 60 (1) No counseling <br /> percent of the median family income for the area,as determined by (2) Pre-counseling <br /> HUD with adjustments for smaller and larger families. (3) Post-counseling <br /> 4. 60+-80 Percent of Area Median Income refers to a household (4) Both <br /> whose annual income exceeds 60 percent and does not exceed 80 2. FHA-Insured(Y/N)? Enter Yes,"Y",or No,"N",to indicate <br /> percent of the median family income for the area,as determined by whether the property's mortgage is insured by FHA. <br /> HUD with adjustments for smaller and larger families. 3. First-time Homebuyer(Y/N)? Enter"Y",if a first-time homebuyer. <br /> If not,enter"N". <br /> Hispanic?Y/N. For each occupied residential unit,enter the ethnicity for 4. Coming from subsidized housing Y/N? Enter"Y"if the homebuyer <br /> the head of household as either"Y"for Hispanic or Latino or"N"if the was living public housing or receiving rental assistance from a <br /> head of household is not Hispanic nor Latino. Hispanic or Latino race is federal,state or local program immediately prior to HOME assistance <br /> defined as a person of Cuban,Mexican,Puerto Rican,South or Central or"N"if not. <br /> American,other Spanish culture or origin,regardless of race. The term, 5. Lease Purchase(Y/N)? (For single address activities.) If there is a <br /> "Spanish origin,"can be used in addition to"Hispanic or Latino." lease purchase agreement,enter the date of the agreement. <br /> Race of Head of Household. For each occupied residential unit,enter one <br /> code only based on the following definitions: <br /> 11. White. A person having origins in any of the original peoples of <br /> Europe,North Africa or the Middle East. <br /> 12. Black/African American. A person having origins in any of the <br /> black racial groups of Africa. Terms such as"Haitian"or"Negro" <br /> can be used in addition to"Black or African American." <br /> 13. Asian. A person having origins in any of the original peoples of the <br /> Far East,Southeast Asia,or the Indian subcontinent. <br /> 14. American Indian/Alaska Native. A person having origins in any of <br /> the original peoples of North and South America(including Central <br /> America),and who maintains affiliation or community attachment. <br /> 15. Native Hawaiian/Other Pacific Islander. A person having origins <br /> in any of the original people of Hawaii,Guam,Samoa or other Pacific <br /> Islands. <br /> 16. American Indian/Alaska Native&White. A person having these <br /> multiple race heritages as defined above. <br /> 17. Asian&White. A person having these multiple race heritages as <br /> defined above. <br /> 18. Black/African American&White. A person having these multiple <br /> race heritages as defined above. <br /> 19. American Indian/Alaska Native&Black/African American. A <br /> person having these multiple race heritages as defined above. <br /> 20. Other Multi Racial. For reporting individual responses that are not <br /> included in any of the other categories listed above. <br /> Household Size. Enter the appropriate number of persons in the <br /> household: 1,2,3,4,5,6,7 or 8 or more persons(for households of more <br /> than 8,enter 8). <br /> Household Type. For each residential unit,enter one code only based on • <br /> the following definitions: <br /> 1. Single,Non-elderly. One-person household in which the person is <br /> not elderly. <br /> 2. Elderly. One or two person household with a person at least 62 years <br /> of age. <br /> 3. Single Parent. A single parent household with a dependent child or <br /> 1 children(18 years old or younger). <br /> Page 6 of 6 Revised(8/06) <br />