WORKSHEET FOR DOCUMENTING ELIGIBLE HOUSEHOLD AND REPAYMENT INCOME
Lender Instructions: Determine eligible household income for the Single Family Housing Guaranteed Loan Program (SFHGLP) bydocumenting all sources/types of income for all household members. Qualify the loan by documenting all sources/type of income that is
stable and dependable utilized to repay the loan.
GENERAL INFORMATION
Applicant(s): Lender: Date:
Identify all Household Members Age Full-time
Student Y/N?
Disabled
Y/N?
Receives
Income Y/N?
Source of Income
ANNUAL INCOME CALCULATION (Consider anticipated income for the next 12 months for all adult household members as described in §1980.347 of RD
Instruction 1980-D.) Website for instructions/administrative notices: http://www.rurdev.usda.gov/RegulationsAndGuidance.html
1. Applicant (Wages, salary, self-employed, commission, overtime, bonus, tips, alimony, child support, pension/retirement, social security,
disability, trust income, etc.). Calculate and record how the calculation of each income source/type was determined in the space below. $
2. Co-Applicant (Wages, salary, self-employed, commission, overtime, bonus, tips, alimony, child support, pension/retirement, social security,
disability, trust income, etc.). Calculate and record how the calculation of each income source/type was determined in the space below. $
3. Additional Income to Primary Income (Automobile Allowance, Mortgage Differential, Military, Secondary Employment, Seasonal
Employment, Unemployment.) Calculate and record how the calculation of each income source/type was determined in the space below. $
4. Additional Adult Household Member (s) who are not a Party to the Note (Primary Employment from Wages, Salary, Self Employed Additional income to Primary Employment, Other Income). . Calculate and record how the calculation of each income
source/type was determined in the space below.
$
5. Income from Assets (Income from household assets as described in §1980.347(d) and §1980.302(a) of RD Instruction 1980-D). Calculate
and record how the calculation of each income source/type was determined in the space below. $
6. Annual Household Income (Total 1 through 5)
$ Attachment A
Page 2 of 3
Rev 1/2013
Applicant(s):
ADJUSTED INCOME CALCULATION (Consider qualifying deductions as described in §1980.348 of RD Instruction 1980-D)
7. Dependent Deduction ($480 for each child under age 18, or full-time student attending school or disabled family member over the age of
18) - #____________ x $480 $
8. Annual Child Care Expenses (Reasonable expenses for children 12 and under). Calculate and record the calculation of the deduction
in the space below.
$
9. Elderly Household (1 household deduction of $400 if 62 years of age or older, or disabled and a party to the note) $
10. Disability (Unreimbursed expenses in excess of 3% of annual income. See §1980.348(d) of RD Instruction 1980-D for eligibility. Calculate
and record the calculation of the deduction in the space below. $
11. Medical Expenses (Elderly households only. Unreimbursed medical expenses in excess of 3% of annual income. See §1980.348(d)(1) of
RD Instruction 1980-D for further information). Calculate and record the calculation of the deduction in the space below. $
12. Total Household Deductions (Enter total 7 through 11) $
13. Adjusted Annual Income (Item 6 minus item 12)
Income cannot exceed Moderate Income Limit to be eligible for SFHGLP
Moderate Income Limit: $_______________________ State: ___________________________ County: ______________________________
$ Attachment A
Page 3 of 3
Applicant(s):
MONTHLY REPAYMENT INCOME CALCULATION(Considerstable and dependable income of partiesto the note as described in §1980.345(a),
1980.345(b) and 1980.345(c) of RDInstruction 1980‐D).
14. Stable Dependable Monthly Income (Parties to note only). Calculate and record how the calculation of each income
source/type was determined in the space below. Identify income type by party to note.
Borrower Co-Borrower
Base Income $________________________
Calculation of Base Income:
$________________________
Calculation of Base Income:
Other Income $________________________
Calculation of Other Income:
$________________________
Calculation of Other Income:
Total Income $________________________ $________________________
Total
$__________
$__________
$__________
15. Monthly Repayment Income (Enter total of 14).
$
Date: ___________________ Prepared by: ______________________________ Lender: _____________________________
Kentucky property eligibility map for USDA and rural development , property eligibility, maps, rhs, usda, rural development, rural housing,
Joel Lobb
Senior Loan Officer
Senior Loan Officer
(NMLS#57916)
American Mortgage Solutions, Inc.
800 Stone Creek Pkwy, Ste 7,
Louisville, KY 40223
phone: (502) 905-3708
Fax: (502) 327-9119
Company ID #1364 | MB73346
