Appointment Date:_______________________

Date Verifications Sent Out:_______________________

Date Sent to CEPCO:_______________________

HUD ADD A HOUSEHOLD MEMBER CHECKLIST

PROPERTY:
UNIT:
TENANT:
EFFECTIVE DATE:

New Household Members 18 years or older

Original Application (time & date stamped)
Landlord Reference Verification
Credit/Criminal Background Check –
MHFA Government Data Practices Act (Include Attachment 1)
Release of Information – 9887-9887A Forms Resident Handouts
Household Questionnaire (time & date stamped) Rules & Regulations

Family Summary Worksheet HUD Residents Rights & Responsibilities

HUD Fact Sheet – 4 Pages
VAWA (Violence Against Women Act)
HUD-9887/A Fact Sheet
HUD Acknowledgement and Acceptance Form
Fraud – Is it Worth It? Form HUD-1141
Annual Student Certification
EIV & You Brochure
Divestiture of Assets
Drug Free Housing Agreement Residents must receive these and sign the
Acknowledgement and Acceptance Form.
Emergency Contact Form
All new household members
Copy of Birth Certificate or State Issued Identification/Driver’s License (Verification of Birth)
Copy of Social Security Card (Verification of Social Security Number)
Race and Ethnic Data Reporting Form (one for each household member)
Tenant Declaration of Citizenship
Supporting Verifications
Verification of Disability/Handicap Status (If Applicable)__________________________________________
Income:________________________________________________________________________________
Assets:_________________________________________________________________________________

RETURN ALL ORIGINAL FORMS IN THE ORDER OF THE CHECKLIST

CEPCO Management, Inc. is an equal opportunity provider and employer

PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343 * Phone 952-935-0359 * Fax 952-935-9612
www.cepcomanagement.com
Rev. 03-2013