HOME/HTF Rent Roll Certification
Please read attached Instructions in their entirety before completing this form. Incomplete or incorrectly completed forms will not be accepted.
Owner Information
Owner Organization: ______________________________________________________________
Owner Name: ____________________________________________________________________
Owner Address: __________________________________________________________________
Owner Email: ____________________________________________________________________
Owner Direct Phone Number: _______________________________________________________
Property Management Information
Property Management Organization: __________________________________________________
Property Management Contact Name: _________________________________________________
Property Management Address: ______________________________________________________
Property Manager Email: ___________________________________________________________
Property Manager Phone Number: ____________________________________________________
Has there been a change of ownership since the previous monitoring? ☐ Yes ☐ No
If yes, provide the current and proposed organization chart and any other applicable documentation.
Has there been a change of Property Management since the previous monitoring? ☐ Yes ☐ No
If yes, provide Property Management Agreement.
Has there been a change to the unit designation since the last monitoring? ☐ Yes ☐ No
If so, provide an explanation in the comments section for the new designation(s) and list the newly designated unit numbers below.
HOME/HTF Rent Roll Certification
Number of Colorado Division of Housing HOME/HTF Assisted Units: __________ County: Select county
REPORT ONLY CDOH HOME/HTF-ASSISTED UNITS ON THIS FORM.
Initial Certification
Tenant Last Name | Unit # | # of bdms | HH Size | Initial Cert. Date | AMI % | Gross Annual HH Income | Gross Rent (tenant portion + UA+HAP) | Tenant Rent Portion | Utility Allowance | Housing Assistance Payment Amount Received | Rental Assistance Type (project-based or tenant-based) | Administrative Agency | ||
Comments (summary of change in unit designation and agency’s plan to re-designate/restore compliance if the household is no longer eligible, etc):
Annual Recertification
Tenant Last Name | Unit # | # of bdms | HH Size | AnnualRecert. Date | AMI % | Gross Annual HH Income | Gross Rent (tenant portion + UA+HAP) | Tenant Rent Portion | Utility Allowance | Housing Assistance Payment Amount Received | Rental Assistance Type (project-based or tenant-based) | Administrative Agency | ||
Comments (summary of change in unit designation and agency’s plan to re-designate/restore compliance if the household is no longer eligible, etc):
Attach copies of the following documents:
Instructions for completing the CDOH HOME/HTF Rent Roll Certification
HOME regulations 24 CFR 92.252 and 92.504 and HTF regulations 24 CFR 93.151 and §93.302 require owners to submit a rent and occupancy report on an annual basis. To ensure the housing is affordable to low income households, this report verifies that:
1. There are the appropriate number and type of CDOH HOME/HTF-assisted units as specified in the Beneficiary and Rent Use Covenant.
2. All the CDOH-assisted units are occupied by income eligible households.
3. The rents charged for CDOH-assisted units are appropriate.
Property Management Contact Name: Name, telephone number, and email address of person to contact for follow up on submitted form.
Number of CDOH-Assisted Units: Report only the CDOH HOME/HTF-assisted units. This number should match the number indicated in the Beneficiary and Rent Use Covenant (attached).
Initial Certification Table: information about the tenant at time of move-in to property or if a newly designated unit, at time of initial HOME/HTF eligibility determination. All current tenants with HOME/HTF assistance must be included in the initial certification section.
Annual Recertification Table: information about the tenant as of their most recent annual recertification. Must be within the previous 12 months of the report date and should have occurred in the same month as initial certification.
Tenant Last Name: if there are tenants with the same last name, use the first initial to differentiate.
Initial Certification and Annual Recertification Date: Report the month, day, and year of initial and annual recertification.
% of AMI. The AMI level designation for the unit according to the Beneficiary and Rent Use Covenant.
Income Limit based on AMI designation for unit: Use the AMI limits found on the CDOH website at:
Gross Annual Household Income: Calculate according to 24 CFR 5 ("Part 5"). Report amounts to the nearest dollar (no cents).
Rent Limit based on AMI designation for unit:
Gross Rent: Sum of tenant rent portion, utility allowance, and rental assistance (HAP amount) payment, as applicable. Must be under the associated rent limit for unit size and AMI designation.
Tenant Rent Portion: Report only the tenant paid portion of the total rent charged for the unit (without Utility Allowance).
Utility Allowance. The dollar amount of utility allowance. If the chosen utility allowance methodology has changed since the last CDOH review, complete the included Utility Allowance Certification form and attached with this form. If all utilities are paid by the property owner, mark N/A.
HAP Amount Received: Amount of any subsidy received on behalf of this unit or household.
Rental Assistance Type: If the tenant is receiving subsidy by means of Housing Assistance Payment (HAP) indicate the type of rental assistance per unit.
Administrative Agency: If the tenant is receiving subsidy by means of Housing Assistance Payment (HAP), provide the name of the administering agency.
