As per HB-I-3550 "Direct Family Housing Program" instructions, this pre-qualification is an INFORMAL CHECK
to see if the information provided by you, indicates possible eligibility for housing assitance.


We will use the following UNVERIFIED INFORMATION provided by you, to evaluate the likelihood that you, as a
potential applicant, would be able to obtain a loan. The results of the pre-qualifications are NOT binding.
Individuals may file an application regardless of the results.
NOTE: The attached 3550-1, "Authorization to Release Information", MUST be Signed and READ by the
applicant and Co-Applicant.
APPLICANT 2
APPLICANT 1
Name1:
 Name2:
Social Security:
Social Security:
Age
 Age
No
Disabled:
 Yes
 Disabled:
 Yes
No
Address:
Address:
Zip Code:
City:
 City:
 State:
State:
Zip Code:
Work Phone:
Home Phone:
Home Phone:
Work Phone:
Yearly:
Applicant Income $:
 Monthly:
Applicant Income $:
Yearly:
Monthly:
Yes:
 No:
Yes:
 No:
Are you a U.S. Citizen?
Are you a U.S. Citizen?
Yes:
 No:
Yes:
 No:
Are you a Permanent Resident Alien?
Are you a Permanent Resident Alien?
Marital Status:
Marital Status:
Single:
Widow:
Single:
 Divorced:
 Separated:
Divorced:
 Widow:
Separated:
(List ALL other verifiable income: Additional employment, Food Stamps, Child Support, AFDC, TANF, Social Security, Unemployment, etc...)
Monthly
 Monthly
 Type/Source
Type/Source
$
$
List All family members/other people living in the household
Name:
 Income
No
Yes
Age
Full -Time Student
Income
No
Yes
Name:
 Age
Full -Time Student
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Copyright Thomas & Company


PREQUALIFICATION
For RH 502/504 INTEREST