2019 SELF-CERTIFICATION FORM FOR CHDO BOARD MEMBERS

Name:
Address:
City/State/Zip:
Email Address:
Organization’s Name:

Check the ONE box that defines your status on the organization’s Board of Trustees

☐ A public official associated with, or an employee of the governmental entity that created the CHDO.

The above can only be checked if this CHDO was created by a governmental entity (examples: a Participating Jurisdiction, a Public Housing Authority, a county or village, OHFA or a Redevelopment Authority). The person who checks this box cannot also qualify as a low-income representative, even if she or he meets the qualifying criteria

☐ Member of a Low‐Income Household (enter your household size in the parentheses below)

I am a member of a household of ( ) people. Our combined total expected income for our household size for 2018 is less than 80% of the area median income (for the same number of people in the household), in the county in which I live. See instructions

☐Resident of Low Income Area (enter the census tract in which you live in the parentheses below)

I reside in census tract number ( ), in which more than 50% of the households in that census tract had incomes less than 80% of the county area median income. See instructions

☐ Elected Representative of a Community Organization Serving People of Low Income

I am elected by the membership of an organization whose membership is open to all residents of a DEFINED COMMUNITY. This organization directly serves the community in which it is located. Examples include neighborhood watch group, food pantry, faith-based community outreach organization, community garden club or book club. In the community served, more than 50% of the households have incomes less than 80% of the county area median income. I serve on the CHDO Board primarily as a representative of that group.See instructions

  • The group’s name is ( )
  • The primary focus of the group is ( )
  • The census tracts served by the group are ( )
  • Select any one census tract in the Community Organization’s service area to evaluate for low-income eligibility. I have evaluated Census Tract ( )

☐I am not an elected or appointed public official, and I am not a representative of the low-income community as defined above.

Signature of Board Member ______Date ______

Revised 9 26 18

INSTRUCTIONS FOR CHDO BOARD MEMBERS TO VERIFY REPRESENTATION OF THE LOW-INCOME COMMUNITY

If you are a member of a low‐income household:

UseTABLE 1- OHIO 2018 HOUSEHOLD INCOME –80% OF MEDIAN INCOME BY COUNTY AND SIZE OF HOUSEHOLD to find the median income for the county in which you live, based on your household size. If your estimated 2018 household income is equal to or less than that number, you are a member of a low-income household for CHDO Board purposes.

If you are a resident of a low-income area:

USE the American FactFinder webpage and TABLE 1- OHIO 2018HOUSEHOLD INCOME –80% OF MEDIAN INCOME BY COUNTY AND SIZE OF HOUSEHOLD to assess the income criteria for your resident census tract.

Find your Census Tract:

  • Scroll down to ADDRESS SEARCH (on the right) to find your census tract
  • A “Select Geographies” box will pop up
  • Fill in info. Click GO
  • Under Geography Type, click on your census tract which you will find in the left-hand column

Find the Household Income for the selectedCensus Tract

  • Click Topics (on the left)
  • Select “People”
  • Select “Income and Earnings”
  • Select “Income/Earnings (Households)
  • Close Select Topics Box
  • Check the box for Table S1901, INCOME IN THE PAST 12 MONTHS (IN 2016 INFLATION-ADJUSTED DOLLARS)
  • Click View

Under the HOUSEHOLDS column, find the median income. Then, use Table 1 to find the income for a 4 Person Household in the county in which you live. If the median income is less than the amount you identified in Table 1, you are a resident of a low income area for CHDO Board purposes.

If you are an elected representative of a community organizationserving people of low income:

Use the procedure above for the census tract you selected on the self-certification form.

Under the HOUSEHOLDS column, find the median income. Then, use Table 1 to find the income for a 4 Person Household in the county in which the census tract is located. If the median income is less than the amount you identified in Table 1, and the community organization meets the criteria set forth in the Self-Certification form, you are a representative of that organization for CHDO Board purposes.

TABLE 1 - OHIO 2018 HOUSEHOLD INCOME - 80% OF MEDIAN INCOME BY COUNTY AND SIZE OF HOUSEHOLD

County / Area Median Income (100%) / 1 Person / 2 People / 3 People / 4 People / 5 People / 6 People / 7 People / 8 People
Adams / $45,100 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Allen / $62,700 / $35,150 / $40,150 / $45,150 / $50,150 / $54,200 / $58,200 / $62,200 / $66,200
Ashland / $61,400 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Ashtabula / $55,000 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Athens / $56,800 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Auglaize / $70,800 / $39,700 / $45,350 / $51,000 / $56,650 / $61,200 / $65,750 / $70,250 / $74,800
Belmont / $65,700 / $35,000 / $40,000 / $45,000 / $50,000 / $54,000 / $58,000 / $62,000 / $66,000
Brown / $55,100 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Butler / $78,300 / $43,900 / $50,150 / $56,400 / $62,650 / $67,700 / $72,700 / $77,700 / $82,700
Carroll / $64,900 / $36,350 / $41,550 / $46,750 / $51,900 / $56,100 / $60,250 / $64,400 / $68,550
Champaign / $63,700 / $35,700 / $40,800 / $45,900 / $50,950 / $55,050 / $59,150 / $63,200 / $67,300
Clark / $65,300 / $35,950 / $41,100 / $46,250 / $51,350 / $55,500 / $59,600 / $63,700 / $67,800
Clermont / $78,300 / $43,900 / $50,150 / $56,400 / $62,650 / $67,700 / $72,700 / $77,700 / $82,700
Clinton / $59,000 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Columbiana / $59,200 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Coshocton / $52,600 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Crawford / $54,000 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Cuyahoga / $70,700 / $39,600 / $45,250 / $50,900 / $56,550 / $61,100 / $65,600 / $70,150 / $74,650
Darke / $57,800 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Defiance / $62,400 / $34,950 / $39,950 / $44,950 / $49,900 / $53,900 / $57,900 / $61,900 / $65,900
Delaware / $76,400 / $42,800 / $48,900 / $55,000 / $61,100 / $66,000 / $70,900 / $75,800 / $80,700
Erie / $60,000 / $35,100 / $40,100 / $45,100 / $50,100 / $54,150 / $58,150 / $62,150 / $66,150
Fairfield / $76,400 / $42,800 / $48,900 / $55,000 / $61,100 / $66,000 / $70,900 / $75,800 / $80,700
Fayette / $51,900 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Franklin / $76,400 / $42,800 / $48,900 / $55,000 / $61,100 / $66,000 / $70,900 / $75,800 / $80,700
Fulton / $67,200 / $37,650 / $43,000 / $48,400 / $53,750 / $58,050 / $62,350 / $66,650 / $70,950
Gallia / $51,000 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Geauga / $70,700 / $39,600 / $45,250 / $50,900 / $56,550 / $61,100 / $65,600 / $70,150 / $74,650
Greene / $65,700 / $36,800 / $42,050 / $47,300 / $52,550 / $56,800 / $61,000 / $65,200 / $69,400
Guernsey / $53,300 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Hamilton / $78,300 / $43,900 / $50,150 / $56,400 / $62,650 / $67,700 / $72,700 / $77,700 / $82,700
Hancock / $71,600 / $40,150 / $45,850 / $51,600 / $57,300 / $61,900 / $66,500 / $71,100 / $75,650
Hardin / $54,300 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Harrison / $54,800 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Henry / $67,700 / $37,950 / $43,350 / $48,750 / $54,150 / $58,500 / $62,850 / $67,150 / $71,500
Highland / $50,300 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Hocking / $56,200 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Holmes / $63,400 / $35,500 / $40,600 / $45,650 / $50,700 / $54,800 / $58,850 / $62,900 / $66,950
Huron / $60,400 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Jackson / $51,900 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Jefferson / $61,500 / $34,450 / $39,400 / $44,300 / $49,200 / $53,150 / $57,100 / $61,050 / $64,950
Knox / $61,800 / $34,650 / $39,600 / $44,550 / $49,450 / $53,450 / $57,400 / $61,350 / $65,300
Lake / $70,700 / $39,600 / $45,250 / $50,900 / $56,550 / $61,100 / $65,600 / $70,150 / $74,650
Lawrence / $54,900 / $30,750 / $35,150 / $39,550 / $43,900 / $47,450 / $50,950 / $54,450 / $57,950
Licking / $76,400 / $42,800 / $48,900 / $55,000 / $61,100 / $66,000 / $70,900 / $75,800 / $80,700
Logan / $62,600 / $35,100 / $40,100 / $45,100 / $50,100 / $54,150 / $58,150 / $62,150 / $66,150
Lorain / $70,700 / $39,600 / $45,250 / $50,900 / $56,550 / $61,100 / $65,600 / $70,150 / $74,650
Lucas / $67,200 / $37,650 / $43,000 / $48,400 / $53,750 / $58,050 / $62,350 / $66,650 / $70,950
Madison / $76,400 / $42,800 / $48,900 / $55,000 / $61,100 / $66,000 / $70,900 / $75,800 / $80,700
Mahoning / $60,100 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Marion / $53,900 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Medina / $70,700 / $39,600 / $45,250 / $50,900 / $56,550 / $61,100 / $65,600 / $70,150 / $74,650
Meigs / $49,700 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Mercer / $71,300 / $39,950 / $45,650 / $51,350 / $57,050 / $61,650 / $66,200 / $70,750 / $75,350
Miami / $65,700 / $36,800 / $42,050 / $47,300 / $52,550 / $56,800 / $61,000 / $65,200 / $69,400
Monroe / $50,600 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Montgomery / $65,700 / $36,800 / $42,050 / $47,300 / $52,550 / $56,800 / $61,000 / $65,200 / $69,400
Morgan / $49,300 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Morrow / $76,400 / $42,800 / $48,900 / $55,000 / $61,100 / $66,000 / $70,900 / $75,800 / $80,700
Muskingum / $58,500 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Noble / $54,100 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Ottawa / $68,100 / $38,150 / $43,600 / $49,050 / $54,500 / $58,900 / $63,250 / $67,600 / $71,950
Paulding / $61,800 / $34,650 / $39,600 / $44,550 / $49,450 / $53,450 / $57,400 / $61,350 / $65,300
Perry / $52,700 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Pickaway / $76,400 / $42,800 / $48,900 / $55,000 / $61,100 / $66,000 / $70,900 / $75,800 / $80,700
Pike / $48,900 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Portage / $73,200 / $41,000 / $46,850 / $52,700 / $58,550 / $63,250 / $67,950 / $72,650 / $77,300
Preble / $59,400 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Putnam / $75,600 / $42,350 / $48,400 / $54,450 / $60,500 / $65,350 / $70,200 / $75,050 / $79,900
Richland / $60,200 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Ross / $59,500 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Sandusky / $60,400 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Scioto / $49,300 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Seneca / $59,200 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Shelby / $71,000 / $39,800 / $45,450 / $51,150 / $56,800 / $61,350 / $65,900 / $70,450 / $75,000
Stark / $64,900 / $36,350 / $41,550 / $46,750 / $51,900 / $56,100 / $60,250 / $64,400 / $68,550
Summit / $73,200 / $41,000 / $46,850 / $52,700 / $58,550 / $63,250 / $67,950 / $72,650 / $77,300
Trumbull / $60,100 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Tuscarawas / $65,400 / $36,450 / $41,650 / $46,850 / $52,050 / $56,250 / $60,400 / $64,550 / $68,750
Union / $83,500 / $46,800 / $53,450 / $60,150 / $66,800 / $72,150 / $77,500 / $82,850 / $88,200
Van Wert / $62,500 / $35,000 / $40,000 / $45,000 / $50,000 / $54,000 / $58,000 / $62,000 / $66,000
Vinton / $49,600 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Warren / $78,300 / $43,900 / $50,150 / $56,400 / $62,650 / $67,700 / $72,700 / $77,700 / $82,700
Washington / $60,800 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Wayne / $68,800 / $36,700 / $41,950 / $47,200 / $52,400 / $56,600 / $60,800 / $65,000 / $69,200
Williams / $57,500 / $34,400 / $39,300 / $44,200 / $49,100 / $53,050 / $57,000 / $60,900 / $64,850
Wood / $67,200 / $37,650 / $43,000 / $48,400 / $53,750 / $58,050 / $62,350 / $66,650 / $70,950
Wyandot / $63,400 / $35,500 / $40,600 / $45,650 / $50,700 / $54,800 / $58,850 / $62,900 / $66,950
SOURCE - 2018 Income Limits |HUD User

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