DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
ANDROSCOGGIN COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 02/05
FAMILY SIZE INCOME
1 $29,600 Above Below
2 33,850 Above Below
3 38,100 Above Below
4 42,300 Above Below
5 45,700 Above Below
6 49,100 Above Below
7 52,500 Above Below
8 55,850 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: _____________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
AROOSTOOK COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $27,600 Above Below
2 31,550 Above Below
3 35,550 Above Below
4 39,450 Above Below
5 42,600 Above Below
6 45,750 Above Below
7 48,900 Above Below
8 52,050 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: _____________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
CUMBERLAND COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $32,400 Above Below
2 37,000 Above Below
3 41,650 Above Below
4 46,250 Above Below
5 49,950 Above Below
6 53,650 Above Below
7 57,350 Above Below
8 61,050 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: _____________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
FRANKLIN COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $27,600 Above Below
2 31,550 Above Below
3 35,500 Above Below
4 39,450 Above Below
5 42,600 Above Below
6 45,750 Above Below
7 48,900 Above Below
8 52,050 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: _____________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
HANCOCK COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $29,900 Above Below
2 34,150 Above Below
3 38,450 Above Below
4 42,700 Above Below
5 46,100 Above Below
6 49,550 Above Below
7 52,950 Above Below
8 56,350 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: _____________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
KENNEBEC COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $30,250 Above Below
2 34,550 Above Below
3 38,900 Above Below
4 43,200 Above Below
5 46,650 Above Below
6 50,100 Above Below
7 53,550 Above Below
8 57,000 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: _____________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
KNOX COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $30,450 Above Below
2 34,800 Above Below
3 39,150 Above Below
4 43,500 Above Below
5 47,000 Above Below
6 50,450 Above Below
7 53,950 Above Below
8 57,400 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: _____________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
LINCOLN COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $31,450 Above Below
2 35,900 Above Below
3 40,400 Above Below
4 44,900 Above Below
5 48,500 Above Below
6 52,100 Above Below
7 55,700 Above Below
8 59,250 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: _____________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
OXFORD COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $27,600 Above Below
2 31,550 Above Below
3 35,500 Above Below
4 39,450 Above Below
5 42,600 Above Below
6 45,750 Above Below
7 48,900 Above Below
8 52,050 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: ______________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
PENOBSCOT COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $27,600 Above Below
2 31,550 Above Below
3 35,500 Above Below
4 39,450 Above Below
5 42,600 Above Below
6 45,750 Above Below
7 48,900 Above Below
8 52,050 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4
Effective 6/13/06
FOR USE BY PRIME CONTRACTOR ONLY
Name of Prime Contractor: ___________________________________________________________________
Project Name: ______________________________________________________________________________
Is new employee Section 3 eligible? ____ Yes _____ No
If yes, must be included in SECTION 3 UTILIZATION REPORT.
Job Title or Construction Trade that new Employee is hired for ____________________________
DEPARTMENT OF ECONOMIC & COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
SECTION 3 INCOME WORKSHEET
PISCATAQUIS COUNTY
To be completed by all new employees residing in the county where the construction work is taking place.
Completion of this worksheet is solely to determine if there is utilization of Section 3 employees on this construction project and should not be considered as a condition of employment.
Please place an "X" in the appropriate spaces pertaining to your family's size, annual income and makeup.
Effective 6/13/06
FAMILY SIZE INCOME
1 $27,600 Above Below
2 31,550 Above Below
3 35,500 Above Below
4 39,450 Above Below
5 42,600 Above Below
6 45,750 Above Below
7 48,900 Above Below
8 52,050 Above Below
*Read This Carefully*
In determining total family income use your Total Adjusted Gross income for your household as reported on your most recent Federal Income Tax form.
If you use Form 1040 – use line 33
If you use Form 1040A – use line 19
If you use Form 1040EZ – use line 4