Management HandbookForm Instructions

TC-52hRACE AND ETHNIC DATA REPORTING FORM

[form HUD-27061-H (9/2003)]

HUD requires that we use their form format only. See the bottom of the form for HUD’s form number and Management’s internal reference form number. This HUD form is used to determine the ethnicity and racial content of households applying for or living in federally assisted properties. A separate form will be used for each household member.

Owners/Agents are required to offer the opportunity to the Head and Co-head of each household to self-certify themselves and each member of his/her household during the application interview and at any time the head of household or household composition changes. Parents or guardians are to complete the self-certification for children under the age of 18. See below under “NOTE” for refusals to complete the form.

Please follow these instructions:

  1. Ensure that the property name, project number and address of the property are entered. Be sure to include the unit number in the address.
  1. Enter in the name of the Owner/Managing Agent: Monarch Properties, Inc., Westmark Management Company or Asset Performance Group as applicable.
  1. Enter the “Type of Assistance or Program Title”: Section 8, 236, S/8-202, etc.
  1. Give the Head, Co-head, and other adults both pages of the form to complete individually and for each dependent household member as applicable – one form for each household member. Ensure that “Ethnic and Racial Categories” have been marked. (See page 2 for the definitions of these categories.)
  1. Ensure that the Head, Co-Head, and adults sign and date where indicated.
  1. Place the original signed copy of the form(s) in the applicant/resident file under the “I/D” tab with the other household identification: Picture I/D, Birth Certificates, etc. Give the applicant/resident a photocopy of the form if requested.

NOTE: There is no penalty for persons who do not wish to complete the form. Owners/Owner’s Agents cannot complete the form on behalf of the applicant or tenant. If this circumstance arises, ask them to write across the form: I do not wish to complete this form. Then, they should sign their name and date the form. Then proceed as in #6 above.

If you have any questions or concerns regarding these instructions, please call your Occupancy Supervisor in the Occupancy Department for assistance.

Ethnicity & Race (2/04)TC52h