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WHAT IS YOUR INCOME?

 Your servicer and housing counselor or attorney will need to know all of your current household income.
Before you speak with them, complete the following worksheet. Although this worksheet asks for net
income amounts (take-home pay) for budgeting purposes, be sure to have gross income amounts
available for the servicer, counselor, or attorney as well.
 It is important that these amounts be accurate and exact.

MONTHLY HOUSEHOLD INCOME:

Sources of Income Exp. Date
Use Net Income (if TOTAL
(Take Home Amount) applicable) Homeowner A Homeowner B A & B
Primary Job $ $ $

Second Job
Social Security/ SSI/SSDI
Child or Spousal Support
Unemployment
Compensation
Workers Disability
Compensation
Veterans Benefits

Retirement Benefits

Monies from Boarders or
Roommates
Childcare assistance
Housing assistance

Rental income from other
homes owned
Other
Other

$ $
Total for Homeowner
Total Household Income $
(A + B)

Include income for all those living in the home. If the amount changes from month to month, look at your
year-to-date amount and determine an average.

NOTE: Make sure you let your servicer know if you expect a change in income in the near future.

January 2020 | Page 22