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OCHA - Employer Verification Form

  1. OCHA Employment Verification Form
    We are required by HUD Regulations to verify the income of all applicants and tenants in our housing programs. We ask your cooperation in supplying the information requested below. This information will be held in confidence for use only in determining family eligibility and rent.
  2. Enter Name of Employee
  3. Enter last four (4) digits of SS number
  4. Enter Start Date of Employment
  5. Enter End Date of Employment
  6. Enter job title of employee
  7. Enter salary or base pay rate
  8. Enter average hours worked - Hours expected
  9. Enter the Overtime Pay Rate
  10. Enter average overtime hours worked - Hours expected
  11. Enter Gross total amount earned year to date
  12. Enter the last pay period end date
  13. Enter name of employer/place of employment

  14. Enter Supervisor Name and Title
  15. Enter Address of Employer/Employment

  16. Email address of supervisor/manager
  17. Notice of Verification
    Please be advise employers may be contacted to verify persons completing this form.
  18. Leave This Blank:

  19. This field is not part of the form submission.