ILLINOIS RENTAL PAYMENT PROGRAM
INCOME ATTESTATION WITHOUT FURTHER DOCUMENTATION
Wage Earner’s Name:
By executing this document, I am hereby asking the Illinois Housing Development Authority to
waive the Standard Requirement (as defined below) that documentation be provided to support
the income determination for the wage earner listed above. I hereby certify and attest that the
2020 annual income for the wage earner listed above is: $
I also hereby certify and attest that I am submitting this written attestation with respect to the
wage earner listed above, due to one or more of the following reasons (check all that apply):
accommodate disabilities
extenuating circumstances related to the pandemic (e.g. place of employment has
closed)
lack of technological access
cash income
no qualifying income
STANDARD REQUIREMENT: In order to complete an application for emergency rental
assistance under the Illinois Rental Payment Program (“ILRPP”), tenants are required to
provide information that enables the Illinois Housing Development Authority (“IHDA”) to
determine the tenant’s income, as well as the income for any wage earner in the household,
in order to confirm whether the household income meets the ILRPP income parameters. As
part of the ILRPP application process, tenants are required to provide documentation for
themselves, and each wage earner in the household, to support the determination of income
for the tenant’s household, such as paystubs, W-2s or other wage statements, tax filings, bank
statements demonstrating regular income, or an attestation from an employer.
Tenant acknowledges that Tenant had an opportunity to review this attestation with an attorney
and agree that Tenant understands and agrees to its terms and conditions.
TENANT’S SIGNATURE:
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