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["MIH Homeowner Income Certification Form"]
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["Last Rev. 12/2024"]
["I. General Information"]
["This form must be submitted to KHRC for review prior to selling a home.  When complete, name the file as follows: MIH Homeowner Income Certification Form NameofGrantee HouseholdLastName.  Following the sale of a home, grantees must also send KHRC a recorded recapture provision, as required and detailed in the grantee's Grant Agreement. Examples of a recapture provision include a deed restriction or a second mortgage and promissory note. \n\nThe purpose of this form is not for KHRC to approve the household prior to the sale, but to determine if the household's income verified by the grantee meets the MIH program limits. This form does not replace the Homeowner Compliance Worksheet that must be submitted annually in April to KHRC. \n\nGrantees may not send KHRC unsolicited documentation used by grantees to verify a household. However, grantees must retain documents used to verify and determine the household's eligibility for the MIH program the life of the grant. Grantees may be audited by KHRC, Legislative Post Audit, and other agencies or agents of the State of Kansas and KHRC reserves the right to request documents used to verify income."]
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["Date:",{"$nulls":4},"Grant Number:"]
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["Grantee Name: ",{"$nulls":5},"County:"]
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["Award Year:",{"$nulls":4},"Amount Awarded:"]
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["Current City/County Contact:"]
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["Name:",{"$nulls":6},"Title:"]
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["Email:",{"$nulls":6},"Phone:"]
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["II. Compliance Information"]
["On the table below, list each household benefitting from MIH funds (this includes projects that received assistance with infrastructure) on the table below. If a household remains in a unit from year to year during the compliance period, they should remain on the report; however, the grantee does not need to nor should they recertify or reverify that household's income. The grantee only needs to verify income during the initial qualification process for the household (i.e. prior to move in). When verifying household income, the grantee must use the income limits that are in effect at the time of income verification. For example, if a household moved into a unit in May of 2024, the grantee must use the 2024 income limits. Please keep in mind that the income limits are published annually (generally in April) and as a result, there will always be a few months of the year that will fall under the previous year's income limits due to when they are published.\n \nThe MIH income limits will be posted on KHRC's website annually and grantees will be expected to stay apprised of the current limits. KHRC will announce via email when updated income limits are posted, so if the grantee has not already done so, please subscribe to MIH emails (link below) so that the grantee receives updated information on the program. Only use the MIH income limits provided by KHRC to determine household eligibility. \n \nHouseholds may qualify for the MIH program based on either the Statewide AMI limits or the Countywide AMI limits, so as long as the qualify within the limits of one or the other. For compliance purposes, grantees must provide both the Statewide limits and the Countywide income limits for the household. Enter the State 150% AMI limit amount and the County 150% AMI limit in each respective field below. "]
{"$rows_empty":11}
["Subscribe to MIH Emails"]
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["Household Last Name",null,"Household Size",null,"Address",null,"Anticipated Closing Date","Household Income Verified by Grantee",null,"Date Income was Verified",null,"150% AMI - State Limit",null,"Between\n60%-150%",null,"150% AMI - County Limit",null,"Between\n60%-150%",null,"Effective Date of Income Limits "]
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[{"$nulls":13},{"$f":"H39/(L39/0.75/2)","v":{"$error":"#DIV/0!"}},null,null,null,{"$f":"H39/(P39/0.75/2)","v":{"$error":"#DIV/0!"}}]
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["III. Awardee Certification"]
["Only a representative from the MIH grantee (City or County) may sign the certification."]
["The Grantee certifies that they have verified the above household's income and that it is in compliance with income limits of the MIH program (60-150% AMI). "]
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["Grantee",{"$nulls":6},"Grantee Representative Name"]
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["Title",{"$nulls":6},"Date"]
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["IV. KHRC Certification"]
["Housing Compliance Division"]
["I certify that I have reviewed this form and that to the best of my knowledge, the above household's income is in compliance with income limits of the MIH program (60-150% AMI)."]
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["Name",{"$nulls":6},"Title",{"$nulls":6},"Date"]
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["Housing Development Division"]
["I certify that I have reviewed this form and that to the best of my knowledge, the above household's income is in compliance with income limits of the MIH program (60-150% AMI)."]
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["Name",{"$nulls":6},"Title",{"$nulls":6},"Date"]