Zero Income Affidavit Form - I, , do swear or affirm, under penalty if perjury that: I hereby certify that i do not individually receive income from any of the following sources: Web description hopwa program regulations require verification of all income from participating households. I, _____________________________ hereby certify that i do not individually receive income from any of the following sources:. This zero income determination worksheet must be completed by all heads of household reporting no ($0). Web income for period covering _ to __ _____ _____ _____ _____ _____ i understand that to perjure myself in order to obtain assistance is a.
Web description hopwa program regulations require verification of all income from participating households. This zero income determination worksheet must be completed by all heads of household reporting no ($0). I hereby certify that i do not individually receive income from any of the following sources: I, , do swear or affirm, under penalty if perjury that: I, _____________________________ hereby certify that i do not individually receive income from any of the following sources:. Web income for period covering _ to __ _____ _____ _____ _____ _____ i understand that to perjure myself in order to obtain assistance is a.