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Worksheet: Household Income Computation

HOUSEHOLD INCOME COMPUTATION WORKSHEET


Residential Loan Program

Oregon Housing and Community Services Department

State of Oregon



Income is the total of the annualized gross income, from any source and before taxes and withholding, of all non-minor persons who will reside in the Single-Family residence. The annualized income is gross monthly income multiplied by 12.


  1. Gross monthly income (before payroll deductions) of:

  1. Wages, salaries and overtime pay $

  2. Commissions, fees, tips, bonuses and royalties

  3. Part-time employment and sick pay

TOTAL $


2. Net income from (Self-Employment Only):

  1. Operation of business or profession $

  2. Rental of real or personal property

TOTAL $


3. Interest and dividend income: $


4. Full amount of periodic payments from:

  1. Social Security and annuities $

  2. Trusts

  3. Insurance policies (not lump sum payments)

  4. Retirement and pension payments

  5. Veterans’ Administration compensation

  6. Other periodic receipts

TOTAL $


5. Payments in lieu of earnings:

  1. Unemployment, disability and workers’ compensation $

  2. Severance pay

TOTAL $


  1. Public assistance: (Include the maximum amount allowed for

Shelter and utilities): $


  1. Periodic and determinable allowance for:

a. Alimony and child support $

b. Separate maintenance

c. Regular contributions or gifts from persons not living in the

residence

TOTAL $


  1. Armed forces income:

a. Regular pay of head of family or spouse $

b. Special pay of head of family or spouse (unless exposed to

hostile fire)

TOTAL $


TOTAL GROSS MONTHLY INCOME $


(Revised 10/14) SFMP 15


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