EMERGENCY RENTAL ASSISTANCE PROGRAM (ERAP)
INCOME COMPUTATION WORKSHEET
Use representative month amount to fill out Income Computation worksheet
ADULT MEMBER NAME
Application Started Date
-
Month
-
Day
Year
Date
START DATE
/
Month
/
Day
Year
Date
END DATE
/
Month
/
Day
Year
Date
CUSTOMER NAME 1
Income for Customer 1
Source
Paid Date
Gross Amount
1
2
3
4
5
6
7
8
9
10
CUSTOMER NAME 2
Income for Customer 2
Source
Paid Date
Gross Amount
1
2
3
4
5
6
7
8
9
10
Customer 1 Total Amount
Customer 2 Total Amount
Grand total all household members
Number of weeks in pay period
Representative Week (grand total divided by weeks in pay period)
Estimated Monthly Gross Income (Representative week divided by 4.33)
Estimated Annual Gross Income (Representative week times 52)
Family Size
Monthly Income Limit
Annual Income Limit
Income Eligible?
Yes
No
Customer Signature
Clear
Date
/
Month
/
Day
Year
Date
Completed By
Date
/
Month
/
Day
Year
Date
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Should be Empty: