1

BMR Unit & Application Date

Enter the BMR unit address you are applying for and today's date

Important: BMR applications must be submitted with all required attachments. Please ensure you have all supporting documents ready including income verification, bank statements, and tax returns.
BMR Unit Address
2

Household Member Information

Enter information for all household members (up to 6). If more than 6, attach a separate sheet.

HH #1

Primary Applicant / Head of Household

3

Household Employment & Income

List each income source for every household member over 18. Members with multiple income sources list each separately.

"HH#" = Using pages 1-2, enter the number for the corresponding Household Member.
Household members with more than one source of income should list each one separately.
TOTAL GROSS ANNUAL INCOME $0.00
4

Household Assets — Non-Retirement

List every cash account showing a household member as account holder. Failure to list all accounts will disqualify your household.

Important: You must list every cash account that shows a household member as an account holder including joint accounts, custodial accounts for minors, and other accounts on which a household member's name appears. Liquid asset accounts include, but are not limited to, checking and savings accounts, Certificates of Deposit, Mutual Funds, stocks, bonds, trust funds, limited liability investments, and any other account in which money is saved. If money is not saved in an institution (e.g. it is saved at home), applicants must list this amount as well. Do not include material assets such as cars or boats. Failure to list all accounts will disqualify your household. Attach additional sheets if necessary.
Total Household Liquid Assets (do not include retirement) $0.00
5

Household Disclosures

The following questions apply to ALL household members

6

Additional Declarations

Complete the applicable declarations based on your household's situation

Income Tax Declaration (if applicable)
If you were not required by law to file Federal Income Tax returns, complete this section. You may be asked to fill out the Federal form 4506-T, the Request for Transcript of Tax Return from the Internal Revenue Service.
Self-Employed Declaration (if applicable)
If you are self-employed, complete this section. This declaration must be accompanied by a signed and dated Year-To-Date Profit and Loss Statement modeled on Schedule C. If you need help, contact HomeSF at 415.202.5464 or info@homesanfrancisco.org.
Year-to-Date Profit & Loss Statement (Self-Employed Only)
Based on IRS Schedule C. See https://www.irs.gov/instructions/i1040sc for instructions.
Part I: Income
1. Gross Receipts or Sales
2. Returns and Allowances
3. Net Sales (auto: line 1 minus line 2)
4. Cost of Goods Sold
5. Gross Profit (auto: line 3 minus line 4)
6. Other Income
7. Total Gross Income (auto: line 5 + line 6)
Part II: Expenses
8. Advertising
9. Car and Truck Expenses
10. Commissions and Fees
11. Contract Labor
12. Depletion
13. Depreciation and Section 179 Expense Deduction
14. Employee Benefit Programs (other than line 19)
15. Insurance (other than health)
16a. Interest – Mortgage (paid to banks, etc.)
16b. Interest – Other
17. Legal and Professional Services
18. Office Expenses
19. Pension and Profit-Sharing Plans
20a. Rent or Lease – Vehicles, Machinery, and Equipment
20b. Rent or Lease – Other Business Property
21. Repairs and Maintenance
22. Supplies
23. Taxes and Licenses
24a. Travel
24b. Deductible Meals
25. Utilities
26. Wages
27a. Other Expenses
27b. Reserved for Future Use
28. Total Expenses (auto-calculated)
29. Profit or Loss (auto: line 7 minus line 28)
Unemployment Declaration (if applicable)
If you are currently unemployed or do not work, complete this section. To be signed by each household member 18 years of age and older with no employment income.
7

Demographics Optional

Help us ensure we are meeting our goal to serve all people. These questions will NOT affect your eligibility.

These questions are OPTIONAL and will not affect your eligibility for housing in any way. Your individual answers are kept completely confidential and used only for statistical purposes.
Use the codes below when entering race/ethnicity for each household member above.
Asian: A1 Chinese, A2 Filipino, A3 Japanese, A4 Korean, A5 Mongolian, A6 Central Asian, A7 South Asian, A8 Southeast Asian, A9 Other Asian
Black: B1 African, B2 African American, B3 Caribbean/Central/South American/Mexican, B4 Other Black
Indigenous: I1 American Indian/Native American, I2 from Mexico/Caribbean/Central/South America, I3 Other Indigenous
Latino: L1 Caribbean, L2 Central American, L3 Mexican, L4 South American, L5 Other Latino
Middle Eastern/W Asian/N African: M1 North African, M2 West Asian, M3 Other
Pacific Islander: P1 Chamorro, P2 Native Hawaiian, P3 Samoan, P4 Other
White: W1 European, W2 Other White
8

Household Certification & Signatures

Must be signed by all applicants 18 years or older

All statements made in this application are true and made for the purpose of applying for an Inclusionary Affordable Housing Program Below Market Rate unit, through the City and County of San Francisco ("City"). Verification may be obtained from any source named in this application. I/we fully understand the City may terminate my/our participation in the Program at any time if it finds that I/we have knowingly provided false, misleading or inaccurate information and documents or withheld information or documents. In such case, I/we understand that I/we may be prohibited from participating in the Program for a minimum of one (1) year, or a longer period of time in the City's sole discretion. For purposes of this Certification, "knowingly" means that an applicant, with respect to any information provided to MOHCD, does any of the following: (1) Has actual knowledge of the information; (2) Acts in deliberate ignorance of the truth or falsity of the information; (3) Acts in reckless disregard of the truth or falsity of the information. Proof of specific intent is not required and reliance on my/our information by MOHCD is also not required. If the City cannot verify a housing lottery preference that you have claimed, you will not receive the preference but will not be otherwise penalized.

The information on this form will be used to determine income eligibility. I/we have listed all persons in my/our household. I/we have provided each household member's acceptable verification of current annual income. I/we have also disclosed ALL assets held by each person listed on the application, and have provided documentation thereof. Under penalties of perjury, I/we certify that the information presented in this Certification is true and accurate to the best of my/our knowledge and belief. The undersigned further understands that providing false representations herein constitutes an act of fraud.

Public Records Act: The City is subject to the requirements of the California Public Records Act, Government Code Section 6250, et seq. All information provided by the applicant(s) may be made available to the public upon appropriate request. MOHCD strives to protect your personally identifiable information (PII) from loss, theft, misuse and unauthorized access and disclosure.

I/We understand and authorize the Mayor's Office of Housing and Community Development, its participating nonprofit housing counseling agencies, HomeSF, alternate contacts designated on the lottery application, and the project's leasing agent or representative to exchange documentation and information provided as part of my/our application.
✓

Application Submitted

Thank you for submitting your SF BMR Rental Housing Program Application. Please retain a copy of your completed application for your records.

Next Steps:

  • Gather all required attachments (income verification, bank statements, tax returns)
  • Contact HomeSF for additional assistance: 415.202.5464
  • Email: info@homesanfrancisco.org