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Rent Supplement Unit
176 Elm Street
Toronto, Ontario M5T 3M4
Tel: 416-981-6160
This package contains your Annual Review Form. Please complete it
immediately or you will lose your rent subsidy.
The Housing Services Act says that Housing Connections must do a yearly review of income and
assets for each person in your household. Based on this review, Housing Connections decides if
you are still eligible for a rent-geared-to-income (RGI) subsidy. If you do not complete
your Annual Review form and return it to the Rent Supplement office immediately you will have to
pay the full market rent for your unit. Please ensure the completed forms are mailed or dropped
off at the Rent Supplement Office.
In addition to the annual review, the Housing Services Act also says that you must report any
changes to your household size, income, or assets within 30 days of the change. Do not wait until
your Annual Review to report changes. You will lose all of your RGI subsidy if you do not
report changes within 30 days.
How to complete your annual review
1. Your Annual Review form shows the latest information on file for your household.
Check the information. Add anything that is missing and correct any mistakes. Include
information for everyone in your household. Add extra paper if you need to.
2. Attach documents to show proof of your income and assets from all sources. For each
household member, the documents must show:
• the amount of income and how often you receive it
• the value of any asset.
In this package is a guide called “How to Show Proof of Your Household Income and Assets.”
This tells you what documents you should attach. Please read the guide.
3. Sign the form. All household members who are 16 or older must sign. There are three places to
sign the form:
• on page 3, and
• on page 4, in two places.
4. Fill out the Emergency Contact Form and include it with your Annual Review.
5. Mail or drop off your completed Annual Review immediately to Housing Connections. The
address is at the top of this page.
In this package:
 Household Income and Assets Review Form
 How to Show Proof of Your Income and Assets
 Employment Form (You can ask your employer to fill this out and attach it to your
Annual Review.)
 Emergency Contact Form (Please fill this out and send it back with your Annual
Review.)
Do you have questions?
Please call the Rent Supplement office at (416) 981-6160.
Household Income and Asset Review
Letter CPP-01(06-2005-Ver1)
Rent Supplement Unit
176 Elm Street
Toronto, Ontario M5T 3M4
Telephone: 416-981-6160
Household Income and Assets Review Form
Address:
Household members:
No of Bedrooms:
Client number:
Daytime phone number:
Review date:
Evening phone number:
Return this form to
Housing Connections
by:
immediately
Household Information
Check the information below for all members of your household. If someone is listed who
does not live with you anymore, cross off their name and write the date they moved out. If
someone has moved in who is not listed, add their name, write the date when they moved in,
and put in all their information. Use extra paper if you need to.
Relationship
to Member 1
Household Members
Date of Birth Male or Check box
mon/day/yyyy Female if you are a
M/F
student
Social Insurance
Number (SIN) and
Citizenship in Canada
full-time
part-time
full-time
part-time
full-time
part-time
full-time
part-time
full-time
part-time
full-time
part-time
full-time
part-time
full-time
part-time
full-time
part-time
full-time
part-time
(SELF)
Has the citizenship or immigration status (Status in Canada) changed for any
household member during the past 12 months?
Yes
No
If yes, please explain. Attach copy of documentation showing proof of status from Immigration
Canada.
Do you understand English?
Yes
No If not, please tell us what language you speak?
FOR OFFICE USE - Do not write here.
Annual Review Received
On:
Required documents:
No
Yes
Household Income and Asset Review
Form CPP-02(06-2005-Ver1)
File audit:
Yes
No
Eligible for subsidy:
Yes
No
Overhoused:
Yes
No
Page 1 of 4
Sources of Income and Assets
Check the information below for each member of your household. Correct everything that is not up
to date. Add anything that is missing. Add extra paper if you need to. You must attach proof of your
income and assets. Use the guide called “How to Show Proof of Your Household Income and
Assets” to find out what kind of documents to attach.
Income:
Report all gross income of every kind and from every source. ‘Gross’ means the total amount of
income before deductions – such as taxes – are taken off. Report any benefits you receive,
such as a pension plan or government support program.
Assets:
An asset is something you own that could grow in value, such as money invested in things like
Guaranteed Investment Certificates (GICs), stocks, or mutual funds or Registered Retirement
Savings Plans (RRSPs that are not locked-in). Locked-in RRSP, is usually money that was
transferred to an RRSP from a pension when you changed employer. It cannot be cashed in
until retirement. An asset could also be property you own, such as a house, condominium, taxi
plates, or precious items, such as antiques or paintings, that you are keeping as an investment.
Note: Full Time students who meet the definition of “child of the household” (below) DO NOT have to report
income.
Child of the household: is someone who has always lived at home except for short periods while in full-time
attendance at school, never had a spouse or same-sex partner and is not a parent of a child living in the household.
INCOME
LAST REPORTED
Household Member Name
Source of Income
Gross Monthly
Amount
Household Income and Asset Review
Form CPP-02(06-2005-Ver1)
Asset
Amount
Gross Monthly
Amount
Please give the
value of your
assets NOW.
ASSETS
LAST REPORTED
Household Member Name
Please give the
amount you are
earning NOW.
Monthly
Interest
Amount
Monthly
Interest
Page 2 of 4
How to sign your Household Income and Assets Review form
Everyone in your household who is 16 or older must sign these statements.
There are three places where each person must sign:


Part A: I declare that my Household Income and Assets Review is complete and correct.
Part B: I consent to Canada Customs and Revenue sharing information from my tax return with Housing
Connections.
Part C: I consent to Housing Connections collecting, using, and sharing information about me and my household.

A witness must sign each statement at the bottom. The witness cannot be a member of your
household. A friend or neighbour can be your witness.
Part A: I declare that my Household Income and Assets Review is complete and
correct.
By signing this statement, you swear that the information you have given on your Household
Income and Assets Review form is complete and correct. You are also swearing that you
understand the following:
1. I understand the meanings given for ‘gross income’ and ‘assets’ on page 2. I have reported
my gross income and assets completely and correctly. I have hidden nothing.
2. I understand that the Housing Connections will use the information on my Household Income
and Assets Review form to:
•
•
decide if my household still qualifies for rent subsidy and
set the rent.
3. I understand that Housing Connections will check the information I have given to make sure it
is complete and correct. I consent to Housing Connections using the information to decide on
and administer our rent subsidy.
4. I understand that I could lose my rent subsidy if I do not give Housing Connections complete
and correct information by the date stated on page 1. Housing Connections could also take
legal action against me.
5. Every member of my household age 16 or older has completed and signed this form. We
have all had a chance to comment on the information given. I therefore waive my right to
further comment.
6. I understand that I must report any changes to my household size, income, or assets within
30 days of the change and that I could lose all of my RGI subsidy if I do not.
7. I understand that Housing Connections will keep a file of the information about my income,
assets, and rent subsidy. I also understand that the Housing Services Act gives Housing
Connections the right to share this information with others, such as the City of Toronto, other
housing providers, service managers, government ministries, Ontario Works, and the Ontario
Disability Support Program.
Signature of all household members age 16 and older
Witness Signature
Household Income and Asset Review
Form CPP-02(06-2005-Ver1)
Date Month/Day/Year
Page 3 of 4
Part B: I consent to Canada Customs and Revenue sharing information from
my tax return with Housing Connections.
I give my consent for Canada Customs and Revenue to give information from my tax returns to Housing
Connections so they can check my income and decide on my rent subsidy.
I understand that Housing Connections will not share this information with anyone else, except as it is
allowed to under the following laws:
•
•
•
Municipal Freedom of Information and Protection of Privacy Act (MFIPPA)
Housing Services Act (HSA)
Income Tax Act, subsection 241(5).
My consent covers the tax year before the date below, the current tax year, and all future tax years if my
household still receives or applies for RGI subsidy.
Signature of all household members age 16 and older
Witness Signature
Date Month/Day/Year
Part C: I consent to Housing Connections collecting, using, and sharing
information about me and my household.
I understand that the Housing Connections collects information from me on my Household Income and
Assets Review form to:
•
•
•
decide if my household still qualifies for rent subsidy
set the rent
administer my rent subsidy.
Housing Connections has the authority to collect this information under the Housing Services Act. I
understand that I cannot get RGI subsidy unless I sign this consent form.
I understand that Housing Connections will keep files on my tenancy and housing subsidy. I consent to
Housing Connections collecting and sharing information about me from and with:
•
•
•
•
landlords
•
co-applicants and other household members •
reference people listed in my application
•
credit check agencies ie. Equifax
my employer
any agencies that provide social services to me
any other people it needs to contact while
administering my rent subsidy.
Signature of all household members age 16 and older
Witness Signature
Do you have questions about your file?
Date Month/Day/Year
If you have questions about access to the information in your files, contact MFIPPA (Municipal
Freedom of Information and Protection of Privacy Act) Co-ordinator at TCHC:
931 Yonge Street, 7th Floor, Toronto Ontario M4W 2H2
Phone: 416-981-5500
Household Income and Asset Review
Form CPP-02(06-2005-Ver1)
Page 4 of 4
How to Show Proof of Your
Household Income and Assets
This checklist shows the most common sources of income and assets. Use it to make sure that
you attach the right documents as proof of your income and assets.
Note: You must report all of your household income and assets, even if they are not shown on
the checklist. Contact the Rent Supplement Office if you have questions about what to report.
Notice of Assessement from Canada Customs and Revenue Agency REQUIRED for
ALL tenants age 16 and older (except students that are “child of the household)”.
Each year, after you do your taxes, you get a
Notice of Assessment in the mail. Include the
most recent Notice of Assessment
… Notice of Assessment from Canada Customs and
Revenue Agency for the last taxation year.
FULL TIME STUDENTS
For students
Then you must attach each of the following documents
for each household member this applies:
… Full time student -child of the household
(always lived at home except for short
periods while in full time attendence at
school, never had a spouse or same sex
partner, is not a parent of a child living in the
household).
… If applicable, copy of OSAP (Ontario Student
Assistance Program) assessment sheet showing total
amount received, name of school and enrollment
period; or
… If no OSAP applies, copy of timetable or letter from
school confirming full time attendence.
… Full time student, not child of the household
… Include proof of income in addition to above.
SOCIAL ASSISTANCE
If anyone in your household receives
benefits from:
Then you must attach each of the following documents
for each household member who receives benefits:
… Ontario Works (OW) or
… Ontario Disability Support Program (ODSP)
… Copy of drug card; and
… Copy of cheque stub
PENSIONS AND ALLOWANCES
If anyone in your household receives income
from:
Then you must attach one of the following documents
for each household member who receives the income:
… Old Age Security (OAS)
… Canada or Provincial Pension (such as CPP
or QPP)
… Guaranteed Annual Income System (GAINS)
… Pensions (such as Widow’s, Retirement,
Private, War Disability, other countries)
… War Veteran’s Allowance (DVA)
… Cheque stub or copy of cheque or
… Copy of bank book showing entries for the past 3
months or
… Monthly bank statement or
… Letter from the government agency that issues the
cheque
… T4As from your previous year’s income tax return.
… Training Allowances
…
Statement from Canada Employment and Immigration
or from employer
EMPLOYMENT INCOME
If anyone in your household is now receiving
income from:
Then you must attach one of the following documents
for each household member who receives the income:
… Full-time, part-time, casual, seasonal
employment
… Commissions, tips, or bonuses
… “Proof of Employment” form from your employer (Use
the form in this package.) or
… Letter from employer showing your rate of pay, gross
income, average weekly hours and start date of
employment; or
… Pay stubs for at least the last 3 months, showing the
name of the employer
… Long or short-term illness pay
… One of the proofs of employment shown above and
… Disability pay
… Letter or cheque stub from the insurance company,
employer, or Workplace Safety Insurance Board (WSIB)
Household Income and Asset Checklist Form-CPP-03 (06-2005-Ver1)
Page 1
of 2
SELF-EMPLOYMENT INCOME
If anyone in your
household receives
income from:
AND they have been
self-employed for:
… Tutoring
… Less than one year
… Affidavit of earnings and expenses sworn before a
Notary Public or Commissioner of Oaths.
… More than one
year
… Financial statements prepared by a public accountant
or
… Babysitting or
childcare
… Taxi
Business
… Other selfemployment
income
Then they must attach:
… Certified income tax return from Canada Custom and
Revenue Agency for the previous year
OTHER INCOME or PAYMENTS
If anyone in your household receives income
from:
Then you must provide one of the following documents
for each household member who receives the income:
… Workplace Safety & Insurance Board (WSIB)
… Cheque stub or letter from government agency or
… Employment Insurance (EI)
… Copy of tax assessment form and confirmation of other
earnings
… Compensation for Victims of Crime Act
SUPPORT INCOME/PAYMENTS
If anyone in your household receives income
from:
Then you must provide one of the following documents
for each household member who receives the income:
… Spousal support payments or child support
… Sworn affidavit with both the receiver and support
payor’s signatures or
… Document signed by both parents or
… Letter from a lawyer
… Sponsorship Support under Immigration Act
… Copy of documentation showing sponsorship amount
ASSETS
If anyone in your household has assets such
as:
Then you must provide one of the following documents
for each household member who receives the income
or has the asset:
… Interest from bank, trust, savings office or
credit union accounts
… Copy of bank passbooks for the last 2 months
… Income from stocks, bonds, shares,
securities, or annuities
… Copy of T3 or T5 tax form
… Registered Retirement Savings Plan (RRSP)
(RRSPs that are not “locked in”)
… Copy of RRSP statement or
… Real estate (such as a house, condominium,
co-ownership, land, cottage, etc.)
… Copy of real estate appraisal for each property
… Guaranteed Income Certificates (GIC), term
deposits, and similar investments
… Copy of each certificate or
… Life insurance (with a cash surrender value)
… Copy of insurance policy
… Art, Antiques, Valuables
… Copy of appraisal(s)
… Copy of T3 or T5 tax form
… Copy of T3 or T5 tax form
Has any member of your household transferred any assets to someone else
during the past 12 months? If yes, please explain what it was:
Household Income and Asset Checklist Form-CPP-03 (06-2005-Ver1)
… Yes
… No
Page 2
of 2
You can use this form to report on your employment for your
Household Income and Assets review.
If you need more forms or more information, please call 416-981-6160.
Proof of Employment Form
About the Employee – The EMPLOYEE completes this section.
Employee last name:
Employee first name:
Address:
Unit:
Daytime phone number:
Evening phone number:
Postal code:
Social Insurance Number:
Has there been any change(s) in employment sources since your last rent review? (ie. employment
insurance, change of employer etc)
yes
no
Please include verification of any changes.
By signing below, I authorize my employer to give the information requested below to Housing
Connections, as required under the Social Housing Reform Act, 2000.
X
Employee Signature
Date
Information about Employment – The EMPLOYER completes this section.
Employee’s position:
Company Name:
Company Address:
City:
Postal Code:
If hourly, what is the
average number of
hours per week?
The employee is
being paid:
Hourly
Weekly
Rate of pay:
Monthly
Yearly
$
Is the employment seasonal/fluctuating?
yes
Date employment started:
no
Gross Earnings in Past 3 months
From: (mm/dd/yy)
To: (mm/dd/yy)
Gross Earnings in Past Year
From: (mm/dd/yy)
To: (mm/dd/yy)
Income Breakdown
This column
for HC use
Basic salary
Overtime, premiums,
shift bonuses
Commissions, tips,
gratuities
Yearly bonus
Other payments
Total Gross Earnings
What was the last rate of increase and when was it from?
Old Rate:
New Rate:
Effective Date of New Rate:
Name of person completing
this form on behalf of the Employer:
Position:
Phone number:
X
Employer Signature
Date
For HC
use
Date received:
Received by:
Proof of Employment Form
Form-CPP-04 (07-2007-Ver2)
Please complete this form and return it with
your Household Income and Assets Review.
If you need more forms or more information,
please call 416-981-6160. Thank you!
Rent Supplement Unit
176 Elm Street
Toronto, Ontario M5T 3M4
Tel: 416-981-6160
Emergency Contact and Special Assistance Information
Last name:
First name:
Address:
Daytime phone number:
Unit:
Evening phone number:
Languages spoken:
Emergency Contact Information
Please give us the names and phone numbers of two people we can call in case of an emergency.
Name of emergency contact person (1):
Daytime phone number:
Relationship to the household:
(for example: mother, son, friend)
Evening phone number:
Name of emergency contact person (2):
Daytime phone number:
Relationship to the household:
(for example: mother, son, friend)
Evening phone number:
X
Tenant Signature
CPP/EmergencyContact&SpecialAssistanceForm
Date
Form-CPP-05 (06-2005-Ver1)