Section 3 Worker and Targeted Section 3
Worker Self-Certification Form
Updated March 2024
Section 3 is a provision of the United States Department of Housing and Urban Development (HUD) Act of 1968. The purpose of Section 3 is to help ensure that employment and other economic opportunities are, to the greatest extent feasible, directed to low- and very low-income persons, particularly those who are recipients of government assistance for housing, and to businesses that provide economic opportunities to low- and very low-income persons. 
Instructions: An individual seeking certification as a Section 3 Worker may self-certify by completing and submitting this form. This form will help determine the individual’s status as a Section 3 Worker or Targeted Section 3 Worker as defined in 24 CFR Part 75. Complete the Individual Information section and then complete either the Section 3 Worker section or the Targeted Section 3 Worker section, as applicable. Once the form is complete, sign, print and date in the applicable fields and provide this form to the appropriate person listed on page 3.
Individual Information
Table 1: Individual Information (person completing this form)
Information Requested	Response	
Name	     	
Address	     	
Phone Number	     	
Email	     	
Employer Name	     	
Section 3 Eligibility
Section 3 Worker
Definition: A Section 3 Worker is any individual who currently fits, or when hired within the past five years fit, at least one of the following categories.
Check only one option below that applies to you:
 Income for the previous or annualized calendar year is below the income limit established by HUD for an individual for your county of residence. 
Using the attached pages, find the one-person income limit for the correct county and compare your annual income to the amounts indicated. Check only one box below: 
 Income is at or below 80% of Area Median Income (AMI)
 Income is at or below 50% of AMI
 Employed by a certified Section 3 Business Concern. Name of business:      
 A YouthBuild participant
Targeted Section 3 Worker
Definition:  A Targeted Section 3 Worker is a Section 3 Worker who currently fits, or when hired within the past five years fit, at least one of the following categories.
Check only one option below that applies to you:
 Employed by a certified Section 3 Business Concern. Name of business:      
 A YouthBuild participant
 Living/lived within the service area or the neighborhood of the project, as defined in 24 CFR Part 75.5
Training, Skills and Affiliations
Please list skills you have in the following areas: 
Construction / Administrative / Computer / Other:      
Certification
I hereby certify, under penalty of law, that the above information is true, complete and correct to the best of my knowledge. I understand that providing false or misleading information may result in decertification as a Section 3 Worker, or other penalties. I understand that by signing this form I am allowing the Section 3 program to send me information about upcoming job opportunities, occupational training and other outreach events.
     	     
Signature	Date
     
Printed Name
If you live outside of the 13-county Twin Cities metro area, send completed certification to: 
Minnesota Housing – Multifamily Division
400 Wabasha St. N
Suite 400
St. Paul, MN 55102 
aaron.keniski@state.mn.us 
If you live in the 13-county Twin Cities metro area, send completed certification to: 
Section 3 Program – City of Saint Paul 
15 West Kellogg Blvd.
Suite 280 
St. Paul, MN 55102 
jef.yang@ci.stpaul.mn.us 
Fax: 651-266-8962