Cleveland, OH · Cuyahoga County
Zero Income Affidavit
This affidavit lets a Cleveland household member report having no current income and provide details used to determine eligibility for programs administered by the city or its partners.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The form records a household member’s statement that they have no income, explains the types of income covered, and asks how household expenses are paid. The City of Cleveland or its partners use the information to determine household eligibility for one or more programs. Complete it when asked to verify zero income for that eligibility review.
Who needs it
A household member asked to verify that they currently have no income for eligibility review by a City of Cleveland program or its partners should complete this form.
How to get this notarized
- 1
Download the Affidavit
Get the City of Cleveland Zero Income Affidavit and review the full form.
- 2
Fill In Your Information
Complete the residence, expense, and bank account questions. Do not sign before your notary appointment.
- 3
Book an Online Notary
Schedule a session with a commissioned online notary and have your identification and unsigned form ready.
- 4
- 5
Submit the Form
Send the notarized affidavit to the City of Cleveland or its partners as instructed.
Preview the form
The blank PDF straight from Cleveland. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the Zero Income Affidavit?
- Fill in your residence, answer the household expense and bank account questions, then sign the affidavit before a notary. Submit the completed form as directed by the city or its partners.
- Do I need to sign this affidavit in front of a notary?
- Yes. The form says it must be sworn before and subscribed in the notary’s presence. Wait to sign until you are with the notary.
- Can I use online notarization for this form?
- Ohio authorizes online notarization by its own notaries under R.C. §§147.60–147.66. You can sign on video with a commissioned online notary; confirm with the city or village if unsure.
- What income should I report?
- The form lists wages, business and rental income, benefits, support, assistance, and other sources. It asks you to certify that you currently have no income and expect no imminent change during the next 12 months.
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