Rent Affordability Worksheet for Housing Choice Voucher Participants

***Please note that while this rent amount is approved on this worksheet, the rent amount must still meet the rent reasonableness analysis test.***

Move in Date			Type of Unit
Authorized Voucher Size			Total BR Size of Unit
Voucher Issue Date			Voucher Expiration Date
Total Family Members			Non-Eligible Non-Citizen Family Members
Gross Annual Income			Adjusted Annual Income
How much is the rent?			Zipcode
Will tenant be renting the entire unit?			Number of Bedrooms Renting

Utilities - indicate which utilities tenant will be paying (not paid for by the owner)
Cooking			Heating
Water Heating			Other Electric- if tenant pays electricity bill
Air Conditioning- if unit has a/c and tenant pays electric bill			Water- if tenant pays water bill
Sewer- if tenant pays sewer bill			Trash - if tenant pays trash collection bill
Tenant supplied appliances - indicate if tenant provides
Range or Microwave if there is no range			Refrigerator

Optional Information
Name			Tenant Code
Prospective Address			Thomas Grid