Rent Affordability Worksheet for Housing Choice Voucher Participants

Move in Date			Type of Unit
Authorized Voucher Size			Total BR Size of Unit
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
Voucher Issue Date			Voucher Expiration Date