HCV Forms
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Affordable Worksheet
Rent Affordability Worksheet for Housing Choice Voucher Participants
Move in Date
Type of Unit
HCV apartments
HCV Detached House
HCV Duplex/Townhouse/Semi-detached
Mobile Home Space
Authorized Voucher Size
0
1
2
3
4
5
6
7
8
9
Total BR Size of Unit
0
1
2
3
4
5
6
7
8
9
Gross Annual Income
Adjusted Annual Income
How much is the rent?
Zipcode
Will tenant be renting the entire unit?
Yes
No
Number of Bedrooms Renting
0
1
2
3
4
5
6
7
8
9
Utilities - indicate which utilities tenant will be paying (not paid for by the owner)
Cooking
Tenant not paying
Natural Gas
Oil/Electric
Tenant not paying
Heating
Tenant not paying
Natural Gas
Oil/Electric
Tenant not paying
Water Heating
Tenant not paying
Natural Gas
Oil/Electric
Tenant not paying
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