Project Address: Project Number: Monthly Rent (including Tenant Paid Utilities) Income Data Household Data (7) (1) (2) Head of Household (4) (5) (6) (8) (11) (12) (13) Monthly Unit No. of (3) Tenant Subsidy Total % of Area Size of Type of Rental (9) (10) Gross No. Bedrooms Occupancy Contribution Amount Rent Median Code Household Household Assistance Hispanic Race Income (2) (3) (10) (11) (12) (13) (8) No. of Occupancy % of Area Median Income Race Household Code Size of Type of Household Rental Assistance Bedrooms Code Code Household Code Code Code Code 1 0-30% 09- Vacant Unit – 0 - 0 Bedroom 1 Tenant 2 30-50% 10 Managers Unit 1 1 Person 1 - Single/non-Elderly 1 Section 8 – – – – – 1 1 Bedroom 2 Owner 3 50-60% 11 White 2 2 Persons 2 Elderly 2 HOME TBRA – – – – – – – 2 2 Bedrooms 9 Vacant 4 60-80% 12 Black/African American 3 3 Persons 3 - Related/Single 3 Other – – – – – – 3 3 Bedrooms 9 Vacant 13 Asian 4 4 Persons Parent 4 No Assistance – – – – – 4 4Bedrooms 14 American Indian/Alaskan Native 5 5 Persons 4 Related/Two Parent 9 Vacant Unit – – – – – 15 Native Hawaiian/Other Pacific 5 5 or more (9) 6 6 Persons 5 Other – – – – Islander Bedrooms Hispanic Ethnicity of 7 7 Persons 9 Vacant Unit –Head – – 16 Amrcn Indn/Alskn Native & White – Household Code: 8 8 + Persons – 17 Asian & White 9 - Vacant – If Hispanic origin, enter Y. 18 Blck/Afrcn Amercn & White – If not Hispanic origin, enter N. 19 Amrcn Indian/Alskn Ntve & – Black/African American 20 Other Multi-Racial – Instructions for Completing the Homeownership Assistance/Rental Read the instructions for each item carefully before completing the report form. Use a typewriter or print carefully with a ballpoint pen. Prepare an original and one copy. Housing Project Set-Up Report Retain a copy and mail the original to: Department of Housing and Community Development
Project Address: Project Number: (1) Unit No. (2) No. of Bedrooms (3) Occupancy Monthly Rent (including Tenant Paid Utilities) Income Data Household Data (4) Tenant Contribution (5) Subsidy Amount (6) Total Rent (7) Monthly Gross Income (8) % of Area Median Code Head of Household (11) Size of Household (12) Type of Household (13) Rental Assistance (9) Hispanic (10) Race (2) No. of Bedrooms Code (3) Occupancy Code (8) % of Area Median Income Code 1 – 0-30% (10) Race Household Code (11) Size of Household Code (12) Type of Household Code (13) Rental Assistance Code 09- Vacant Unit 0 - 0 Bedroom 1 – Tenant 2 – 30-50% 10 – Managers Unit 1 – 1 Person 1 - Single/non-Elderly 1 – Section 8 1 – 1 Bedroom 2 – Owner 3 – 50-60% 11 – White 2 – 2 Persons 2 – Elderly 2 – HOME TBRA 2 – 2 Bedrooms 9 – Vacant 4 – 60-80% 12 – Black/African American 3 – 3 Persons 3 - Related/Single 3 – Other 3 – 3 Bedrooms 9 – Vacant 13 – Asian 4 – 4 Persons Parent 4 – No Assistance 4 – 4Bedrooms 5 – 5 or more Bedrooms (9) Hispanic Ethnicity –Head of Household Code: 14 – American Indian/Alaskan Native 15 – Native Hawaiian/Other Pacific Islander 16 – Amrcn Indn/Alskn Native & White 5 – 5 Persons 6 – 6 Persons 7 – 7 Persons 8 – 8 + Persons 4 – Related/Two Parent 5 – Other 9 – Vacant Unit 9 – Vacant Unit 17 – Asian & White 9 - Vacant If Hispanic origin, enter Y. 18 – Blck/Afrcn Amercn & White If not Hispanic origin, enter N. 19 – Amrcn Indian/Alskn Ntve & Black/African American 20 – Other Multi-Racial Instructions for Completing the Homeownership Assistance/Rental Housing Project Set-Up Report Read the instructions for each item carefully before completing the report form. Use a typewriter or print carefully with a ballpoint pen. Prepare an original and one copy. Retain a copy and mail the original to: Department of Housing and Community Development