Utility Allowance Questionnaire
This form must be completed by all owners requesting to switch utility allowance methodologies,
including those requesting approval of the Actual Use Methodology, and when submitting an
allowance for annual review. With any question, please contact Stephanie Naquin at (512)657-5528
or via email at firstname.lastname@example.org.
1. Name of Development:
2. Development address:
3. County in which Development is located:
4. Types of TDHCA Program Funding :
Type of Funding File Number
5. Type of request:
6. If this request is for the annual review of the current methodology, was prior approval from the
Department obtained to switch to the methodology involved in the request?
a. If yes, as of what date (include copy of Department approval letter)?
b. If no, please select reason:
7. Please give a brief description of the request:
8. What is the beginning date of the 90 day review period?
9. Has the proposed utility allowance been posted in a common area of the Leasing Office for
resident review 10TAC§60.109(f)?
a. As of what date (Please attach notice to the request):
10. What is the intended effective date?
11. Does the Development receive assistance from USDA- Rural Development (formerly Farmer’s
Home Administration (FmHa))?
a. If yes, do any of the residents in the Development receive Rental Assistance from the
1 Revised August 3, 2009
12. Is the building a HUD-regulated building?
13. Are the rents and utility allowances of the buildings reviewed by HUD (or HUD Contractor) on an
14. What is the current Utility Allowance being used at the Development (attach copy of current UA
Utility Source Effective Date Methodology
15. What Utilities do residents pay?
Resident Is Utility Paid To or
Owner Pays Not Applicable
Pays Through the Owner?
Gas Yes No
Electric Yes No
Water Yes No
Sewer Yes No
Trash Collection Yes No
The property has: individual hot water heaters boiler system
The stoves in the unit are: gas electric
The units are heated by: gas electric
The units are cooled by: evaporative electric
If individual hot water heaters, they are: gas electric
16. If any of the above utilities are paid to or through the owner of the building, please confirm billing
Actual Consumption Allocation Formula RUBS
2 Revised August 3, 2009
17. What is the Building Configuration?
18. What is the unit mix at the Development? (Please list each unit type separately)
# Bedrooms # Bathrooms Square Footage Total of Unit
19. Please give a brief explanation demonstrating the necessity of switching the utility allowance
methodology and attach any applicable back-up. If the request is a result of the local utility
company unwilling to provide an updated estimate, documentation to that effect must be submitted
Completed By Date
Title Company Name
3 Revised August 3, 2009