Utility Allowance Questionnaire

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					                         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 stephanie.naquin@tdhca.state.tx.us.



   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
                USDA?

                                                    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
    annual basis?
14. What is the current Utility Allowance being used at the Development (attach copy of current UA
    documentation)?


     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
    type:
     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
                                                                                Type




    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
        for review.




Completed By                                              Date


Title                                                     Company Name




                                                      3                                 Revised August 3, 2009