SUGGESTED FORMAT - RENT REASONABLENESS CHECKLIST

							                       RENT REASONABLENESS SURVEY AND CHECKLIST

Street Address or Unit Number:______________________________________________

City:_________________________ County:___________________________________

Unit Type ____________________                 Number of Bedrooms _____

Published Fair Market Rents for this type unit is:                 $ _______
Contract Rent: $ _______ + utilities $_______ =       $Gross Rent: $ _______

Does it meet HQS? _______                Square Feet _______      Year Built: _________

Location (accessibility to services) _____________________________________________

Management and maintenance services present (e.g., on-site maintenance, after-hours
number, etc.) _____________________________________________________________

Facilities (e.g., laundry room) ________________________________________________

Amenities (e.g., pool, Bar BQ, etc.) _____________________________________________

Comments _______________________________________________________________

The following are rent-comparable:

                               Unit #1                Unit #2             Unit #3

Address


Unit type


Number of bedrooms


Fair Market Rents


Allowance for tenant-
supplied utilities

Gross rent (contract
rent + utilities)


Meets HQS




MODMH Housing Manual Attachment 16                                             August 2006
Square Feet


Year Built


Location: accessibility
to services (list)

Mgt. and maintenance
services: (list)


Facilities: (list)


Amenities: (list)


Comments



In accordance with 24 CFR 882.106, I certify that based on information available to
this office, the requested Contract Rent / / is / / is not reasonable.


_______________________________________________________________________
Name of Processing Center

By:_____________________________________________________________________
                                (signature)

________________________________________________________________________
    (print name)                  (title)                       (date)




MODMH Housing Manual Attachment 16                                         August 2006
                        RENT REASONABLENESS CERTIFICATION

1.     Head of Household Name: ___________________________________________

       Street Address and Apt. No.: _________________________________________

       City, State and Zip Code:_____________________________________________


       Name of Owner/Agent:______________________________________________

       Owner/Agent Address:_______________________________________________

       Phone Number:_____________________________________________________

2.     Number of Bedrooms:_______

3.     Type of Unit: _______ Subsidized
                     _______ Unsubsidized
                     _______ Rent Controlled

4.     Published Fair Market Rent:                                       $_______
       (a)     HUD approved exception rent, if applicable                $_______

       (b)     $ above published FMR                                     $_______

5.     Owner's Proposed Contract Rent                                    $_______
       (a)   Allowance for tenant-furnished utilities, if any            $_______

       (b)     Gross Rent                                                $_______

6.     Owner's Most Recent Rent Charged                                  $_______
       (a)   Did this rent include all utilities?     Yes ___   No ___
             (If no, explain)

               ____________________________________________________________

               ____________________________________________________________
       (b)     Amount of increase over current rent, if any $_______

       (c)     Reason for rent increase?

               ____________________________________________________________

       (d)     Owner's reason for increase in rent justified?   Yes___         No___
               (If no, explain)

               ____________________________________________________________



MODMH Housing Manual Attachment 16                                          August 2006
              ____________________________________________________________

7.     Comparable Rent for Similar Type Unit                       $_______
       (with comparable amenities)
       Name of Apt. Complex, if applicable:___________________________________

       Street Address:_____________________________________________________

       City, State and Zip Code:_____________________________________________

       Name of Owner/Agent:______________________________________________

       Owner/Agent Address:_______________________________________________

       Phone Number:_____________________________________________________

       Number of Bedrooms:_______

8.     Is the rent for the unit higher than rents the owner charges for comparable
       unassisted units?
       Yes___           No___ (If "yes", the rent may not be approved as reasonable)

The agency hereby certifies that the Contract Rent is reasonable.

_______________________________________________________________________
Name of Processing Center

By:_____________________________________________________________________
                                (signature)

________________________________________________________________________
    (print name)                  (title)                       (date)




MODMH Housing Manual Attachment 16                                            August 2006