Form Hacfl-001 - Request For Rent Increase Decrease (Page 2 of 2) in pdf

UNIT QUALITY

(Please check one of the following)

Newly constructed or completely renovated

Well maintained and/or partially renovated

Adequate, but some repairs may be needed soon

Utility Information

(check the appropriate boxes):

Does the information below indicate a change in the utility responsibilities?

Yes

(If Yes, a new Housing Assistance Payment Contract must be executed with HACFL)

The owner shall provide or pay for the utilities and appliances indicated below by an “O”. The tenant shall provide or pay for the

utilities and appliances indicated below by a “T”. Unless otherwise specified below, the owner shall pay for all utilities and

appliances provided by the owner.

Item

Specify fuel type

Paid By

Natural Gas

Electric

Heating

Natural Gas

Electric

Cooking

Natural Gas

Electric

Water Heating

Other Electric

Water

Sewer

Trash Collection

Refrigerator

Range/Microwave

Other (specify)

Acknowledgement and Signature:

I have reviewed this form and acknowledge (1) the Owner’s request for a rent increase and (2) that the utility

information above correctly describes who is responsible for paying each utility and providing the stove and

refrigerator. By signing below I understand that this request may result in an increase in my portion of the rent. I

also understand that I may exercise my right to relocate with my voucher if I cannot afford my new portion.

Participant Signature

Date

I certify that the information provided on this form is complete and accurate to the best of my knowledge and that

the rent requested is not greater than the rent for any other unassisted unit in the building. I understand that the

request may result in an increase in the tenant’s portion of the rent and that the tenant may exercise their right to

move. By submitting this rent increase request, I understand that HACFL must thoroughly evaluate my request

including comparing the requested rent to rents charged for comparable, market-rate units in the vicinity of the

subject unit. This could result in one of three outcomes: (1) a denial of the request to change the rent amount (2) a

decrease in the current rent amount or (3) an approval of my request to increase the rent amount. I also

understand that the rent for this unit may be reduced or re-determined at any time if the HACFL finds that the rent

charged by the Owner exceeds rents charged for other comparable unassisted units. Request for rent increases

must be requested at least 60 days before the anniversary of the lease for the new rent to be effective on the

anniversary date. HACFL shall not grant a rent increase unless the Owner has complied with obligations under the

HAP contract, including compliance with the HQS for all contract units. HACFL may require owners of multi-unit

rental projects to provide a rent roll. HACFL may limit and/or deny rent increase requests due to funding

availability or restrictions.

Owner Signature

Date

HACFL-001 Request for Rent Increase/Decrease

Form Hacfl-001 - Request For Rent Increase Decrease Page 2

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