Cedar City Housing Authority

Rent Survey

Help Cedar City Housing Authority continue to provide low income families with housing assistance by filling out this quick survey! Please share it with family and friends to help us meet our participant goal. Thank you!

This house, apartment, or mobile home is...RentedOccupied without payment of rentOwned by you or someone in this household with a mortgage or loanOwned by you or someone in this household free and clear (without a mortgage or loan)This is NOT a residential house, apartment, or mobile home.Note: If this is a mobile home, answer in terms of whether or not you own or rent the mobile home, and NOT the pad it is located on.

If you checked “Rented” please continue to the next question. If you checked any other box, you’re done! Please submit the survey!

How long have you lived at this house, apartment or mobile home?Less than 2 years2 years or more

If this house, apartment, or mobile home were on the market for sale or rent, how many bedrooms would you say it has?No bedrooms; it is an efficiency or studio1 bedroom2 bedrooms3 bedrooms4 or more bedrooms

Which best describes this building?A mobile homeA one-family house detached from any other houseA one-family house attached to one or more houses – for example, a duplex, townhouse or rowhouseA building with 2 or more apartmentsOther (please specify)

If you answered "Other" please specify here.

Was this house, apartment or mobile home built within the last two years?Yes, it was built within the last two yearsNo, it is more than two years old

Do you or does any member of this household live or stay at this address year round?YesNoIf this is your vacation or seasonal home, apartment, or mobile home where you do not live year round, please select “No”.

Is this house, apartment, or mobile home owned by a relative?YesNoIf this home, apartment, or mobile home is owned by your spouse or another individual living at this address then please select “No.”

Do you do any work for your landlord so you can pay less rent?YesNo

Apart from utility costs, does this house, apartment, or mobile home rent for the same amount every month of the year?YesNo

If the rent changes month-to-month, why does the rent change during the year?The owners’ charge different rents during the summer and winter seasonsThe owners’ charge a different rent during the school yearThe owners’ costs – like heating and air conditioning – change during the year so they charge different rentSome other reason (please specify)

If you answered "Other" please specify here.

As part of your rental agreement, do you have to recertify your income every year to determine how much rent you pay?YesNo

Is your rent amount lower because you are in a government-housing program?YesNo

Does your household have a voucher that allows you to choose where you live and pays for part of your rent?YesNo

How much do YOU or does YOUR FAMILY pay for rent each month for this house, apartment, or mobile home?

USD

Do not include separate parking fees or utility costs.

Do you have any roommates or housemates that pay part of the rent who are not members of your household?YesNo

If so, how much is the TOTAL monthly rent for this house, apartment, or mobile home?

USD

This should be how much you pay, what all other roommates pay, and any assistance you might receive. Do not include separate parking fees or utility costs.

Are utilities included in your rent, or do you pay for them separately?Yes, utilities are included in the rentNo, pay separately for utilitiesUtilities are heat, air conditioning, lights, water, sewage, cooking fuel, or trash collection.

If you checked “Yes, utilities are included in the rent,” skip to the last question

If you checked “No”, please fill out the following questions.

Do you pay separately for heat?YesNo

If you answered Yes, which FUEL is used MOST for heating this house, apartment, or mobile home?Gas: from underground pipes serving the neighborhoodGas: bottled, tank, or LPElectricityFuel, oil, kerosene, etc.No fuel usedOther fuel (please specify)

If you answered "Other" please specify here.

Do you pay separately for electricity?YesNo

Do you pay separately for water?YesNo

Do you pay separately for sewage?YesNo

Do you pay separately for trash collection?YesNo

In case we have questions or there is a problem, could you please provide a ten-digit telephone number where we can reach you?(Area Code First)

Contact

364 South 100 East, Cedar City UT 84720

Phone: (435) 586-8462

Fax: (435) 865-9397

Rely Utah 711

ccha@cedarcity.org

FRAUD HOTLINE

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