*1.Is this 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.(Required.)

Rented - skip to 2

Occupied without payment of rent - complete, please submit

Owned by you or someone in this household with a mortgage or loan - complete, please submit

Owned by you or someone in this household free and clear (without a mortgage or loan) - complete, please submit

This is NOT a residential house, apartment or mobile home. - complete, please submit

2.How long have you lived at this house, apartment or mobile home

Less than 2 years

2 years or more

3.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 studio

1 bedroom

2 bedrooms

3 bedrooms

4 or more bedrooms

4.Which best describes this building?

A mobile home

A one-family house detached from any other house

A one-family house attached to one or more houses - for example, a duplex, townhouse or rowhouse

A building with 2 or more apartments

Other (please specify)

5.Was this house, apartment or mobile home built with the last two years?

Yes, it was built within the last two years

No, it is more than two years old

6.Do you or does any member of this household live or stay at this address year round?

Yes

No

7.Is this house, apartment or mobile home owned by a relative?

Yes

No

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

Yes

No

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

Yes - Skip to 11

No

10.If you answered No to question 9 - Why does the rent change during the year?

The owners' charge different rents during the summer and winter seasons

The owners' charge a different rent during the school year

The owners' costs - like heating and air conditioning - change during the year so they charge different rent

Some other reason - please specify __________________________________________________________________________________________________________________

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

Yes

No

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

Yes

No

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

Yes

No

14.How much do YOU or does YOUR FAMILY pay for rent each month for this house, apartment or mobile home? Do not include separate parking fees or utility costs.

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

Yes

No - Skip to 17

16.How much is the TOTAL monthly rent for this house, apartment or mobile home? 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.

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

Yes, utilities are included in the rent - Skip to 23

No

18.Do you pay separately for heat?

Yes

No

19.Do you pay separately for electricity?

Yes

No

20.Do you pay separately for water?

Yes

No

21.Do you pay separately for sewage?

Yes

No

22.Do you pay separately for trash collection?

Yes

No

23.In case we have questions or there is a problem, could you please provide a ten-digit telephone number where we can reach you?