AHS New Orleans Metropolitan Sample

AHS-30(WS)

FORM
(2-24-2009)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

AMERICAN HOUSING
SURVEY WORKSHEET

We expect it will take about 15 minutes for you to
provide this information, but it may be somewhat
shorter or longer, depending on your circumstances.
If you have any comments on this survey or have
recommendations for reducing its length, please
send them to the Director, Housing and Demographic
Analysis Division, Office of Policy Development and
Research, Office of Economic Affairs, Department of
Housing and Urban Development, Washington, DC
20410. The Office of Management and Budget
(OMB) control number for this survey is 2528-0017.
This number confirms that we have approval from
OMB to conduct this survey. Approval for this survey
expires on 01/31/2012.

UTILITY COSTS FOR MOST RECENT MONTHS
Utility

January

April

December

August

Electricity

$

$

$

$

Gas

$

$

$

$

OTHER HOUSING COSTS
Total cost of fuel oil for the past year?

$

Total garbage and trash collection costs for the past year?

$

Total water and sewer costs for the past year?

$

OTHER COSTS FOR HOME OWNERS

Total real estate tax for the past year?

$

Amount borrowed for current mortgage?

$

And current interest rate?
Total amount of the down payment for this house?
(Enter the amount in dollars or as the percent of the purchase price.) $

%
Percent of

or purchase
price

This worksheet is not a questionnaire but an aid to help you when our field representative contacts you.
Do not mail this back to the U.S. Census Bureau. Keep it for your reference. Thank you again
for your time and effort in completing this important survey!
Completing the survey will be easier if you will look up the following bills in your checkbook or other
records before the interview. Record the amounts for the past year in the spaces provided, skipping any
costs that do not apply to you. Please keep this worksheet for reference, so you can refer to it
when our field representative contacts you.

USCENSUSBUREAU

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