worksheet

WHAT IS THIS SURVEY ALL ABOUT?
The purpose of the American Housing Survey (AHS) is to provide up-to-date information on
housing quality and housing costs. To measure housing quality, the survey includes
questions about equipment breakdowns, leaks, and other problems. There are also
questions about amenities such as garages, balconies, and pools. To measure housing
costs, the survey includes questions about mortgage and rental costs, utility costs, and
repair and remodeling costs. The AHS also asks about your household, including basic
demographic and income questions.
Combining household information with housing quality and housing cost information helps to
measure the housing challenges faced by homeowners and renters. The information also helps
to measure important changes in our housing stock as it ages, and when it is eventually
remodeled or replaced.
HOW WAS I SELECTED FOR THIS SURVEY?
We chose your address, not you personally. The U.S. Census Bureau scientifically selected a
sample of addresses throughout the United States. If you move away, this address will stay in
the survey and we will interview the household that moves here.
IS THIS SURVEY AUTHORIZED BY LAW? WHAT PROTECTIONS DO I HAVE?
Congress requires the U.S. Department of Housing and Urban Development (HUD) to collect
this information under the Housing and Urban-Rural Recovery Act of 1983 (Title 12 of the
U.S.C.). HUD has asked the Census Bureau to conduct the survey. Title 13, U.S.C., Section 8
provides the Census Bureau with the authority to collect this information. All information that
individuals give to the Census Bureau is held in the strictest confidence by law (Title 13, U.S.C.,
Section 9). You may decline to answer any or all questions, but each item not answered
lessens the quality of the final results. Your answers may be combined with information that you
give to other agencies to enhance the statistical use of these data, but all data will be kept
strictly confidential. If you wish to request that your information not be combined with
information from other agencies, we ask that you notify the field representative at the time of
the interview.
HOW LONG WILL IT TAKE?
We expect it will take about 40 minutes for you to provide this information, but it may be
somewhat shorter or longer, depending on your circumstances. Completing the enclosed
worksheet and having it available may help to shorten your interview. An agency cannot
conduct, sponsor, or require a response to a collection of information unless the collection
displays a currently valid Office of Management and Budget (OMB) approval number. The
OMB approval number for this survey is 2528–0017 and the expiration date is May XX, 20XX.
If you have any comments or suggestions about this survey, please send them to the
Associate Director for Administration, Paperwork Reduction Project 2528–0017, Bureau of the
Census, 4600 Silver Hill Road, Washington, DC 20233–1500 or [email protected].
I THOUGHT THAT THE CENSUS BUREAU OPERATED ONLY EVERY TEN
YEARS WHEN IT COUNTED PEOPLE. WHAT IS THE CENSUS BUREAU DOING
NOW?
Besides the decennial census conducted every ten years, we collect many different kinds of
statistics through other censuses and surveys. We conduct other censuses at regular intervals,
including the Economic Census and the Census of Governments. In addition, we conduct
various surveys to collect data on a monthly basis in order to provide current information on
unemployment rates, retail and wholesale trade, various manufacturing activities, new housing
construction, and a number of other topics. Also, we conduct annual surveys on business,
manufacturing, governments, family income, health, and education. You may also encounter the
Census Bureau conducting collections on behalf of other agencies, like the AHS, which the Census
Bureau conducts for HUD.
AHS-26/66(L) (10-2014)

FORM

AHS-30(WS)(X-X-20XX)

OMB No. 2528-0017: Expiration date 0X/XX/201X
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

AMERICAN HOUSING SURVEY
WORKSHEET

U.S. CENSUS BUREAU

This worksheet will assist you when our field representative contacts you. It is not a questionnaire.
DO NOT MAIL THIS WORKSHEET BACK TO THE U.S. CENSUS BUREAU.
Completing the survey will be easier if you look up the information in your records before the interview.
Record your answers in the spaces provided, skipping any questions that do not apply to you.
Please keep this worksheet and copies of your utility bills, regular mortgage statement, and year- end
mortgage statement (IRS Form 1098), so you can refer to them when our field representative contacts you.
Thank you for your time and effort in completing this worksheet!

ABOUT YOUR HOME
Year your home or building was built?

Square footage of your home?

sq. ft.

HOUSING COSTS
Average monthly electric bill?

$

Average monthly gas bill?

$

Total cost of fuel oil for the past year?

$

Total cost of other fuels for the past year?

$

Total garbage and trash collection costs for the past year?

$

Total water and sewer costs for the past year?

$

Amount spent in a typical year for routine repairs and maintenance (painting, plumbing, etc.)?

$

Cost for land/site rent?

$

per

Manufactured/Mobile home (MH) park fee?

$

per

Other MH fees (utility hookups, association, etc.)?

$

per

Condo/Coop/Homeowner’s association fee ?

$

per

OTHER COSTS FOR HOME OWNERS
Total real estate tax for the past year?

$

Total amount of the down payment for this
house?(Dollars or percent)

$

%
st

nd

1 Mortgage/ Home
Loan

When did you get this loan? (Month/Year)

3rd Mortgage/ Home
Loan

2 Mortgage/ Home
Loan

/

/

/

How much was borrowed?

$

$

$

...the amount you still owe?

$

$

$

...the current payment?

$

$

$

...the current interest rate?

%

%

%

We expect it will take about 15 minutes for you to provide the information for this worksheet, but it may be somewhat
shorter or longer, depending on your circumstances. The OMB approval number for this survey is 2528–0017 and the
expiration date is MMM XX, 20XX. If you have any comments or suggestions, please send them to the Associate Director
for Administration, Paperwork Reduction Project 2528–0017, Bureau of the Census, 4600 Silver Hill Road, Washington, DC
20233–1500 or [email protected].