Attachment X Email/Fax Form - Short

Consumer Price Index Housing Survey

ATT X_Housing Survey Final - SP.xlsx

Consumer Price Index (CPI) Housing Survey (CADC)

OMB: 1220-0163

Document [xlsx]
Download: xlsx | pdf
Consumer Price Index Update Form: Housing
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BLS Contact: <Enter Name>





















Contact Phone: <Enter Phone>
















Please Return Form By: <Add Date> Last time contacted: <Enter date from Collection Instrument> Contact Fax: <Enter Fax>
















Number of Units: <Enter Number>


Contact Email: <Enter Email>
















Address:

















Unit:



















Tenant Name OR Initials <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant> <Enter Name of Occupant>
Is the occupancy the same, different, or vacant since ? <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One> <Select One>
When did the person, who has lived in this house the longest, move in? <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date> <Enter Date>
Is this unit occupied by the owner or is it rented? <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select>
How much rent is the tenant paying for this house now? <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount>
What is the rental period? <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select> <Select>
Was the rent lowered because the Landlord received a subsidy from the government such as Section 8? <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No>
If Yes, how much was the subsidy?



<Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount>
Was the rent lowered because someone did work for the landlord? <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No>
If Yes, how much was the work reduction?



<Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount>



Total Rent: $- $- $- $- $- $- $- $- $- $- $- $- $- $- $- $- $- $- $- $-
Does this rent include any optional extra charges? <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No>
If Yes, what are they and how much is each one?



<Enter Text and Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount> <Enter Amount>
Since , has there been any changes to who pays the Utilities? This includes, water, sewer, electricity, air conditioning, heating, and hot water. <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No> <Select Yes or No>
Additional Information:






























































Respondent Comments:
























































































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