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PRIVATE RENTAL SURVEY
HOUSES – APARTMENTS – MOBILE HOMES

Office of the Secretary (OS)
Form 2000

OMB Control Number 1084-0033
Expires xx-xx-xxxx

Realty Company Name:

Street Address of Rental Unit:

Owner/Agent Name:

Unit City:

Owner/Agent Phone:

Survey Community and State:

Owner/Agent Address or Email:

Comp I.D. Number:

Owner/Agent City:
Owner:

State:
Agent:

Zip Code:

Tenant:

State:

Zip Code:

Community Code:
Contractor’s Representative:

Date Collected:

HOUSING DATA (FILL IN APPROPRIATE BLANKS AND CHECK BEST CHOICE)
1. Year Constructed

10. Central Cooling System
None

2. Gross Finished Floor Space of this
Housing Unit (square feet)
Basement

11. Window Cooling Units
No. of Refrigerated Air Units

Other Floors
3. Gross Unfinished Basement Space
(square feet)

5. Number of Bathrooms

Evaporative Air
Both Refrigerated & Evaporative

First Floor

4. Number of Bedrooms

Refrigerated Air

No. of Evaporative Air Units
12. Garage/Carport
None

.

(sink/toilet/bathtub = 1.0; sink/toilet/shower = 0.75)

6. Number of Rooms
(excludes bathrooms)

7. Exterior Condition
Excellent
Good
Fair
Poor
8. Interior Condition
Excellent
Good
Fair
Poor
9. Primary Heating Energy
Natural Gas
Liquid Propane Gas
Fuel Oil
Electricity – resistance heat
Electricity – heat pump
Coal
Wood
Solar
None

Garage – Single Car
Garage – Double Car

No
No
No
No
No
No
No
No
No
No

16. Furnishings Provided by Landlord
(enter # of furnished rooms)

No Fireplace or Not Working
Plexed

Apartment
Mobile Home
14. Appliances Provided by Landlord
Refrigerator

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Yes, Working Fireplace Available

13. Rent Class

(enter # included)

Water (incl. well)
Sewer (incl. septic)
Garbage
Lawn Care
Cable TV
Satellite Dish
Electricity
Heating Fuel
Firewood
Snow Removal

17. Fireplace

Carport

House

15. Services Paid for by Landlord (included)

18. Free Standing Stove (a stove that is not
inside of, attached to, in front of or vented
through a fireplace)

Yes

No

19. Monthly Contract Rent
(round to nearest dollar)

Range
Dishwasher
Washer
Dryer
Freezer
Microwave Oven
Trash Compactor

OS-2000

Office of the Secretary (OS)
Form 2000

PRIVATE RENTAL SURVEY
HOUSES – APARTMENTS – MOBILE HOMES

OMB Control Number 1084-0033
Expires mm-dd-yyyy

Paperwork Reduction Act Statement: This information is being used to determine private sector rental rates for houses,
apartments and mobile homes, and subsequently to establish rental rates for occupants of government-furnished quarters.
Response to this request is voluntary. No action may be taken against you for refusing to supply the information requested. An
agency may not conduct or sponsor a collection of information unless it displays a current valid Office of Management and Budget
(OMB) control number.
Estimated Burden Statement: Public reporting burden for this form is estimated to average 6 minutes per response, including
the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments
regarding the burden estimate, or any other aspect of this form, to the U.S. Department of the Interior, Office of the Secretary,
Office of Acquisition and Property Management, 1849 C Street NW, MS 4262, Washington, DC 20240.
Privacy Act Statement: Your participation is voluntary. If you do participate, you do not have to give us personal information in
order to complete this form. The data obtained from you will be treated anonymously, and will be used only for statistical purposes
– to measure private rental rates in your community and region. However, we reserve the right to contact you to clarify this
information or to verify our contractor’s performance. We will not disclose this information; it is published only in aggregate form.
We do not give, sell or transfer any personal information to a third party. It will not be shared with other property managers or
rental companies. Direct comments regarding the Privacy Act, or any other aspect of this form, to the U.S. Department of the
Interior, Office of the Secretary, Office of Acquisition and Property Management, 1849 C Street NW, MS 4262, Washington, DC
20240.

OS-2000