Owner Rent Increase Request

Owner Information

Owner Name*

First Last

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Email Address*

Tenant/Unit Information

Name*

First Last

Tenant/Unit Address*

Street Address Address Line 2 City State ZIP Code

Number of Bedrooms*

Current Rent*

Proposed Rent*

Effective Date*

Warning: Requests not received 60 days prior to the effective date are prohibited by program rules. However, please proceed with submission of this form. You will be contacted to clarify the effective date.

What is the term of release renewal?*

One Year
Month-to-Month
Other

Other term of release renewal:

Are there any changes in the provisions of the lease?*

Yes
No

Please attach a copy of any renewal notice

Drop files here or

Max. file size: 512 MB.

Please attach a copy of the revised lease with any renewal notice

Drop files here or

Max. file size: 512 MB.

Is the term of the lease being changed?

Yes
No

Since the terms of the lease are changing, a new tenancy must be approved and a new HAP contract signed.

I understand

Is responsibility for any utilities changing?

Yes
No

Since responsibility for utilities are changing, a new tenancy must be approved and new HAP contract signed.

I understand

Reminder and Comments

Reminder: The rent must be determined to be reasonable. HRHA will compare the requested rent to going rents of similar, unassisted rental units in the same market area. If your request cannot be approved, we will contact you promptly. Otherwise, the new rent will be reflected in a revised rent letter containing updated tenant and HRHA portions. If you have any comments or questions feel free to leave them below.

Certification

I hereby certify that I am the owner or the duly authorized representative of the property for which this rent increase request is being submitted and that all information provided is true and correct to the best of my knowledge. I certify that I have given a 60-day notice of this rent increase to the tenant. I certify that I am maintaining the unit in accordance with housing quality standards. I certify that the rent to owner does not exceed rents charged for rental of comparable unassisted units in the premises. I certify that except for the specified rent to owner amount, I have not received and will not receive any payments or other consideration from the family for the rent of the unit during the contract term. I understand that clicking this checkbox is the equivalent to my handwritten signature.

I understand and certify

Owner Information

Tenant/Unit Information

Our Information

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