Allowances for
Tenant-Furnished Utilities and Other Services / U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing / OMB Approval No. 2577-0169
(exp. 07/31/2007)

See Public Reporting Statement and Instructions on back

Locality
as / Unit Type / Date (mm/dd/yyyy)
Utility or Service / Monthly Dollar Allowances
0 BR / 1 BR / 2 BR / 3 BR / 4 BR / 5 BR
Heatinga. Natural Gas / 23 / 32 / 42 / 51 / 66 / 75
b. Bottle Gas / 61 / 85 / 110 / 134 / 171 / 196
c. Fuel Oil / 37 / 51 / 66 / 80 / 102 / 116
d. Electric / 17 / 25 / 32 / 39 / 50 / 56
Cookinga. Natural Gas / 2 / 3 / 4 / 5 / 7 / 8
b. Bottle Gas / 12 / 17 / 22 / 27 / 34 / 39
c. Electric / 3 / 5 / 6 / 8 / 10 / 11
Other Electric / 12 / 17 / 22 / 27 / 34 / 39
Water Heating a. Natural Gas / 6 / 9 / 12 / 14 / 18 / 21
b. Bottle Gas / 32 / 45 / 58 / 71 / 90 / 103
c. Fuel Oil / 19 / 26 / 34 / 41 / 52 / 60
d. Electric / 11 / 15 / 19 / 24 / 30 / 34
Water / 24 / 34 / 44 / 54 / 68 / 78
Sewer / 21 / 29 / 37 / 45 / 57 / 66
Trash Collection / 15 / 15 / 15 / 15 / 15 / 15
Range/Microwave / 3 / 3 / 3 / 3 / 4 / 4
Refrigerator / 4 / 4 / 4 / 5 / 6 / 6
Other -- specify (Furnace Fan)
Blower / 2 / 2 / 3 / 3 / 4 / 5
Actual Family Allowances To be used by the family to compute allowance. Complete below for the actual unit rented. / Utility or Service / per month cost
Heating / $
Cooking
Name of Family
Other Electric
Air Conditioning
Address of Unit / Water Heating
Water
Sewer
Trash Collection
Range/Microwave
Refrigerator
Number of Bedrooms / Other
Total / $
Previous editions are obsolete / Page 1 of 1 / form HUD-52667 (12/97) ref. Handbook 7420.8