"*" indicates required fields HiddenRIR This form is used to request a rent increase through the Housing Choice Voucher program.Requests must be submitted at least 60 days, prior to the effective date of the proposed rent increase. Please note that the effective date must be the first day of the month.Rent increases are subject to rent reasonableness regulations.Upload a copy of the 60-day notice that you provided your tenant below.Acceptable forms of notice include a dated email or letter addressed to the tenant that states the address of the rental unit, the proposed rent rate, and effective date of the increase.*Accepted file types: jpg, gif, png, pdf, Max. file size: 32 MB.OWNER INFORMATION:Name* First Last Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Phone Number*Email* Tenant Name* First Last Rental Unit Information* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Number of Bedrooms* RENT INFORMATION:Current Rent*Proposed Rent*Effective Date of Increase* MM slash DD slash YYYY TERM OF LEASE:Will the lease be renewed on a month-to-month basis?* Yes No If no, how many months is the new lease term? Ceritifications:* I certify that the tenant indicated above was provided at least 60 days' notice of the proposed rent increase. I certify that I have attached a copy of the 60-day notice provided to the tenant indicated above, which is a dated email or letter addressed to the tenant that states the address of the rental unit, the proposed rent rate, and the effective date of the increase. I certify that I am the owner, or the duly authorized representative, of the rental unit indicated above, and understand that clicking this checkbox is equivalent to my handwritten signature. Please note that this form can only be submitted for one tenant. Submitting an increase for multiple tenants on the same form or notice cannot be accepted and may lead to a delay in the effective date of the increase.PhoneThis field is for validation purposes and should be left unchanged.
