Rent Increase Request Form | Housing Authority of the County of Santa Cruz

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This form is used to request a rent increase through the Housing Choice Voucher program.

Requests must be submitted at least 60 days, but no more than 90 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.

OWNER INFORMATION:

Name*

First Last

Mailing Address*

Street Address City State Zip Code

Phone Number*

Email*

Tenant Name*

First Last

Rental Unit Information*

Street Address City State Zip Code

Number of Bedrooms*

RENT INFORMATION: Please note: Proposed rent rates must be submitted in whole dollar amounts only (no cents).

Current Rent*

Proposed Rent*

Effective Date of Increase*

TERM OF LEASE:

Will the lease be renewed on a month-to-month basis?*

Yes

If no, how many months is the new lease term?

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.

If your property is exempt from the Tenant Protection Act of 2019, upload documents verifying the exemption here:

Max. file size: 32 MB.

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.