Utility Allowance Verification Worksheet

Worksheet to verify the applicable utility allowance schedule and document its use in tenant rent calculations.

Submission Notice

• Purpose of this worksheet
• I understand this form will be used to document the utility allowance verification and rent calculation audit trail.
• What happens after I submit?

Property and Unit Details

• Property name
• Unit number
• Tenant or household identifier
  Use an internal identifier only. Do not enter SSN or other sensitive PII.
• Effective date for the rent calculation

Utility Responsibility

• Tenant pays electric
• Tenant pays gas
• Tenant pays water/sewer
• Tenant pays trash removal
• Other tenant-paid utility

Utility Allowance Schedule

• Utility allowance schedule source
• Schedule reference name
• Schedule effective date
• Schedule expiration date
• Verification method

Allowance Calculation

• Electric allowance amount
• Gas allowance amount
• Water/sewer allowance amount
• Trash allowance amount
• Total utility allowance
• Rent calculation notes
  Document any adjustments, assumptions, or exceptions used in the calculation.

Review and Audit Trail

• Reviewed by
• Review date
• Verification complete