Owner Services TTY (800) 735-2929 www.fresnohousing.org Rent Adjustment Form (Rev 10.25.2021)
INSTRUCTIONS: Read all items carefully and answer all questions. Read and sign the owner’s acknowledgement and certification.
Attach copies of the 60-day notice of rent increase “and” the new lease addendum signed by all parties “if” there are any changes
to tenant or owner responsibilities for utilities or appliances.
Please note, effective January 1, 2022, the owner/agent can request to increase or decrease the contract rent after the initial
lease term or after one year has lapsed from the most recent effective date of the HAP contract. Rent adjustments to owners
will only be considered once in a 12-month period.
Owner:
Tenant:
Phone Number:
Unit Address:
Email:
City/Zip:
Check the Applicable Boxes:
Change in Contract Rent (Attach 60-Day notice)
Change in responsibilities for utilities and/or appliances (Attach signed lease addendum)
AB -1482 applies to me (informational link here) https://fresnohousing.org/partners/landlord-resources/ab-1482-qa/
1. Proposed Rent
2. Effective Date
4. No. of Bathrooms
5. Square Footage
6. Year Built
7. Water
Owner
Tenant
8. Garbage
Owner
Tenant
10. PGE/So Cal
Owner
Tenant
11. Stove
Owner
Tenant
12. Refrigerator
Owner
Tenant
AMENITIES Additional information used in determining rent reasonableness
Property Condition
Poor
Fair
Average
Above Average
Excellent
Building Quality
Poor
Fair
Average
Above Average
Excellent
Unit type
Apartment
Duplex
House
Mobile Home
Town House
Other
Microwave provided
Laundry room on site
Washer/Dryer Hookup
Washer/Dryer provided
Dishwasher
Garbage Disposal
Swamp Cooler
A/C Window/Wall
A/C Central
Ceiling Fan
Other
1 - Carport
2 - Carports
1 Car Garage
2 Car Garage
3 Car Garage
Gated Community
Lawn Care
Pest Control
Swimming Pool
Upgrades:
Owner Acknowledgement and Certification
The program requires the PHA to certify that the rent charged to the housing choice tenant is not more than the rent charged for
other unassisted comparable units. The owner agrees to reduce the Housing Assistance Payment (HAP) contract rent in
accordance with 24 CFR 982.507 if unassisted comparable units in the area result in a lower reasonable rent.
Owners of projects with more than 4 units must complete the following section for comparable unassisted units leased within the
premises in the past 12 months.
Address and Unit Number
Date Rented
Rental Amount
1.
2.
3.
I hereby certify that I am the owner or duly authorized representative of the unit for which this rent adjustment request is being
submitted and that a 60 (sixty) day notice of rent increase has been issued to the tenant, and attest that all information is true.
_________________________________________ ____________________________ ADDITIONAL INSTRUCTIONS ON THE BACK
Signature of Owner/Agent Date
Request for Rent Adjustment/Changes in Lease or Rent
Mail To: HCV Owner Services
1331 Fulton Street
Fresno CA 93721 (email and fax accepted)
Assisted Housing Division
Housing Choice Department
hcvrentadjustments@fresnohousing.org
Fax: 559-445-8980
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Owner Services Rent Adjustment Form (Rev 10.25.2021)
OFFICE USE ONLY
________________
Date Received
_________________________________
Print Reviewer’s Name
_____________________________
Reviewer’s Signature
__________________
Date Complete
Tenant Code:
Property/Program:
Move-In Date:
SSN:
Vendor Number:
$
OLD
NEW
Utilities Paid by
Tenant:
A/C
C/G
C/E
H/G
H/E
WH/G
WH/E
WGS
Stove
Fridge
N/A
CR
$
$
HAP
$
$
Rent Requested:
$
Rent Approved:
$
TR
$
$
Rent reasonable test results in a lower contract rent.
Request is disapproved due to incomplete information or improper notice to tenant.
URP
$
$
Voucher Size:
Payment Standard:
$
Comments:
ADDITIONAL INSTRUCTIONS
Mail, fax or email the completed form, 60-day notice and lease addendum to the address on the front of this form.
A complete Rent Adjustment form is required for each HCV tenant issued a notice of rent increase or change in lease terms.
Housing Assistance Payment shall not continue unless Fresno Housing (FH) has approved a new tenancy in accordance with
program requirements and has executed a new HAP contract with the owner:
o If there are any changes in lease requirements governing tenant or owner responsibilities for utilities or appliances;
o If there are any changes in lease provisions governing the term of the lease;
o If the family moves to a new unit, even if the unit is in the same building or complex.
The owner must notify FH of any changes in the amount of rent to owner at least (60) sixty days before any such changes go
into effect, and the amount of the rent to owner following any such agreed change may not exceed the reasonable rent for the
unit as most recently determined or re-determined by FH in accordance with HUD requirements.
You should receive the results of your request within 45-60 days after the request is received. There can be NO change in the
tenant’s portion of rent or housing assistance payment until this process is complete.
Do you have questions? Call Owner Services at (559) 266-9941, or e-mail us at hcvrentadjustments@fresnohousing.org
Monday thru Thursday and alternating Fridays from 8:00 a.m. to 4:30 p.m.
What is a rent adjustment?
A rent adjustment is a formal request to increase or decrease the existing contract rent. The owner/agent can request that the
contract rent be increased or decreased. The following steps must take place before the request can be approved:
The owner/agent must submit a COMPLETED Rent Adjustment form to the Housing Authority (HA).
The unit must have passed Housing Quality Standard inspection within the last twelve months.
The effective date of the change will be the first day of the month. Effective dates cannot fall in the middle of a month. Example:
60 day notice served December 10, 2018; effective 02/10/2019; rent adjustment effective date will be 03/01/2019.
In order for the rent adjustment to be effective in a timely manner, the Housing Authority must receive the documents within
10 business days from the date notice was served to the tenant.
What happens when my rent adjustment is disapproved?
If the request is disapproved, ALL documents will be returned to you with a letter stating why the increase was disapproved. Here
are a few reasons why the request would be disapproved:
The Rent Adjustment form was turned in without a 60-day notice, or the 60-day notice is turned in without the form.
The unit has not passed a HQS inspection within the past 12 months.
The Rent Adjustment form is incomplete, i.e. not all boxes are complete, missing signature, etc.
The tenant is in the transfer process or moved completely from the unit.
The unit is at maximum rent based on comparable units within the area and the rent cannot be negotiated.
The tenant has lived in unit for less than one (1) year.
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