Property Intake Form and Model Request
Point of Contact (POC) Information
POC Name
*
First Name
Last Name
Company Name
*
Contact Title
*
Contact Title
Company/Owner Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
POC Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
POC Email Address
*
example@example.com
Basic Property Information
Property Name
*
Occupancy Type
*
Please Select
Senior
Multifamily
Ownership Entity
*
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Property Status
*
Underwriting
Application
Established/Occupied
New Construction
If property is not occupied, expected date of occupancy:
-
Month
-
Day
Year
Date
LIHTC #
*
LIHTC Type
*
Please Select
4%
9%
CMTS ID (TX Only)
FHFC Key # (FL Only)
Expected UA Implementation Date:
*
-
Month
-
Day
Year
Date
Intended 90-Day Notice Posting Date:
*
-
Month
-
Day
Year
Date
Are you applying for, or have you received Multifamily Direct Loans (MFDL) with the state (e.g. HOME)?
*
Yes
No
Are you applying for MFDL from another jurisdiction?
*
Yes
No
If "Yes", what jurisdiction:
Will there be HUD-Regulated buildings (other than those that are HUD Regulated due to MFDL)?
*
Yes
No
Will there be any RHS assisted buildings or tenants?
*
Yes
No
Unit Mix and Types
*
Rows
Unit Type 1
Unit Type 2
Unit Type 3
Unit Type 4
Unit Type 5
# of Bedrooms
# of Bathrooms
Unit Type
Total # of Units
Square Ft.
Current UA (in $)
Total # of Units
*
Total # of Buildings
*
Please check off all the items below that you have.
*
Site Plans
Design Drawings
Construction Drawings
As-built/Record Drawings
Conceptual Drawings
None
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Utility Information
*
Rows
Utility Type
Who Pays
Tenant Bill Paid To
Heating
Resident
Owner
N/A
Utility Provider
Property
3rd Party
N/A
Cooking
Resident
Owner
N/A
Utility Provider
Property
3rd Party
N/A
Water Heating
Resident
Owner
N/A
Utility Provider
Property
3rd Party
N/A
Air Conditioning
Resident
Owner
N/A
Utility Provider
Property
3rd Party
N/A
Other Electric
Resident
Owner
N/A
Utility Provider
Property
3rd Party
N/A
Sewer
Resident
Owner
N/A
Utility Provider
Property
3rd Party
N/A
Water
Resident
Owner
N/A
Utility Provider
Property
3rd Party
N/A
Trash
Resident
Owner
N/A
Utility Provider
Property
3rd Party
N/A
*
Rows
Name of Utility Provider
Units Metered By
Electric
Gas
Water
Sewer
Trash
Do you have will-serve letters from utility providers?
*
Yes
No
If 'Yes", please upload a copy of these letters:
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Will there be Solar PV or another alternate Energy Source?
*
Yes
No
If "Yes", please explain:
Current Utility Allowance Methodology:
*
Please Select
Public Housing Authority (PHA)
Written Local Estimate
HUD Utility Schedule Model (HUSM)
Energy Consumption Model (ECM)
Actual Use Method
PHA Name
PHA Schedule Effective Date
-
Month
-
Day
Year
Date
PHA Schedule Building Type
Energy and Water End Uses
Will units have washer/dryer hookups?
*
Yes
No
Will there be a common area laundry facility on site?
*
Yes
No
Will the property be providing washers/ dryers to tenants?
*
Yes
No
What is the type of lighting used in the units? (majority)
*
Please Select
Halogen
Incandescent
Fluorescent
Compact Fluorescent Lamps (CFL)
Let Emitting Diode (LED)
Clothes Dryer Model # (exact or similar)
*
Clothes Washer Model # (exact or similar)
*
Refrigerator Model # (exact or similar)
*
Dishwasher Model # (exact or similar)
*
Water Heating Model # (exact or similar)
*
Type of Heating/Cooling System (HVAC)
Cooling Model
*
Please Select
Split System
Packaged System
Evaporative System
No Cooling
Heating Model
*
Please Select
Heat Pump
Electric Resistance
Gas Furnace
No Heating
We recommend the following plumbing fixture flow rates: Kitchen Faucet (1.5 gpm), Lavatory (1.0 gpm), Toilet (1.28 gpf), Shower Head (1.5 gpm). Please confirm below that you adhere to these flow rates or specify if you'll be incorporating different flow rates.
*
If there is any additional information you would like to share with us, please provide it below:
IMPORTANT! If property is occupied, provide at least one tenant bill for each tenant paid utility. If the utility will be sub-metered, residents will be billed using commercial rates. Provide a full month's worth of all house electric bills. If water heating is provided by a natural gas central water heating system, please provide house natural gas bills. If water is a tenant paid utility, provide a full month's worth of all property water bills.
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The information provided in this form is accurate as of the date of signature and to the best of my knowledge. Please sign below:
*
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