Rental Increase Request Form

Floyd County Housing Authority_logo
Phone: 606.285.3833 | Fax: 606.285.3835
402 John M. Stumbo Drive, Langley, KY 41645
FCHA-KY.org
Equal Housing Opportunity logo, Handicapped Accessible logo, and Website Accessible logo

[{"type":"paragraph","subtype":"p","label":"<div>In accordance with HUD regulations and the Housing Assistance Payment Contract Part C: Tenancy Addendum; Section 15-Changes in Lease or Rent (d): The owner must notify the PHA of any changes in the amount of the rent to owner at least 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 determine or re-determined by the PHA in accordance with HUD requirements. </div><div><br></div><div>If you would like our office to process a rental increase for your unit, please complete this form entirely. If the request is approved, we require a new lease reflecting the new amount. </div><div><br></div><div>You will receive an email response with the outcome of your request. </div>","className":"d-block"},{"type":"header","subtype":"h4","label":"General Information and Rent Amounts","className":"d-block"},{"type":"date","required":true,"label":"Today's Date","name":"Todays-Date","className":"col-md-6 col-lg-3"},{"type":"text","required":true,"label":"Landlord/Owner Name","name":"LandlordOwner-Name","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"Tenant/Participant Name","name":"TenantParticipant-Name","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Recertification Month","name":"Recertification-Month","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"Current Rent Amount","name":"Current-Rent-Amount","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","required":true,"label":"Rent Amount Requested","name":"Rent-Amount-Requested","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"date","required":true,"label":"Effective Date","name":"Effective-Date","className":"col-md-6 col-lg-3"},{"type":"text","required":true,"label":"Unit Address","name":"Unit-Address","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"header","subtype":"h4","label":"Utilities","className":"d-block"},{"type":"radio-group","required":true,"label":"Electric","inline":true,"name":"Electric","className":"col-md-6 col-lg-3","values":[{"label":" Landlord","value":" landlord"},{"label":" Tenant","value":" tenant"}]},{"type":"radio-group","required":true,"label":"Water","inline":true,"name":"Water","className":"col-md-6 col-lg-3","values":[{"label":" Landlord","value":" landlord"},{"label":" Tenant","value":" tenant"}]},{"type":"radio-group","required":true,"label":"Trash","inline":true,"name":"Trash","className":"col-md-6 col-lg-3","values":[{"label":" Landlord","value":" landlord"},{"label":" Tenant","value":" tenant"}]},{"type":"radio-group","required":true,"label":"Sewer","inline":true,"name":"Sewer","className":"col-md-6 col-lg-3","values":[{"label":" Landlord","value":" landlord"},{"label":" Tenant","value":" tenant"}]},{"type":"radio-group","required":true,"label":"Gas","inline":true,"name":"Gas","className":"col-md-6 col-lg-3","values":[{"label":" Landlord","value":" landlord"},{"label":" Tenant","value":" tenant"},{"label":" N/A","value":" n/a"}]},{"type":"header","subtype":"h4","label":"Contact Information","className":"d-block"},{"type":"text","required":true,"label":"Name of person submitting the request","placeholder":"Contact Information","name":"Name-of-person-submitting-the-request","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Contact Email","name":"Contact-Email","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","required":true,"label":"Contact Phone Number","name":"Contact-Phone-Number","className":"col-md-6"},{"type":"text","subtype":"tel","label":"Fax Number","name":"Fax-Number","className":"col-md-6"},{"type":"textarea","label":"Additional Comments","name":"Additional-Comments","subtype":"textarea","className":"d-block"}]