Complete this form for properties financed by Minnesota Housing using Housing Tax Credits, HOME, National Housing Trust Funds, or a Minnesota Housing deferred loan, where residents are responsible for paying utilities.  If the property consists of buildings with different unit types (e.g., apartments and townhomes) complete a separate form for each type. If the buildings consist of townhouse units and the PHA utility allowance is used, include the PHA’s policy as to whether the townhouse/duplex allowance or apt/multi allowance is used, as PHA policies may differ based on the number of townhouse units in a building.

Owners and managers of Housing Tax Credit properties are urged to read Treasury Regulations 1.42-10 effective May 2, 1994, and amended July 29, 2008, as well as the Final and Temporary Utility Allowance Regulations 1.42-10T issued March 3, 2016.  Utility allowances are also addressed in MHFA's Housing Tax Credit Program Compliance Guide.  Owners and managers of properties financed with HOME are urged to read HOME Fires Vol. 13, No. 2, guidance on how to establish utility allowances for HOME-assisted properties.  Utility allowances are also addressed in MHFA’s HOME/NHTF Programs Compliance Guide.

A Ratio Utility Billing System (RUBS) is a formula that allocates a property's utility bill among its units based on the units’ relative floor space, number of occupants, or some other quantitative measure, but not based on actual consumption.  All payments under a RUBS are considered rent and are not included in a utility allowance. 

Property Name       		This UA applies to the following address(es)/BIN(s):	
MHFA D      		     	
Unit Type (e.g., Apts, Townhomes)      		     	
Utility Allowance Effective Date:       		     	

Utility allowance Source:

	Local Public Housing Agency (PHA) that administers Housing Choice Vouchers in the area.  
Enter the name of the PHA:        	
	HUD Utility Schedule Model (HUSM)		Energy Consumption Model (ECM)	
	As approved for HUD programs (including Section 8)		As approved by USDA	

For each size unit that applies to the building(s) identified above, indicate the utilities that are paid by residents by placing an X in the respective utility type on the next pages.  In UA Amount, enter the amount of the Utility Allowance according to the source documentation.  Enter Totals for each unit size.  
If Total results in cents, round up to the next whole dollar (e.g., If the Total is $52.01, enter $53.00). 
Supporting documentation from the applicable utility source must be provided.

0BR/Efficiency/Studio		1 Bedroom	
	Gas	Elec	Oil	L.P.	Other		UA Amount			Gas	Elec	Oil	L.P.	Other		UA Amount	
Unit Heat							     		Unit Heat							     	
Water Heat							     		Water Heat							     	
Cooking							     		Cooking							     	
Unit Electric							     		Unit Electric							     	
Water Svc							     		Water Svc							     	
Sewer							     		Sewer							     	
Trash							     		Trash							     	
TOTAL:							     		TOTAL:							     	

2 Bedrooms		3 Bedrooms	
	Gas	Elec	Oil	L.P.	Other		UA Amount			Gas	Elec	Oil	L.P.	Other		UA Amount	
Unit Heat							     		Unit Heat							     	
Water Heat							     		Water Heat							     	
Cooking							     		Cooking							     	
Unit Electric							     		Unit Electric							     	
Water Svc							     		Water Svc							     	
Sewer							     		Sewer							     	
Trash							     		Trash							     	
TOTAL:							     		TOTAL:							     	

4 Bedroom		5 Bedroom	
	Gas	Elec	Oil	L.P.	Other		UA Amount			Gas	Elec	Oil	L.P.	Other		UA Amount	
Unit Heat							     		Unit Heat							     	
Water Heat							     		Water Heat							     	
Cooking							     		Cooking							     	
Unit Electric							     		Unit Electric							     	
Water Svc							     		Water Svc							     	
Sewer							     		Sewer							     	
Trash							     		Trash							     	
TOTAL:							     		TOTAL: