Ahs-30 American Housing Survey Worksheet

FORM

AHS-30(WS) (xx-xx-xxxx)

U.S. DEPARTMENT OF COMMERCE

AMERICAN HOUSING
SURVEY WORKSHEET

Economics and Statistics Administration

U.S. CENSUS BUREAU

This worksheet is not a questionnaire but an aid to help you when our field representative contacts you.
DO NOT mail this back to the U.S. Census Bureau.
Completing the survey will be easier if you will look up these costs in your checkbook or other records before the interview.
Record the amounts for the past year in the spaces provided, skipping any costs that do not apply to you.
Please keep this worksheet and copies of your utility bills, regular mortgage statement, and year end mortgage
statement (IRS Form 1098), so you can refer to them when our field representative contacts you.
Thank you for your time and effort in completing this worksheet!

UTILITY COSTS FOR MOST RECENT MONTHS
Utility

January

April

August

December

Electricity

$

$

$

$

Yes
No Are your costs for electricity the same every month?

Are you billed separately for electricity?
Utility

January

April

Gas

$

$

Are you billed separately for gas?

August

Yes
No

December

$
$
Yes
No Are your costs for gas the same every month?

Yes
No

OTHER HOUSING COSTS
Total cost of fuel oil for the past year?

$

Total garbage and trash collection costs for the past year?

$

Total water and sewer costs for the past year?

$

OTHER COSTS FOR HOME OWNERS
Total real estate tax for the past year?
Total amount of the down payment for this
house? (Dollars or percent)

$
$
1st Mortgage/
Loan

When did you get this loan? (month/year)

Home

%
2nd Mortgage/ Home
Loan

3rd Mortgage/
Home Loan

/

/

/

How much was borrowed?

$

$

…the amount you still owe?

$

$

$

…the current payment?

$

$

$

…the current interest rate?

%

%

%

We expect it will take about 15 minutes for you to provide the information for this worksheet, but it may be somewhat shorter
or longer, depending on your circumstances. If you have any comments on this survey or have recommendations for
reducing its length, please send them to the Director, Housing and Demographic Analysis Division, Office of Policy
Development and Research, Office of Economic Affairs, Department of Housing and Urban Development, Washington, DC
20410. The Office of Management and Budget (OMB) control number for this survey is 2528-0017. This number confirms
st