FORM AHS-30(WS) (1-16-2009)     
 U.S. DEPARTMENT OF COMMERCE
 Economics and Statistics Administration
 U.S. CENSUS BUREAU

AMERICAN HOUSING SURVEY WORKSHEET
 
We expect it will take about 15 minutes for you to provide this information, 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 that we have approval from OMB to conduct this survey.  Approval for this survey expires on ________.

	
UTILITY COSTS FOR MOST RECENT MONTHS 	
Utility 	January 	April 	August 	December 	
Electricity 	$ 	$ 	$ 	$ 	
Gas 	$ 	$ 	$ 	$ 	
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? 	$ 	
Amount borrowed for current mortgage? 	$ 	
And current interest rate? 	% 	
Total amount of the down payment for this house? (Enter the amount in dollars or as the percent of the purchase price.) 	$ 	or 	% Percent of purchase price 	
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. Keep it for your reference. 
Thank you again for your time and effort in completing this important survey! 

Completing the survey will be easier if you will look up the following bills 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 for reference, so you can refer to it when our field representative contacts you.

USCENSUSBUREAU