H11.
[Answer this question if you pay rent for your housing unit.]
a. If you pay rent by the month --
What is the monthly rent?
Write the amount here _____.00
and
Fill one circle here
[] Less than $10
[] $10 to $19
[] $20 to $29
[] $30 to $39
[] $40 to $49
[] $50 to $59
[] $60 to $69
[] $70 to $79
[] $80 to $89
[] $90 to $99
[] $100 to $119
[] $120 to $149
[] $150 to $199
[] $200 or more
b.
[If you do not pay monthly rent]
What is your rent, and what period of time does it cover?
$ (Nearest dollar) _____.00 per (Week, half-month, year, etc.) _____
[Ask question H15 if rented for cash.]
H15. In addition to the rent entered in H11, do you also pay for -
a. Electricity?
[] Yes, average monthly cost is
$_____.00
[] No, included in rent
[] No, electricity not used
b. Gas?
[] Yes, average monthly cost is
$_____.00
[] No, included in rent
[] No, gas not used
c. Water?
[] Yes, yearly cost is
$______.00
[] No, included in rent or no charge
d. Oil, kerosene, charcoal, wood, etc.?
[] Yes, yearly cost is
$_____.00
[] No, included in rent
[] No, these fuels not used