Form OS-2000 Private Rental Survey Houses - Apartments - Mobile Homes

ATTACHMENT B
PRIVATE RENTAL SURVEY
HOUSES – APARTMENTS – MOBILE HOMES

Office of the Secretary (OS)
Form 2000

OMB Control Number 1084-0033

City and State:
Address of Housing Sample:
Name of Owner/Agent:
Address of Owner/Agent:

Survey I.D. Number:

Community Code:

Survey Community and State:

Zip Code:

Owner/Agent Phone:

HOUSING DATA (FILL IN APPROPRIATE BLANKS AND CHECK BEST CHOICE)
1. Year Constructed

15. Duplex / Triplex

10. Central Cooling System
A. Refrigerated Air

2. Gross Finished Floor Space of Each
Individual Housing Unit (square feet)
Basement

Yes

C. Both

D. None

11. Window Cooling

First Floor

No. of Refrigerated Air Units

Other Floors

No. of Evaporative Air Units

3. Gross Unfinished Basement Space

4. Number of Bedrooms

12. Trailer Pad Construction

.

(note: .25 per fixture; shower only = .75)

A. Excellent

D. Poor

B. Good

E. Obsolete

C. Fair

13. Garage/Carport
A. Garage – Single Car

14. Rent Class
Single Family House
A. 4 Bedroom

8. Interior Condition

B. 3 Bedroom

A. Excellent

D. Poor

C. 2 Bedroom

B. Good

E. Obsolete

D. 1 Bedroom

C. Fair
9. Primary Heating Energy

Range
Dishwasher
Washer
Dryer
Microwave Oven

D. None

7. Exterior Condition

Refrigerator

B. Natural Surface (dirt, gravel, etc.)

C. Carport

(excludes bathrooms)

(Insert #)

Freezer

B. Garage – Double Car

6. Number of Rooms

16. Appliances Furnished by Landlord

A. Hard Surface (cement, asphalt, etc.)
C. Not Applicable

5. Number of Bathrooms

No

B. Evaporative Air

Apartment Unit
E. 3 Bedroom

Trash Compactor
17. Services Paid for by Landlord
Water (incl. well)
Yes
Sewer (incl. septic)
Yes
Garbage
Yes
Lawn Care
Yes
Cable TV
Yes
Satellite Dish hook-up
Yes
Electricity
Yes
Heating Fuel
Yes
Firewood
Yes
Snow Removal
Yes
18. Furnishings Provided by Landlord
(enter # of furnished rooms)

19. Fireplace

A. Natural Gas

F. 2 Bedroom

A. Working Fireplace

B. Liquid Propane Gas

G. 1 Bedroom

B. No Fireplace or Not Working

C. Fuel Oil

H. 0 Bedroom (Efficiency)

D. Electricity – resistance heat

Mobile Home

E. Electricity – heat pump

M. Any Size

F. Coal
G. Wood
H. Solar
I.

No
No
No
No
No
No
No
No
No
No

20. Free Standing Stove (i.e. a stove that is
not inside of, attached to, in front of or
vented through a fireplace)
Yes

No

21. Monthly Contract Rental Rate
(round to nearest dollar)

None

OS-2000

ATTACHMENT B
Office of the Secretary (OS)
Form 2000

PRIVATE RENTAL SURVEY
HOUSES – APARTMENTS – MOBILE HOMES

OMB Control Number 1084-0033

Paperwork Reduction Act Statement: This information is being used to determine private sector rental rates for houses,
apartments and mobile homes, and will be used to establish rental rates for occupants of government-furnished quarters.
Response to this request is voluntary. No action may be taken against you for refusing to supply the information requested.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays
a current valid Office of Management and Budget (OMB) control number.
Estimated Burden Statement: Public reporting burden for this form is estimated to average 8 minutes per response, including
the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments
regarding the burden estimate, or any other aspect of this form, to the U.S. Department of the Interior, Office of the Secretary,
Office of Acquisition and Property Management, 1849 C Street NW, MS 2607-MIB, Washington, DC 20240.
Privacy Act Statement: Your participation is voluntary. If you do participate, you do not have to give us personal information
in order to complete this form. The data obtained from you will be treated anonymously, and will be used only for statistical
purposes – to measure private rental rates in your community and region. However, we reserve the right to contact you to
clarify this information or to verify our contractor’s performance. We will not disclose this information; it is published only in
aggregate form. We do not give, sell or transfer any personal information to a third party. It will not be shared with other
property managers or rental companies. Direct comments regarding the Privacy Act, or any other aspect of this form, to the
U.S. Department of the Interior, Office of the Secretary, Office of Acquisition and Property Management, 1849 C Street NW,
MS 2607-MIB, Washington, DC 20240.

Completed By:________________________________________________

Printed Name:________________________________________________

Date:_______________________________

OS-2000