Please use the below form to submit you rent change. Contact InfoFirst Name(Required) Last Name(Required) Phone(Required)Email(Required) Tenant InfoTenant Name First Last Tenant Address(Required) Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Current Rental Fee(Required) Requested Rental Fee Change(Required) Effective Date Requested(Required) UtilitiesOven/Stove Useage(Required) Natural Gas Bottled Gas/Propane Electric Oven/Stove Paid By(Required) Tenant Landlord Heating(Required) Natural Gas Bottled Gas/Propane Electric Oil Heating Paid By(Required) Tenant Landlord Water Heating(Required) Natural Gas Bottled Gas/Propane Electric Oil Water Heating Paid By(Required) Tenant Landlord Sewer(Required) Public Septic Sewer Paid By(Required) Tenant Landlord Other Electrical Paid By(Required)Example: Lights & Appliances. Tenant Landlord Air Conditioning(Required) YES NO Air Conditioning Paid By(Required) Tenant Landlord Trash Removal Paid By(Required) Tenant Landlord Oven/Stove provided by(Required) Tenant Landlord Refrigerator provided by(Required) Tenant Landlord 60 Day Notice(Required)By CHECKING the following box, you are certifying that you have given a 60 day notice to the tenant currently residing at the property for which this request is being made. I Provided a 60 day notice Your rent increase wil be approved if the following conditions are met: The owner has filled out this form in its entirity. The rent is reasonable compared to similar units that are not assisted by the Section 8 program. CCHA will notify you within 15 days of your request if the proposed rent is reasonable. The tenant has been notified of the proposed rent increase at least 60 days prior to the effective date. Additional CommentsPhoneThis field is for validation purposes and should be left unchanged.