[] Less than $50 [] $160 to $169
[] $50 to $59 [] $170 to $179
[] $60 to $69 [] $180 to $189
[] $70 to $79 [] $190 to $199
[] $80 to $89 [] $200 to $224
[] $90 to $99 [] $225 to $249
[] $100 to $109 [] $250 to $274
[] $110 to $119 [] $275 to $299
[] $120 to $129 [] $300 to $349
[] $130 to $139 [] $350 to $399
[] $140 to $149 [] $400 to $499
[] $150 to $159 [] $500 or more

"Report the rent agreed to or contracted for, even if the rent is unpaid or paid by someone else. If rent is not paid by the month, change the rent to a monthly amount; and then fill the appropriate circle in question H12.

"If rent is paid: Multiply rent by:

By the day 30
By the week 4
Every other week 2

"If rent is paid: Divide rent by:
4 times a year 3
2 times a year 6
Once a year 12