2.2.1 Attachment 3 - DR-4832-TN Direct Lease Property Inspection Checklist.pdf

form HUD-52580 (4/2023) Previous editions are obsolete Page 1 of 8

OMB Approval No. 2577-0169 (Exp. 04/30/2026)

Inspection Checklist U.S. Department of Housing and Urban Development

Housing Choice Voucher Program Office of Public and Indian Housing

OMB Burden Statement: The public reporting burden for this collection of information is estimated to average 0.50 hours per response, including the time for re viewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. As surances of confidentiality are not provided under this collection. Send comments regarding this burden estimate or any other aspect of this collection of informat ion, including suggestions to reduce this burden, to the Office of Public and Indian Housing, US. Department of Housing and Urban Development, Washington, DC 20410. HUD may not conduct and sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid contr ol number.

Privacy Notice: The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form by 24 CFR § 982.401.

The information is used to determine if a unit meets the housing quality standards of the Section 8 rental assistance program. The Personally Identifiable Inform ation (PII) data collected on this form are not stored or retrieved within a system of record.

Name of Family Tenant ID Number Date of Request (mm/dd/yyyy)

Inspector Neighborhood/Census Tract Date of Inspection (mm/dd/yyyy)

Type of Inspection

Initial Special Reinspection

Date of Last Inspection (mm/dd/yyyy) PHA

A. General Information

Inspected Unit Year Constructed (yyyy) Housing Type (check as appropriate)

Single Family Detached

Duplex or Two Family

Row House or Town House

Low Rise: 3, 4 Stories, Including Garden Apartment

High Rise; 5 or More Stories

Manufactured Home

Congregate

Cooperative

Independent Group Residence

Single Room Occupancy

Shared Housing

Other

Full Address (including Street, City, County, State, Zip)

Number of Children in Family Under 6

Owner

Name of Owner or Agent Authorized to Lease Unit Inspected Phone Number

Address of Owner or Agent

B. Summary Decision On Unit (To be completed after form has been filled out

Pass

Fail Inconclusive

Number of Bedrooms for Purposes of the FMR or Payment Standard

Number of Sleeping Rooms

Inspection Checklist

Item No. 1. Living Room

Yes Pass

No Fail

In- Conc. Comment

Final Approval Date (mm/dd/yyyy)

1.1 Living Room Present

1.2 Electricity

1.3 Electrical Hazards

1.4 Security

1.5 Window Condition

1.6 Ceiling Condition

1.7 Wall Condition

1.8 Floor Condition

form HUD52580 (4/2023)

Previous editions are obsolete Page 2 of 8

* Room Codes: 1 = Bedroom or Any Other Room Used for Sleeping (regardless of type of room); 2 = Dining Room or Dining Area;

3 = Second Living Room, Family Room, Den, Playroom, TV Room; 4 = Entrance Halls, Corridors, Halls, Staircases; 5 = Additional Bathroom; 6 = Other

Item

No.

1. Living Room (Continued) Yes

Pas

No

Fail

In-

Conc. Comment

Final Approval

Date (mm/dd/yyyy)

1.9 Lead-Based Paint

Are all painted surfaces free of deteriorated paint?

If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component?

Not Applicable

2. Ki tchen

2.1 Kitchen Area Present

2.2 Electricity

2.3 Electrical Hazards

2.4 Security

2.5 Window Condition

2.6 Ceiling Condition

2.7 Wall Condition

2.8 Floor Condition

2.9 Lead-Based Paint

Are all painted surfaces free of deteriorated paint?

If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component?

Not Applicable

2.10 Stove or Range with Oven

2.11 Refrigerator

2.12 Sink

2.13 Space for Storage, Preparation, and Serving

of Food

3. Bathroom

3.1 Bathroom Present

3.2 Electricity

3.3 Electrical Hazards

3.4 Security

3.5 Window Condition

3.6 Ceiling Condition

3.7 Wall Condition

3.8 Floor Condition

Flush Toilet in Enclosed Room in Unit

3.11 Fixed Wash Basin or Lavatory in Unit

3.12 Tub or Shower in Unit

3.13 Ventilation

Lead-Based Paint

Are all painted surfaces free of deteriorated paint?

If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component?

Not Applicable

3.9

3.10

Item No. 4. Other Rooms Used For Living and Halls Comment

Final Approval Date (mm/dd/yyyy)

4..1 Room Code* and (Circle One) (Circle One)

Room Location Right/Center/Left Front/Center/Rear ____Floor Level

4.2 Electricity/Illumination

4.3 Electrical Hazards

4.4 Security

4.5 Window Condition

4.6 Ceiling Condition

4.7 Wall Condition

4.8 Floor Condition

4.9 Lead-Based Paint

Are all painted surfaces free of deteriorated paint?

If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component?

4.10 Smoke Detectors

4.1 Room Code* and (Circle One) (Circle One)

Room Location Right/Center/Left Front/Center/Rear ____Floor Level

4.9 Lead-Based Paint

Are all painted surfaces free of deteriorated paint?

If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component?

4.10 Smoke Detectors

4.1 Room Code* and

Room Location

4.2 Electricity/Illumination

4.3 Electrical Hazards

4.4 Security

4.5 Window Condition

4.6 Ceiling Condition

4.7 Wall Condition

4.8 Floor Condition

4.9 Lead-Based Paint

Are all painted surfaces free of deteriorated paint?

If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component?

In- Conc.

Yes Pass

No Fail

Right/Center/Left Front/Center/Rear ____Floor Level (Circle One) (Circle One)

Not Applicable

Not Applicable

4.2 Electricity/Illumination

4.3 Electrical Hazards

4.4 Security

4.5 Window Condition

4.6 Ceiling Condition

4.7 Wall Condition

4.8 Floor Condition

Not Applicable form HUD-52580 (4/2023) Previous editions are obsolete form HUD-52580 (4/2023) Previous editions are obsolete Page 4 of 8

Item No.

4. Other Rooms Used For Living and Halls Yes Pass

No Fail

In- Conc. Comment

Final Approval Date (mm/dd/yyyy)

4.1 (Circle One) (Circle One)

Right/Center/Left Front/Center/Rear ____Floor Level

Room Location

4.2 Electricity/Illumination

4.3 Electrical Hazards

4.4 Security

4.5 Window Condition

4.6 Ceiling Condition

4.7 Wall Condition

4.8 Floor Condition

4.9 Lead-Based Paint

Are all painted surfaces free of deteriorated paint?

If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component?

Not Applicable

4.10 Smoke Detectors

4.1 Room Code* and (Circle One) (Circle One)

Room Location Right/Center/Left Front/Center/Rear ____Floor Level

4.2 Electricity/Illumination

4.3 Electrical Hazards

4.4 Security

4.5 Window Condition

4.6 Ceiling Condition

4.7 Wall Condition

4.8 Floor Condition

4.9 Lead-Based Paint

Are all painted surfaces free of deteriorated paint?

If not, do deteriorated surfaces exceed two square feet per room and/or is more than 10% of a component?

Not Applicable

4.10 Smoke Detectors

5. All Secondary Rooms (Rooms not used for living)

5.1 None Go to Part 6

5.2 Security

5.3 Electrical Hazards

5.4 Other Potentially Hazardous

Features in these Rooms

Room Code * and Room Location

Previous editions are obsolete Page 5 of 8 form HUD-52580 (4/2023)

Item 6. Building Exterior No.

6.1 Condition of Foundation

6.2 Condition of Stairs, Rails, and Porches

6.3 Condition of Roof/Gutters

6.4 Condition of Exterior Surfaces

6.5 Condition of Chimney

6.6 Lead Paint: Exterior Surfaces

Are all painted surfaces free of deteriorated paint?

If not, do deteriorated surfaces exceed 20 square feet of total exterior surface area?

Not Applicable

6.7 Manufactured Home: Tie Downs

7. Heating and Plumbing

7.1 Adequacy of Heating Equipment

7.2 Safety of Heating Equipment

7.3 Ventilation/Cooling

7.4 Water Heater

7.5 Approvable Water Supply

7.6 Plumbing

7.7 Sewer Connection

8. General Health and Safety

8.4 Garbage and Debris

8.5 Refuse Disposal

8.6 Interior Stairs and Commom Halls

8.7 Other Interior Hazards

8.8 Elevators

8.9 Interior Air Quality

8.10 Site and Neighborhood Conditions

8.11 Lead-Based Paint: Owner's Certification Not Applicable

If the owner is required to correct any lead-based paint hazards at the property including deteriorated paint or other hazards identified by a visual assessor, a certified lead-based paint risk assessor, or certified lead-based paint inspector, the PHA must obtain certification that the work has been done in accordance with all applicable requirements of 24 CFR Part 35. The Lead -Based Paint Owner Certification must be received by the PHA before the execution of the HAP contract or within the time period stated by the PHA in the owner HQS violation notice.

Receipt of the completed and signed Lead-Based Paint Owner Certification signifies that all HQS lead-based paint requirements have been met and no re-inspection by the HQS inspector is required.

Comment

Yes

Pass

No

Fail

In -

Conc.

Final Approval

Date (mm/dd/yyyy)

8.1 Access to Unit

8.2 Fire Exits

8.3 Evidence of Infestation

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Previous editions are obsolete Page 6 of 8 form HUD-52580 (4/2023)

C. Special Amenities (Optional)

This Section is for optional use of the HA. It is designed to collect additional information about other positive features of the unit that may be present.

Although the features listed below are not included in the Housing Quality Standards, the tenant and HA may wish to take them into consideration in decisions about renting the unit and the reasonableness of the rent.

Check/list any positive features found in relation to the unit.

D. Questions to ask the Tenant (Optional)

1. Living Room

High quality floors or wall coverings Working fireplace or stove Balcony, patio, deck, porch Special windows or doors

Exceptional size relative to needs of family

Other: (Specify)

4. Bath

Special feature shower head

Built-in heat lamp

Large mirrors

Glass door on shower/tub

Separate dressing room Double sink or special lavatory Exceptional size relative to needs of family

Other: (Specify)

2. Kitchen Dishwasher

Separate freezer Garbage disposal Eating counter/breakfast nook Pantry or abundant shelving or cabinets Double oven/self cleaning oven, microwave Double sink

High quality cabinets Abundant counter-top space

Modern appliance(s) Exceptional size relative to needs of family

Other: (Specify)

5. Overall Characteristics

Storm windows and doors

Other forms of weatherization (e.g., insulation, weather stripping) Screen doors or windows

Good upkeep of grounds (i.e., site cleanliness, landscaping, condition of lawn)

Garage or parking facilities Driveway

Large yard

Good maintenance of building exterior Other: (Specify)

3. Other Rooms Used for Living

High quality floors or wall coverings

Working fireplace or stove Balcony, patio, deck, porch Special windows or doors

Exceptional size relative to needs of family

Other: (Specify)

6. Accessibility for Individuals with Disabilities Unit is accessible to a particular disability.

Disability

NoYes

Previous editions are obsolete Page 7 of 8 form HUD-52580 (4/2023)

1. Does the owner make repairs when asked? Yes No

2. How many people live there? _____

3. How much money do you pay to the owner/agent for rent? $ ____________

4. Do you pay for anything else? (specify) __________________________________________________________________

5. Who owns the range and refrigerator? (insert O = Owner or T = Tenant) Range ______ Refrigerator _____ Microwave __

6. Is there anything else you want to tell us? (specify) Yes No

Previous editions are obsolete Page 8 of 8

E. Inspection Summary/Comments (Optional) form HUD- 52580 (4/2023)

Provide a summary description of each item which resulted in a rating of "Fail" or "Pass with Comments."

Tenant ID Number Inspector Date of Inspection (mm/dd/yyyy) Address of Inspected Unit

Type of Inspection Initial Special Reinspection

Item Number Reason for "Fail" or "Pass with Comments" Rating

Continued on additional page Yes No

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