Inspection Checklist OMB A pr oval N . 25 7-0169

1 Previous editions are obsoletePage 1 of8formHUD-52580(4/2015)ref Handbook Department ofHousingOMB Approval No. 2577-0169and Urban Development(Exp. 04/30/2018)Housing Choice Voucher ProgramOffice of Public and Indian HousingPublic reporting burden for this collection of information is estimated to average hours per response, including the time for reviewing instructions,searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may notconduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control of confidentiality are not provided under this collection of information is authorized under Section 8 of the Housing Act of l937 (42 1437f).

2 The information is used to determineif a unit meets the housing quality standards of the section 8 rental assistance Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this formbySection 8 of the Housing Act of 1937 (42 1437f). Collection of the name and address of both family and the owner is mandatory. Theinformation is used to determine if a unit meets the housing quality standards of the Section 8 rental assistance program. HUD may disclose this informationto Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions.

3 It will not be otherwise disclosed orreleased outside of HUD, except as permitted or required by law. Failure to provide any of the information may result in delay or rejection of family of FamilyTenant ID NumberDate of Request (mm/dd/yyyy)InspectorNeighborhood/Census TractDate of Inspection (mm/dd/yyyy)Type of InspectionInitialSpecialReinspectionDate of Last Inspection (mm/dd/yyyy)PHAA. Ge n e r a l I nf or m at ionInspected UnitYear Constructed (yyyy)Housing Type(check as appropriate)Single Family DetachedDuplex or Two FamilyRow House or Town HouseLow Rise: 3, 4 Stories,Including Garden ApartmentHigh Rise; 5 or More StoriesManufactured HomeCongregateCooperativeIndependent GroupResidenceSingle Room OccupancyShared HousingOtherFull Address (including Street, City, County, State, Zip)Number of Children in Family Under 6 OwnerName of Owner or Agent Authorized to Lease Unit InspectedPhone NumberAddress of Owner or AgentB.

4 Summary Decision On Unit(To be completed after form has been filled outPassFailInconclusiveNumber of Bedrooms for Purposesof the FMR or Payment StandardNumber of Sleeping RoomsInspection ApprovalDate (mm/dd/yyyy) Room ConditionPrevious editions are obsoletePage 2 of8formHUD-52580 (4/2015)ref Handbook *RoomCodes: 1 = Bedroomor Any Other RoomUsed for Sleeping (regardless of type of room);2 = Dining Roomor Dining Area;3 = Second Living Room, Family Room, Den, Playroom, TV Room; 4 = Entrance Halls, Corridors, Halls, Staircases; 5 = Additional Bathroom; 6 = . L i vi n g R o o m ( Co n t i n u e d) ApprovalDate (mm/dd/yyyy) PaintAre all painted surfaces free of deterioratedpaint?)

5 If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?Not Applicable2 . K i t c h e Area PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?Not Stove or Range with for Storage, Preparation, and Servingof Food3. ConditionFlush Toilet in Enclosed Room in Fixed Wash Basin or Lavatory in Tub or Shower in Ventilation Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per roomand/or is more than10%of a component?

6 Not Other Rooms Used For Living and HallsCommentFinal ApprovalDate (mm/dd/yyyy) Code* and(Circle One)(Circle One)Room LocationRight/Center/LeftFront/Center/Re ar____Floor Electrical Window Ceiling Wall Floor Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component? Smoke Room Code* and(Circle One)(Circle One)Room LocationRight/Center/LeftFront/Center/Re ar____Floor Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?

7 Smoke Room Code* andRoom Electrical Window Ceiling Wall Floor Lead-Based PaintAre all painted surfaces free of deterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component? Level(Circle One)(Circle One)Not ApplicableNot Electrical Window Ceiling Wall Floor ConditionNot ApplicablePrevious editions are obsoletePage 3of8form HUD 52580 (4/2015) ref Handbook editions are obsoletePage 4 of8formHUD-52580 (4/2015)ref Handbook Other Rooms Used For Living and ApprovalDate (mm/dd/yyyy) (Circle One)(Circle One)

8 Right/Center/LeftFront/Center/Rear____Fl oor LevelRoom PaintAre all painted surfaces free ofdeterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?Not Smoke Code* and(Circle One)(Circle One)Room LocationRight/Center/LeftFront/Center/Re ar____Floor PaintAre all painted surfaces free ofdeterioratedpaint?If not, do deteriorated surfaces exceed twosquare feet per room and/or is more than10% of a component?Not Smoke Detectors5. All Secondary Rooms(Rooms not used for living) to Part Potentially HazardousFeatures in these RoomsRoom Code *and Room Location Previous editions are obsoletePage5of8formHUD-52580 (4/2015)ref Handbook Building Condition of of Stairs, Rails, and Condition of Condition of Exterior Condition of Paint:Exterior SurfacesAre all painted surfaces free of deterioratedpaint?

9 If not, do deteriorated surfaces exceed 20square feet of total exterior surface area?Not Manufactured Home: Tie Downs7. Heating and Adequacy of Heating of Heating Water Approvable Water Sewer Connection8. General Health and and Stairs and Commom Interior Air Site and Neighborhood Lead-Based Paint: Owner's CertificationNot ApplicableIf the owner is required to correct any lead-based paint hazards at the property including deteriorated paint or other hazards identified by avisual assessor, a certified lead-based paint risk assessor, or certified lead-based paint inspector, the PHA must obtain certification that thework has been done in accordance with all applicable requirements of 24 CFR Part 35.

10 The Lead -Based Paint Owner Certification must bereceived by the PHA before the execution of the HAP contract or within the time period stated by the PHA in the owner HQS violation of the completed and signed Lead-Based Paint Owner Certification signifies that all HQS lead-based paint requirements have beenmet and no re- Inspection by the HQS inspector is ApprovalDate (mm/dd/yyyy) Access to Fire Evidence of InfestationPreviouseditions are obsoletePage6of 8formHUD-52580 (4/2015)ref Handbook 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 the features listed below are not included in the Housing Quality Standards, the tenant and HA may wish to take them into consideration indecisions about renting the unit and the reasonableness of the any positive features found in relation to the Questions to ask the Tenant(Optional)1.