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Inspection Checklist U .S . Department of Housing OMB Approval No . 2577-0169 <br /> Housing Choice Voucher Program and Urban Development ( Exp . 9/30/2010 ) <br /> Office of Public and Indian Housing A TRUE COPY <br /> CERTIFICATION ON LAST PAGE <br /> J . K . BARTON , CLERK <br /> Public reporting burden for this collection of information is estimated to average 0 . 50 hours per response , including the time for <br /> reviewing instructions , <br /> searching existing data sources , gathering and maintaining the data needed , and completing and reviewing the collection of information <br />. This agency <br /> may not conduct or sponsor, and a person is not required to respond to , a collection of information unless that collection displays a valid <br /> OMB control number. <br /> This collection of information is authorized under Section 8 of the U . S . Housing Act of 1937 (42 U . S . C . 1437f) . The information <br /> is used to determine if <br /> a unit meets the housing quality standards of the section 8 rental assistance program . <br /> Name of Family Tenant ID Number Date of Request (mm/dd/yyyy) <br /> Inspector ! Neighborhood/CensusTract Date of Inspection (mm/dd/yyyy) <br /> 1 <br /> Type of Inspection Date of Last Inspection (mm/ddlyyyy) PHA <br /> Initial ❑ SpecialL tt Reinspection j <br /> A. General Information <br /> Inspected Unit Year Constructed (yyyy) Housing Type (check as appropriate) <br /> Full Address (including Street, City, County, State, zip) Single Family Detached <br /> Duplex or Two Family <br /> Row House or Town House <br /> C Low Rise: 3 , 4 Stories , <br /> IncludingGarden Apartment <br /> Number ofhil re <br /> C d n in FamilyUnder 6 <br /> : :> .:. _ ' .' High Rise; 5 or More Stories <br /> Manufactured Home <br /> . . . : . ;. : . . <br /> Owner F_� Congregate <br /> Name of Owner or Agent Authorized to Lease Unit Inspected Phone Number F� Cooperative <br /> Independent Group Resi- <br /> dence <br /> Address of Owner or Agent Single Room Occupancy <br /> Shared Housing <br /> Other <br /> B . Summary Decision On Unit To be completed after form has been filled out <br /> Pass Number of Bedrooms for Purposes Number of Sleeping Rooms <br /> a Fail of the FMR or Payment Standard <br /> u <br /> Inconclusive <br /> Inspection Checklist <br /> Item Yes No In- Final Approval <br /> No. 1 , Living Room Pass Fail Cone Comment Date (mm/dd/yyyy) <br /> 1 . 1 Living Room Present <br /> 1 . 2 Electricity <br /> 1 . 3 Electrical Hazards <br /> 1 . 4 Security <br /> 1 .5 Window Condition <br /> 1 . 6 Ceiling Condition <br /> 1 .7 Wall Condition <br /> 1 . 8 Floor Condition <br /> Room Codes : 1 = Bedroom or Any Other Room Used for Sleeping (regardless of type of room) ; 2 = Dining Room or Dining Area <br />; <br /> 3 = Second Living Room , Family Room , Den , Playroom, TV Room ; 4 = Entrance Halls , Corridors , Halls , Staircases ; 5 = Additional <br />Bathroom; 6 = Other <br /> Previous editions . are obsolete Page 1 of 7 form HUD-52580 (312001 ) <br /> ref Handbook 7420 .8 <br />