Form Hud 52580 - Inspection Checklist Template
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8Inspection Checklist
U.S. Department of Housing
OMB Approval No. 2577-0169
and Urban Development
(Exp. 04/30/2018)
Housing Choice Voucher Program
Office of Public and Indian Housing
Public reporting burden for this collection of information is estimated to average 0.50 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 not
conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number
.
Assurances of confidentiality are not provided under this collection.
This collection of information is authorized under Section 8 of the U.S. Housing Act of l937 (42 U.S.C. 1437f). The information is used to determine
if a unit meets the housing quality standards of the section 8 rental assistance program.
Privacy Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form by
Section 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f). Collection of the name and address of both family and the owner is mandatory. The
information is used to determine if a unit meets the housing quality standards of the Section 8 rental assistance program. HUD may disclose this information
to Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions. It will not be otherwise disclosed or
released 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 participation.
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
Date of Last Inspection (mm/dd/yyyy)
PHA
Initial
Special
Reinspection
A. General Inf ormation
Housing Type
(check as appropriate)
Inspected Unit
Year Constructed (yyyy)
Full Address (including Street, City, County, State, Zip)
Single Family Detached
Duplex or Two Family
Row House or Town House
Low Rise: 3, 4 Stories,
Including Garden Apartment
Number of Children in Family Under 6
High Rise; 5 or More Stories
Manufactured Home
Owner
Congregate
Name of Owner or Agent Authorized to Lease Unit Inspected
Phone Number
Cooperative
Independent Group
Residence
Address of Owner or Agent
Single Room Occupancy
Shared Housing
Other
B. Summary Decision On Unit (To be completed after form has been filled out
Number of Bedrooms for Purposes
Number of Sleeping Rooms
Pass
of the FMR or Payment Standard
Fail
Inconclusive
Inspection Checklist
Item
Yes
No
In-
Final Approval
No.
Pass
Fail
Conc.
Date (mm/dd/yyyy)
Living Room
Comment
1.
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
Page 1 of 8
form HUD-52580 (4/2015)
Previous editions are obsolete
ref Handbook 7420.8
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