Form Hud-52580-A - Inspection Form
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8U.S. Department of Housing
OMB Approval No. 2577-0169
Inspection Form
(exp. 9/30/2002)
and Urban Development
Housing Choice Voucher Program
Office of Public and Indian Housing
Public reporting burden for this collection of information is estimated to average 3 minutes 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.
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.
PHA
Tenant ID Number
Date of Request (mm/dd/yyyy)
Inspector
Date Last Inspection (mm/dd/yyyy)
Date of Inspection (mm/dd/yyyy)
Neighborhood/Census Tract
Type of Inspection
Project Number
Initial
Special
Reinspection
A. General Information
Housing Type (check as appropriate)
Street Address of Inspected Unit
Single Family Detached
Duplex or Two Family
City
County
State
Zip
Row House or Town House
Name of Family
Current Telephone of Family
Low Rise: 3,4 Stories, Including
Garden Apartment
Current Street Address of Family
High Rise; 5 or More Stories
Manufactured Home
City
County
State
Zip
Congregate
Cooperative
Number of Children in Family Under 6
Independent Group Residence
Name of Owner or Agent Authorized to Lease Unit Inspected
Telephone of Owner or Agent
Single Room Occupancy
Shared Housing
Address of Owner or Agent
Other:(Specify)
B. Summary Decision on the Unit
C. How to Fill Out This Checklist
(to be completed after the form has been filled in)
Complete the checklist on the unit to be occupied (or currently occupied) by the
tenant. Proceeed through the inspection as follows:
Housing Quality Standard Pass or Fail
Area
Checklist Category
1. Fail If there are any checks under the column headed “Fail” the unit
room by room
1. Living Room
fails the minimum housing quality standards. Discuss with the owner the
2. Kitchen
repairs noted that would be necessary to bring the unit up to the standard.
3. Bathroom
2. Inconclusive If there are no checks under the column headed “Fail”
4. All Other Rooms Used for Living
and there are checks under the column headed “Inconclusive,” obtain addi-
tional information necessary for a decision (question owner or tenant as
5. All Secondary Rooms Not Used for Living
indicated in the item instructions given in this checklist). Once additional
basement or utility room
6. Heating & Plumbing
information is obtained, change the rating for the item and record the date of
outside
7. Building Exterior
verification at the far right of the form.
overall
8. General Health & Safety
3. Pass If neither (1) nor (2) above is checked, the unit passes the
Each part of the checklist will be accompanied by an explanation of the item
minimum housing quality standards. Any additional conditions described in the
to be inspected.
right hand column of the form should serve to (a) establish the precondition
Important: For each item numbered on the checklist, check one box only
of the unit, (b) indicate possible additional areas to negotiate with the owner,
(e.g., check one box only for item 1.4 "Security,”in the Living Room.)
(c) aid in assessing the reasonableness of the rent of the unit, and (d) aid the
In the space to the right of the description of the item, if the decision on the item
tenant in deciding among possible units to be rented. The tenant is responsible
is: “Fail” write what repairs are necessary; If “Inconclusive” write in details.
for deciding whether he or she finds these conditions acceptable.
Also, if ”Pass” but there are some conditions present that need to be brought
Unit Size: Count the number of bedrooms for purposes of the FMR
to the attention of the owner or the tenant, write these in the space to the right.
or Payment Standard. Record in the box provided.
If it is an annual inspection, record to the right of the form any repairs made
since the last inspection. If possible, record reason for repair (e.g., ordinary
Year Constructed: Enter from Line 5 of the Request
maintenance, tenant damage).
for Tenancy Approval form. Record in the box provided.
If it is a complaint inspection, fill out only those checklist items for which
complaint is lodged. Determine, if possible, tenant or owner cause.
Number of Sleeping Rooms: Count the number of rooms which
Once the checklist has been completed, return to Part B (Summary Decision
on the Unit).
could be used for sleeping, as identified on the checklist. Record in the box
provided.
Previous editions are obsolete
form HUD-52580-A (9/2000)
Page 1 of 20
ref Handbook 7420.8
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