Hud 52517 Form – Fill Out and Use This PDF

GASTONIA HOUSING AUTHORITY

PASSING THE SECTION 8 HQS INSPECTION

COMMONLY FAILED ITEMS

All property must pass a Section 8 HQS inspection before the property can be placed on the Section 8 program. The property passes inspection when it is in compliance with the HUD Housing Quality Standards and the GHA Acceptability Criteria Variations. These documents are available from the Gastonia Housing Authority main office located at 340 W Long Ave or GHA’s website at www.ghanc.org.

The following 25 items are the main reasons why most properties fail the inspection. Correcting these items prior to the inspection will give an estimated 95% assurance that the property will be in compliance with HQS and ACV and pass inspection.

The first 10 items are by far the most commonly failed items. The next 15 also have been found to contribute significantly to failed inspections. The items are listed in order of highest to lowest failure rate.

1.Utilities not turned on. All utilities must be on and all appliances and equipment operable. The utilities may be in the landlords name for the inspection but must be transferred to the tenant before the Housing Assistance Payment (HAP) Contract is executed

2.Missing light globes

3.Cracked/missing electrical switch plates and receptacle covers

4.Windows painted shut

5.Smoke detectors, missing batteries

6.Chipping/peeling paint on siding, window sills, trim, porches, etc.

7.Open ground receptacles

8.Foundations vents missing or foundation vent screening missing or damaged

9.Water temps too high, must be between 100 and 120 degrees Fahrenheit (at tap)

10.Refrigerator temperature too high, must be no higher than 38 degrees

11.Handrails required for four (4) or more risers

12.Holes and cracks in foundation

13.Doors: Must be weather tight with workable locks and no double cylinder deadbolts

14.Handrails/guardrails: Maximum of 4” between vertical members

15.No GFCI receptacles in kitchen and bathroom

16.No attic access, R-19 or better insulation required in the attic

17.Water Heater: Must have drain pipe to T & P relief valve, no leaks

18.Broken/cracked window panes and windows without secure workable locks

19.Bathroom must have at least one window that can be opened or a mechanical vent system

20.Storm doors: All components must be present and operable

21.Bedrooms: No blocked egress (windows, doors) – at least one window must provide unobstructed egress from the room

22.Stove: All burners and oven must be operable. All knobs must be present and marked.

23.Refrigerator: All components must be present and workable

24.Gutters and downspouts must be sound and secure and free from hazard

25.All dwellings units must display house numbers as assigned by the local jurisdiction

The above items are prioritized by the highest percentage rate of failure on first time out inspections.

F:\DATAFILE\Housing Programs\Section 8 Program\HQS\25 most common fail items.doc

	Submit completed forms to: p.m.clark@ghanc.org or 704-867-3587		OMB Approval No. 2577-0169
			(exp. 9/30/2010)
	Request for Tenancy Approval	U.S. Department of Housing	OMB Approval No. 2577-0169
		and Urban Development	(exp. 9/30/2010)
	Housing Choice Voucher Program
		Office of Public and Indian Housing

Public reporting burden for this collection of information is estimated to average .08 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.

Eligible families submit this information to the Public Housing Authority (PHA) when applying for housing assistance under Section 8 of the U.S. Housing Act of l937 (42 U.S.C. 1437f). The PHA uses the information to determine if the family is eligible, if the unit is eligible, and if the lease complies with program and statutory requirements. Responses are required to obtain a benefit from the Federal Government. The information requested does not lend itself to confidentiality.

3. Requested Beginning Date of Lease	4. Number of Bedrooms	5. Year Constructed	6. Proposed Rent	7. Security Deposit Amt.	8. Date Unit Available for Inspection
9. Type of House/Apartment

10. If this unit is subsidized, indicate type of subsidy:

11. Utilities and Appliances

The owner shall provide or pay for the utilities and appliances indicated below by an “O”. The tenant shall provide or pay for the utilities and appliances indicated below by a “T”. Unless otherwise specified below, the owner shall pay for all utilities and appliances provided by the owner.

Item	Specify fuel type					Provided by *	Paid by**
Heating	Natural gas	Bottle gas	Oil	Electric	Coal or Other
Cooking	Natural gas	Bottle gas	Oil	Electric	Coal or Other
Water Heating	Natural gas	Bottle gas	Oil	Electric	Coal or Other
Other Electric
	*Provided by = who is responsible for service/maintenance
Water
	/repairs on the system/service
Sewer	**Paid by = who is responsible for paying for the cost of the
	utility.
Trash Collection
	***Refrigerator / Range / Microwave = who purchased the
	appliance and will be responsible for repairs to theappliance
Air Conditioning
Refrigerator ***
Range/Microwave ***
Other (specify)

Previous editions are obsolete	Page 1 of 2	form HUD-52517 (06/2003)
		ref. Handbook 7420.8

*Question 12 applies only to apartment complexes with four or more non-Section 8 units

Previous editions are obsolete	Page 2 of 2	form HUD-52517 (06/2003)
		ref. Handbook 7420.8

To be completed by the Landlord

GASTONIA HOUSING AUTHORITY

340 W. Long Avenue

PO Box 2398

Gastonia, NC 28053

ghanc.org

Landlord Utility Certification

THE GASTONIA HOUSING AUTHORITY WILL NOT ACCEPT A REQUEST FOR TENANCY APPROVAL IF THE UTILITIES HAVE NOT BEEN TURNED ON.

I certify that all applicable utilities (Electric, water, and gas) for the unit located at

_________________________________________________________ are currently in service under:

(Unit Number, Street and City)

It is my understanding that it is the landlord’s responsibility to physically insure that all utilities are in service, electrical breakers are on, all pilot lights (If any) are lit, and all water valves (Main and under sinks) are turned to the open position. Failure to have the utilities in operation on the day of inspection will result in a failed inspection (2 being the maximum). Should a unit fail the initial inspection, reinspection will not be made for 30 days. It is my understanding that a Housing Assistance Payments contract cannot be entered into nor any HAP payments made until all the utilities for which the tenant will be responsible have been transferred into the head of household’s name and the applicant has submitted a Utility Account Verification Form or receipts from each utility (company) showing the date the service began and the account number. Utility verification forms or receipts must be submitted by the applicant within 5 days of the date the unit passes inspection. Failure to do so may result in the denial of the applicant’s housing assistance.

The landlord must check each utility listed below that the tenant will be responsible for and list the name of the utility provider:

ELECTRICITY	________________________________________
	(Utility Company Name)
WATER	________________________________________
	(Utility Company Name)
SEWER	________________________________________
	(Utility Company Name)
GAS	________________________________________
	(Utility Company Name)
TRASH PICKUP	________________________________________
	(Utility Company Name)

OWNER’S SIGNATURE

DATE

F:\DATAFILE\Housing Programs\Section 8 Program\FORMS\LL Utility Certification-Rev-03-28-08.doc

To be completed by the Landlord and the Tenant together

Sample Disclosure Format for Target Housing Rentals and Leases

Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards

Lead Warning Statement

Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can pose health hazards if not taken care of properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978 housing, landlords must disclose the presence of known lead-based paint and lead-based paint hazards in the dwelling. Tenants must also receive a Federally approved pamphlet on lead poisoning prevention.

Lessor’s Disclosure (initial)

____ (a) Presence of lead-based paint and/or lead-based paint hazards (check one below):

Known lead-based paint and/or lead-based paint hazards are present in the housing (explain).

_______________________________________________________________________________________

Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.

____ (b) Records and reports available to the seller (check one below):

Lessor has provided the purchaser with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing (list documents below).

_______________________________________________________________________________________

Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.

Lessee’s Acknowledgment (initial)

(c)________ Lessee has received copies of all information listed above.

(d)________ Lessee has received the pamphlet Protect Your Family from Lead in Your Home.

Agent’s Acknowledgment (initial)

(e)________ Agent has informed the seller of the seller’s obligations under 42 U.S.C. 4852d and is aware of his/her responsibility to ensure compliance.

Certification of Accuracy

The following parties have reviewed the information above and certify, to the best of their knowledge, that the information provided by the signatory is true and accurate.

________________________________________________		__________________________________________________
Lessor	Date	Lessor	Date
________________________________________________		__________________________________________________
Lessee	Date	Lessee	Date
________________________________________________		__________________________________________________
Agent	Date	Agent	Date

F:\DATAFILE\Housing Programs\Section 8 Program\FORMS\Lead-Based Paint Disclosure.doc

To be completed by the Landlord and Tenant together

GASTONIA HOUSING AUTHORITY

Section 8 Housing Choice Voucher Program

Lease Addendum

(For Office Use Only)

TermofoftheLease:Lease:

Lease	of one year and shall c	on ___________________.	.
Lease shallbe for theterm of one year and shallommenceommence on

Lease shall end on ________________________.

Lease shall end on __________________.

Utilities and Appliances:

The TENANT shall be responsible for supplying the following utilities/services to the unit:

Electricity

Gas

Water

Sewer

Trash Pickup

None

The OWNER shall be responsible for supplying the following utilities/services to the unit:

Owner reserves the right to terminate tenancy should lessee or any person under lessee's control* become involved with any type of violent or drug-related criminal activity or any activity that threatens the health, safety, or right to peaceful enjoyment of the other occupants or neighbors.

*HUD defines 'person under lessee's control' to mean: any family member(s), guest(s), visitor(s), etc which the family allows access to the assisted unit or grounds of the assisted unit.

Landlord’s Signature	Date
__________________________________________________	_________________
Tenant’s Signature	Date

***All terms of this addendum override any language contained in the owner's lease.

F:\DATAFILE\Housing Programs\Section 8 Program\FORMS\Lease Addendum.doc\Rev. 8/25/2010

Dear Tenant,

In order for the Gastonia Housing Authority (GHA) to inspect your home, you or an adult family member must be present at the time of the inspection. If you miss an inspection appointment you are in danger of losing your housing assistance. You can avoid this potential problem by signing and submitting the form below. Please read all forms carefully before you sign.

THE GASTONIA HOUSING AUTHORITY

Consent to Inspect and Indemnification Agreement

I.Purpose and Definitions

Pursuant to the Gastonia Housing Authority’s legal obligation to provide Section 8 housing in accordance with applicable housing quality standards under 24 C.F.R. 982, the following agreement is entered voluntarily by the Gastonia Housing Authority, ____________________________________, as tenant and Section 8 recipient (tenant), and ____________________________________, as

propertyownerandlandlordofpropertylocatedat

_____________________________________________________.

II.Consent to Enter and Inspect

To facilitate the Gastonia Housing Authority’s obligations relating to the provision of Section 8 housing, and in consideration of its payment of the tenant’s rent obligation as determined under the appropriate calculations, the undersigned tenant hereby authorizes the Gastonia Housing Authority to enter the occupied premises as needed for the purpose of conducting either routine or follow-up inspections to assure that the housing meets housing quality standards. The Housing Authority may enter all closets, bathrooms, and other confined spaces, and open cabinets and fixtures in order to complete this inspection. The undersigned tenant further agrees to hold the Gastonia Housing Authority harmless from any claims incurred during the ordinary course of an inspection.

III.Agreement to Indemnify

The undersigned owner agrees to make all housing leased under Section 8 available for inspection and assist agents of the Gastonia Housing Authority in accessing all areas required to be inspected. The undersigned owner further agrees to hold the Gastonia Housing Authority harmless from any claims incurred during the ordinary course of an inspection, and to indemnify the Gastonia Housing Authority from liability arising from all such claims.

IV.	Obligations of the Housing Authority
	The Gastonia Housing Authority agrees that at least 72 hours prior to the inspection, the Housing
	Authority shall provide written notice to both the tenant and owner of the date and approximate time of
	the inspection and offer each the opportunity to be present. The same standards for time and manner
	apply to follow up inspections.
	________________________________________	________________________________________
	Tenant	Landlord
	_____________	_______________
	Date	Date
	_________________________________________	______________
	GHA Representative	Date

F:\DATAFILE\Housing Programs\Section 8 Program\FORMS\Consent to Inspect and Indemnification Agreement- Tenant.doc