ࡱ>   e f g h i j k l m n o p q r s t u v w x y z { ЁbjbjBrBr -l  -:nh r ~~~tV2 YB@xa5?l8:L&LY0Y8_bf_|<_~<` `L`L YF#F#F#F#_ .: PURPOSE: To assess management and oversight of multifamily housing projects. INSTRUCTIONS: This form is to be completed by HUD staff, Performance Based Contract Administrators (PBCA), Traditional Contract Administrators (CAs) and Mortgagees of Coinsured Projects (Mortgagees). The Management Review form consists of three parts: Desk Review, On-site Review with Addenda, and Summary Report. All reviewers of subsidized projects must complete Addenda (A, B, C, & D). Reviewers of unsubsidized projects must complete Addenda B & C only. If any questions on any given form are not relevant to the program under review or if the information is not available, notate with N/A. FHEO staff provide MFH staff a list of requests for documents and special observations each year. Additional guidance regarding the management process can be found in HUD Handbooks 4350.1, REV-1 and 4566.2. A. Prior to On-Site Review Complete Part I Desk Review To complete the Desk Review worksheet prior to the on-site visit, review the project files, system reports, and other documents, and contact the HUD representative for any unavailable information needed to complete the desk review. Fair Housing/Civil Rights review requirements are all in Addendum B. This portion of the review will assist the reviewer in identifying potential problem areas. Owner must complete Addendum B, Part A, and send it to Multifamily Housing. HUD staff must complete the entire Desk Review for subsidized projects. For unsubsidized projects, HUD staff/mortgagees must complete all applicable sections. CAs must complete the entire Desk Review except where noted This question applies only to HUD Staff/Mortgagees. Schedule a date for the on-site review with the owner/agent and confirm the review date in writing. The owner/agent should be given at least a two-week notice in writing and notified of the documents that need to be available the day of the review, as specified in Addendum C. Addendum C provides a list of documents notated by the reviewer that the owner/agent must have available during the on-site review. Addendum C and Part A of Addendum B must be forwarded to the owner/agent with the letter confirming the scheduled on-site review. The reviewer may request additional items as necessary. B. Conducting the On-Site Review Complete Part II On-Site Review On-Site Reviews will be completed as follows: (1) HUD staff and Mortgagees must complete all applicable questions in Part II. (2) CAs must complete all questions in Part II except where noted This question applies only to HUD staff/Mortgagees. (3) HUD staff completing a review of a project which is also reviewed by a CA will only complete questions not applicable to CAs. In accordance with Part D, bring back all information requested by FHEO. Use additional sheets as necessary to complete applicable questions. Upon completion of the on-site review, the reviewer will hold a close-out session with the owner/agent to discuss observations and conclusions. C. After On-Site Review The reviewer will record deficiencies, findings and corrective actions. Findings must include the condition, criteria, cause, effect and required corrective action. The condition describes the problem or deficiency. The criteria should cite the statutory, regulatory or administrative requirements that were not met. The cause explains why the condition occurred. The effect describes what happened because of the condition. The corrective action provides what the owner/agent must do to eliminate the deficiency. The corrective action must include a requirement that the owner determine and correct not only the discovered errors and omissions, but also describe to the reviewer how and what systems, controls, policies and procedures were adjusted or changed to assure that the errors and omissions do not reoccur. In completing the Report of Findings, the reviewer should also indicate the target completion date. The reviewer retrieves Addendum B and forwards the completed form to FHEO, along with the approved initial or updated Affirmative Fair Housing Marketing Plans in accordance with General Operational Procedures for the Civil Rights Front-End and Limited Monitoring Reviews of Subsidized Multifamily Housing Projects, which may be found on FHEOs web site. Complete Summary Report as follows: Based on the Report of Findings, the reviewer will assess the overall performance for each applicable category. The reviewer must indicate A (Acceptable) or C (Corrective action required) and include target completion dates (TCD) for all corrective action items. For those items not applicable, indicate N/A in the TCD column. For each of the seven major categories (A, B, C, D, E, F, and G), rate each category by entering a score between 1 and 100. If a category was not reviewed, enter a score of zero (0). After rating the individual categories, an overall rating must be assessed. This rating will be based upon the ratings assigned in categories A through G. CAs will rate all categories except Category D. Category D is for HUD staff and Mortgagees only. Additional guidance for ratings can be found in HUD Handbook 4350.1, REV-1. Distribute the Summary Report and cover letter as follows: Project Owner (original) Management Agent (copy) HUD office for PBCA reviews rated below average or unsatisfactory HUD office for all traditional CA reviews *A copy of the completed Management Review Report, form HUD-9834 and supporting documents must be maintained in the project file. If a below average or unsatisfactory rating is determined, the owner/agent must be afforded an opportunity to appeal. Guidance on appeal procedures is provided in HUD Handbook 4350.1, REV-1. All Secure Systems users must document all required data in the Integrated Real Estate Management System (iREMS). D. Management Review Deficiency Follow up: Reviewer must conduct follow-up activity until all corrective actions as required in the Summary Report have been completed. Enter applicable close-out dates in iREMS. Housing reviewers will forward all completed FHEO checklists and attachments to FHEO within five (5) business days of their own on-site reviews or within 5 business days of receipt of the checklists from the CA, as applicable. Follow-up instructions may be found on FHEOs web site. NOTE: The Fair Housing and Equal Opportunity (FHEO) checklist has been included as part of this management review form; however no determination of compliance with applicable Fair Housing laws and regulations is included in the summary report. CAs must forward the original checklist (Addendum B) to HUD staff. HUD staff must maintain the original checklist in the project file and forward a copy to the Office of FHEO in the appropriate jurisdiction for review. Date of On-Site Review:  FORMTEXT       Date of Report:  FORMTEXT       Project Number:  FORMTEXT       Contract Number:  FORMTEXT       Section of the Act:  FORMTEXT       Name of Owner:  FORMTEXT       Project Name:  FORMTEXT       Project Address:  FORMTEXT       Loan Status:  FORMCHECKBOX  Insured  FORMCHECKBOX  HUD-Held  FORMCHECKBOX  Non-Insured  FORMCHECKBOX  Co-Insured Contract Administrator:  FORMCHECKBOX  HUD  FORMCHECKBOX  CA  FORMCHECKBOX  PBCA Type of Subsidy: Type of Housing:  FORMCHECKBOX  Family  FORMCHECKBOX  Disabled  FORMCHECKBOX  Elderly  FORMCHECKBOX  Elderly/Disabled  FORMCHECKBOX  Other (please specify)  FORMCHECKBOX  Section 8  FORMCHECKBOX  PAC  FORMCHECKBOX  Section 236  FORMCHECKBOX  Section 221(d)(3) BMIR FORMCHECKBOX  Rent Supplement  FORMCHECKBOX  RAP  FORMCHECKBOX  PRAC  FORMCHECKBOX  Unsubsidized  For each applicable category, assess the overall performance by checking the appropriate column. Indicate A (Acceptable) or C (Corrective action required). Include target completion dates (TCD) for all corrective action items. For those items not applicable, place N/A in the TCD column. A. General Appearance and SecurityA CTCDEnter a score between 1 and 100 for the General Appearance and Security Rating. If this Section was not reviewed, enter 0.  FORMTEXT     is 10% of the overall score. This category is rated  FORMTEXT      1. General Appearance FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      2. Security FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      B. Follow-up and Monitoring of Project InspectionsA CTCDEnter a score between 1 and 100 for the Follow-up and Monitoring of Project Inspections Rating . If this Section was not reviewed, enter 0.  FORMTEXT     is 10% of the overall score. This category is rated  FORMTEXT      3. Follow-Up and Monitoring of Last Physical Inspection and Observations FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      4. Follow-Up and Monitoring of Lead-Based Paint Inspection FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      C. Maintenance and Standard Operating ProceduresA CTCDEnter a score between 1 and 100 for the Maintenance and Standard Operating Procedures Rating. If this Section was not reviewed, enter 0.  FORMTEXT     is 10% of the overall score. This category is rated  FORMTEXT       5. Maintenance FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      6. Vacancy and Turnover FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      7. Energy Conservation FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       D. Financial Management/ProcurementA CTCDEnter a score between 1 and 100 for the Financial Management/Procurement Rating. If this Section was not reviewed, enter 0.  FORMTEXT     is 25% of the overall score. This category is rated  FORMTEXT      8. Budget Management FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      9. Cash Controls FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      10. Cost Controls FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      11. Procurement Controls FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      12. Accounts Receivable/Payable FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      13. Accounting and Bookkeeping FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      E. Leasing and OccupancyA CTCDEnter a score between 1 and 100 for the Leasing and Occupancy Rating. If this Section was not reviewed, enter 0.  FORMTEXT     is 25% of the overall score. This category is rated  FORMTEXT      14. Application Processing/ Tenant Selection FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      15. Leases and Deposits FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      16. Eviction/Termination of Assistance Procedures FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      17. Enterprise Income Verification (EIV) System Access and Security Compliance FORMCHECKBOX   FORMCHECKBOX   FORMTEXT       18. Compliance with Using EIV Data and Reports FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      19. Tenant Rental Assistance Certification Systems (TRACS) Monitoring and Compliance FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      20. TRACS Security Requirements FORMCHECKBOX  FORMCHECKBOX   FORMTEXT       21. Tenant File Security FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      22. Summary of Tenant File Review FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      F. Tenant/Management Relations A CTCDEnter a score between 1 and 100 for the Tenant Services Rating. If this Section was not reviewed, enter 0.  FORMTEXT     is 10% of the overall score. This category is rated  FORMTEXT      23. Tenant Concerns FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      24. Provision of Tenant Services FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      G. General Management PracticesA CTCDEnter a score between 1 and 100 for the General Management Practices Rating. If this Section was not reviewed, enter 0.  FORMTEXT     is 10% of the overall score. This category is rated  FORMTEXT      25. General Management Operations FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      26. Owner/Agent Participation FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      27. Staffing and Personnel Practices FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      Overall Rating:  FORMCHECKBOX  Superior  FORMCHECKBOX  Above Average  FORMCHECKBOX  Satisfactory  FORMCHECKBOX  Below Average  FORMCHECKBOX  Unsatisfactory  FORMTEXT     Overall Score: To calculate an overall score: Multiply the derived performance value by the assigned percentage of the overall rating for each category. Once all tested categories have been calculated based on the performance indicator and performance indicator values, the total calculated points is divided by the total percentage of overall rating and rounded to the nearest whole number. For convenience, a utility is included with this form which will perform all of the necessary calculations.  Name and Title of Person Preparing this Report: (Please type or print):  FORMTEXT       Name and Title of Person Approving this Report: (Please type or print):  FORMTEXT       Signature: _____________________________________________________________ Date:  FORMTEXT      Signature:______________________________________________________________ Date:  FORMTEXT        NOTE: If this review is conducted by a CA or PBCA as indicated above, the overall rating reflects a review as it relates to compliance with the Housing Assistance Payment Contract (HAP) only. SUMMARY REPORT FINDINGS For each C item checked on the summary report, reference the appropriate citing, and target completion date. Findings must include the condition, criteria, cause, effect and required corrective action: The condition describes the problem or deficiency The criteria cites the statutory, regulatory or administrative requirements that were not met The cause explains why the condition occurred The effect describes what happened because of the condition Corrective actions are required for all findings. Item NumberFindingTarget Completion Date FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       PART I. DESK REVIEW  The reviewer must complete this section prior to the on-site review using all relevant information in project files and HUD database systems. Questions on the desk review, which include category references, are linked to the on-site review. Category references on the desk review that relate to the on-site review must be considered when determining the category rating. Category references are marked following the applicable question (i.e. B3, E14). If any questions on any given form are not relevant to the program under review or if the information is not available notate with  N/A . 1. What is the most recent Physical Assessment Subsystem (PASS) score? B3 Enter PASS Score  FORMTEXT     Date of REAC inspection  FORMTEXT       If required, has the project filed a certification that all items listed on the previous REAC inspection have been completed? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If more than one inspection is of record, does the reviewer note repetitive defects? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       2. Were Exigent Health and Safety (EH&S) conditions cited in the report? B3 Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       3. Have all latent defects been corrected? This question applies only to newly constructed projects within the last 24 months. This question applies only to HUD Staff and Mortgagees. Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If not, list depository and amount of any construction escrows remaining.  FORMTEXT       Comments:  FORMTEXT       Questions 4 through 6 only apply to subsidized family properties or elderly properties housing children under the age of six that were constructed prior to 1978. If the lead based paint inspection has been conducted and the information was documented on a previous management review, proceed to question 7. 4. Document the year of construction for Lead-Based Paint compliance. Obtain this information from the Physical Condition/PASS screen in iREMS Open the REAC Inspection Report, then open the PASS Physical Inspection Report. The year of construction can be found under Buildings/Units. Date of Construction  FORMTEXT       If construction occurred after 1977, proceed to question 7. 5. Has a lead-based paint inspection been conducted? 4B Yes  FORMCHECKBOX  No  FORMCHECKBOX  Information Not Available  FORMCHECKBOX  Comments:  FORMTEXT       6. What were the results of the Lead-Based Paint Inspection/Evaluation: 4B Was lead found? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If yes, is there a HUD approved lead hazard control plan? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments  FORMTEXT       7. Is an Annual Financial Statement required? (If no, proceed to question 10). Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. Comments:  FORMTEXT       8. What was the most recent Financial Assessment Subsystem (FASS) score? Score  FORMTEXT     This question applies only to HUD Staff If financial reporting is not required, determine why; and record the reason in reviewer comments below. Comments:  FORMTEXT       9. Have the following reports been consistently submitted on a timely basis? (Look at multiple periods) Check the appropriate box for reports received, and indicate whether or not the report was received timely. This question applies only to HUD Staffand Mortgagees  FORMCHECKBOX Annual Audited Financial Statement Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Date last report was due:  FORMTEXT       Date last report received:  FORMTEXT        FORMCHECKBOX  Monthly Accounting Report Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX   FORMCHECKBOX  Excess Income Report (HUD-93479, 80, 81) Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX   FORMCHECKBOX  Quarterly performance report for projects on flexible subsidy, modification, workout, etc. Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX   FORMCHECKBOX  Annual operating budget (cooperatives) Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If the reports have been submitted, were they received in acceptable form? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       10. Has the owner corrected all findings on HUD financial and/or Inspector General audits? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  This question applies only to HUD Staff and Mortgagees. List findings outstanding and determine whether remedial action is required to assure correction within established goals:  FORMTEXT        FORMTEXT        FORMTEXT       Comments:  FORMTEXT       11. Do project operating expenses appear reasonable compared with similar projects? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. D10 Indicate latest OPIIS rating and check problem areas flagged by OPIIS.  FORMCHECKBOX  Administrative  FORMCHECKBOX  Maintenance  FORMCHECKBOX  Utility  FORMCHECKBOX  Taxes and Insurance  FORMCHECKBOX  Financial Also, use OPIIS to conduct an expense comparison with other similar projects. Comments:  FORMTEXT       12. Does annual financial analysis or FASS printouts indicate that project is free of actual or potential financial problems? This question applies only to HUD Staff. Yes  FORMCHECKBOX  No  FORMCHECKBOX  For each of last 3 years, enter Profit (Loss) before depreciation (from the Statement of Profit & Loss). Year  FORMTEXT      $ FORMTEXT        FORMTEXT      $ FORMTEXT        FORMTEXT      $ FORMTEXT       Comments:  FORMTEXT       13. If the owner/agent has taken unauthorized distributions, reimbursements, or supervision fees, have these been repaid? This question applies only to HUD Staff and Mortgagees. Yes  FORMCHECKBOX  No  FORMCHECKBOX  If no, indicate amount due to the project. $ FORMTEXT       14. If applicable, have all deposits due to the residual receipts fund been made? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. Comments:  FORMTEXT       15. Based on the last FASS submission, are accounts payable reasonably current? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff and Mortgagees. D12 Indicate the amount of accounts payable more than 60 days old $ FORMTEXT       Comments:  FORMTEXT       16. Does the balance in the security deposit trust account equal or exceed the project s liability account? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff and Mortgagees. If no, explain how deficit will be funded.  FORMTEXT       Comments:  FORMTEXT       17. If security deposits are invested in an interest-bearing account, is interest passed through to tenants or transferred to project account? This question applies only to HUD Staff and Mortgagees. Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       18. Have the owner and managing agent executed and submitted an appropriate Management Certification (form HUD-9839A, B, or C) to HUD? This question applies only to HUD Staff and Mortgagees. Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, please enter date of certification.  FORMTEXT       Determine that the content of certification is consistent with present operations. Comments:  FORMTEXT       19. Is the management fee paid to the agent in accordance with the Management Certification? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff and Mortgagees. Comments:  FORMTEXT       20. Has the owner and management agent executed a management agreement in accordance with the management certification? This question applies only to HUD Staff and Mortgagees. Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       21. Does the management agreement reflect HUD s regulations and guidelines? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  This question applies only to HUD Staff and Mortgagees. Comments:  FORMTEXT       22. Has a management entity profile been submitted to HUD? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff and Mortgagees. If yes, is it relevant to the agent s organization and how it operates? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Date of the management entity profile  FORMTEXT       23. Do the Management Entity Profile and Management Certifications clearly describe the relationships and responsibilities of the owner and agent? This question applies only to HUD Staff and Mortgagees. Yes  FORMCHECKBOX  No  FORMCHECKBOX  Determine if management is by an identity-of-interest contractor, and compare the contract arrangement to the annual financial report. Comments:  FORMTEXT       24. Have the principals and board members listed received HUD-2530 approval? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  This question applies only to HUD Staff. Request a list of all current principals and board members and check for HUD-2530 approval. Comments:  FORMTEXT       25. Is the agent charging the project for expenses which the agreement requires the agent to pay? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff and Mortgagees. Comments:  FORMTEXT       Questions 26  29 apply to OAHP restructuring. If not applicable proceed to question 30. 26. Has the project s mortgage been restructured? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. If yes, is there a use agreement on the project? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If there is a use agreement, does it require any owner certifications? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If owner certifications are required, have they been submitted timely? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If applicable, has work required under the Rehabilitation Escrow been/is being completed according to schedule? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       27. Is the owner eligible for incentives? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. If yes, has the owner calculated those incentives correctly? (i.e., Capital Recovery Fee (CRF) and/or Incentive Performance Fee (IPF)) Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       28. Does the HUD billing statement (HUD-92771) indicate timely and accurate payments toward the Mortgage Restructuring Note? This question applies only to HUD Staff. Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       29. If an owner is in non-compliance with HUD business agreements, has the owner been notified by HUD within the required timeframes? This question applies only to HUD Staff Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       Questions 30 through 33 apply to Section 236 projects. If this is not a Section 236 project proceed to question 34. 30. Does the rental income generate excess income? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  This question applies only to HUD Staff. Comments:  FORMTEXT       31. Has the owner/agent received approval to retain excess income? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. D13 Comments:  FORMTEXT       32. Was an annual report submitted for usage of retained excess income? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. D13 Comments:  FORMTEXT       33. Are there any delinquent excess income payments due HUD? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. D13 If yes, is there a payment plan? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       34. Are rent increase requests submitted to HUD promptly when needed? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. Review the timing of the last three rent increase requests and the results of the requests (approval, denial or modification to requested amount), and whether the rents are comparable to other neighboring properties. If a wide disparity exists, determine the cause of the difference. Does owner/agent generally provide sufficient documentation for rent increases? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       35. If approval is required, are rent increase requests submitted promptly? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       36. Complete chart below. (This question applies only to HUD Staff/Mortgagees) Name of ReserveAs of  FORMTEXT      Held in Interest Bearing Account?TotalPer UnitMonthly DepositReplacement Reserve$ FORMTEXT      $ FORMTEXT      $ FORMTEXT      Yes  FORMCHECKBOX  No  FORMCHECKBOX  General Operating Reserve (Co-ops)$ FORMTEXT      $ FORMTEXT      $ FORMTEXT      Yes  FORMCHECKBOX  No  FORMCHECKBOX  Residual Receipts$ FORMTEXT      $ FORMTEXT      $ FORMTEXT      Yes  FORMCHECKBOX  No  FORMCHECKBOX  Other$ FORMTEXT      $ FORMTEXT      $ FORMTEXT      Yes  FORMCHECKBOX  No  FORMCHECKBOX   a. Do balances in replacement or general operating reserve accounts appear adequate to meet future needs? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If not, what action is recommended?  FORMTEXT       b. Are repairs consistently paid from the appropriate operating expense account, and eligible items reimbursed from the reserves? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       37. Has the owner/agent performed an analysis to determine future Reserve for Replacement needs when submitting a budget based rent increase? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       38. If there is a utility allowance, what was the effective date of last utility allowance adjustment?  FORMTEXT       What was the date of approval?  FORMTEXT       If a utility allowance was approved was it implemented in accordance with HUD guidelines? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       39. What is the effective date of the last rent adjustment?  FORMTEXT       Comments:  FORMTEXT       40. Is the current approved rent schedule sufficient to meet project needs? Yes  FORMCHECKBOX  No  FORMCHECKBOX  This question applies only to HUD Staff. Comments:  FORMTEXT       41. Has a special rent increase been approved? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If yes, please check the appropriate box.  FORMCHECKBOX  Insurance  FORMCHECKBOX  Taxes  FORMCHECKBOX  Utilities  FORMCHECKBOX  Security  FORMCHECKBOX  Service Coordinator Comments:  FORMTEXT       42. Are monthly rental subsidy vouchers submitted on time? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       43. Is the owner/agent submitting tenant certification data to TRACS to support the voucher billings? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       44. Is the owner/agent transmitting data for Section 236 and Section 221(d)(3) BMIR tenants to TRACS as required by the automation rule? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       45. What is the term of the subsidy contract?  FORMTEXT       Date the contract term ends:  FORMTEXT       Comments:  FORMTEXT       46. List vacancy activity for the past twelve months, and indicate the number for each month. C6. This information can be obtained from the TRACS Voucher Detail Summary. JANFEBMARAPRMAYJUNEJULYAUGSEPTOCTNOVDEC FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     47. Does review of the EIV reports listed below include information that needs a resolution or explanation by the owner/agent? E18b Income Discrepancy Report? Yes  FORMCHECKBOX  No  FORMCHECKBOX  New Hires Report Yes  FORMCHECKBOX  No  FORMCHECKBOX  Failed EIV Pre-Screening Report? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Failed Verification Report (Failed the SSA Identity Test)? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Deceased Tenant Report? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Multiple Subsidy Report? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       48. Is there a Neighborhood Networks Center for the project? (Check iREMS or other available source) Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If no, answer  N/A and proceed to 50. Comments:  FORMTEXT       49. If yes to question 48, does the Neighborhood Networks Center have a Strategic Tracking and Reporting Tool (START) Business Plan? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, date HUD approved:  FORMTEXT       If no, when will a START Business Plan be completed?  FORMTEXT       Projected date for START Business Plan:  FORMTEXT       Comments:  FORMTEXT       50. Are there any unresolved findings from previous management reviews? If yes, specify in the comments section. Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       51. Review complaints, congressional inquiries, etc. received within the last 12 months regarding the overall management practices. Provide a general description below and attach applicable documentation. G25 Issue/ComplaintStatus FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT        FORMTEXT       Indicate by marking the appropriate box - Yes, No, or N/A if not applicable. Provide comments as needed. CATEGORY A. GENERAL APPEARANCE & SECURITY1. General Appearance Based on observation, are the projects exterior and common areas (i.e., grounds, landscaping, parking lots, playgrounds, hallways, laundry room, elevator, garbage area, stairwells, management office) clean, free of graffiti, debris and damage? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If no, provide location and describe condition(s).  FORMTEXT       Comments:  FORMTEXT       2. Security a. Indicate whether any of the events below have been documented in the last twelve months, and the frequency of the event(s). EventFrequencyEvent Frequency FORMCHECKBOX  Break-Ins FORMTEXT       FORMCHECKBOX  Arrests FORMTEXT       FORMCHECKBOX  Vandalism FORMTEXT       FORMCHECKBOX  Drug Activity FORMTEXT       FORMCHECKBOX  Auto Theft FORMTEXT       FORMCHECKBOX  Other (please specify):  FORMTEXT       FORMTEXT       FORMCHECKBOX  Personal Assaults FORMTEXT       FORMCHECKBOX  None Comments:  FORMTEXT       b. Indicate which types of security measures, if any, are utilized on site.  FORMCHECKBOX  Tenant Patrol  FORMCHECKBOX  Volunteer Organization  FORMCHECKBOX  Paid Car Patrol  FORMCHECKBOX  Paid on-site Guard  FORMCHECKBOX  Police Patrol  FORMCHECKBOX  TV Monitor  FORMCHECKBOX  Drug Free Housing Plan  FORMCHECKBOX  Security Cameras  FORMCHECKBOX  Motion Sensors  FORMCHECKBOX  Crime Prevention Plan  FORMCHECKBOX  Community Policing  FORMCHECKBOX  Other (please specify)  FORMTEXT        FORMCHECKBOX  None Comments:  FORMTEXT       c. Based on the answers provided in questions a and b above, what corrective actions, if any, have been taken by the owner/agent? Comments:  FORMTEXT       d. Has the owner/agent requested a rent increase based on cost increases in security costs? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, indicate security measures taken.  FORMTEXT       Comments:  FORMTEXT       CATEGORY B. FOLLOW-UP & MONITORING OF PROJECT INSPECTIONS3. Follow-Up & Monitoring of Project Inspections and Observations (Sampling is at reviewers discretion to respond to questions a and b below)a. Based on a sampling, if EH&S items were identified have the deficiencies been corrected and documented according to the owner/agents certification for the most recent REac inspection? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If no, provide an explanation.  FORMTEXT       Does the analysis show any repetitive or systemic problems? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. Based on a sampling of units and common areas, for all other deficiencies noted in the REAC inspection, as applicable, verify that corrective actions have been taken. Have the deficiencies been corrected? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If no, is there a schedule for correcting the deficiencies within a reasonable timeframe to comply with decent, safe, sanitary and good repair standards? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       4. Follow-Up & Monitoring of Lead-Based Paint Inspection  The following questions only apply to subsidized family properties or elderly properties housing children under six years of age that were constructed prior to 1978. If constructed after 1977, check N/A for questions a and b.a. Is there a certification on file documenting that the project has been certified to be free of lead-based paint or lead hazards? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If there is a certification, obtain a copy for the project file. Comments:  FORMTEXT       b. Is the owner in compliance with the HUD approved lead hazard control plan as noted on the desk review? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       CATEGORY C. MAINTENANCE & STANDARD OPERATING PROCEDURES5. Maintenancea. Indicate below to confirm that there is a schedule for preventive maintenance/servicing for the items listed that are applicable.  FORMCHECKBOX  Heating and A/C Equipment  FORMCHECKBOX  Water Heaters  FORMCHECKBOX  Carpets and Drapes  FORMCHECKBOX  Roof, gutter and Fascia Inspection  FORMCHECKBOX  Major Appliances  FORMCHECKBOX  Elevators  FORMCHECKBOX  Motor Vehicles  FORMCHECKBOX  Sewer lines  FORMCHECKBOX  Exterior painting  FORMCHECKBOX  Windows  FORMCHECKBOX  Recreational equipment  FORMCHECKBOX  Landscaping maintenance  FORMCHECKBOX  Other (please specify):  FORMTEXT       Comments:  FORMTEXT       b. Is there a satisfactory inventory system to account for tools, equipment, supplies, and keys (serial numbers, bar codes, etc.)? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       c. Has the owner/agent secured inventory items, such as appliances and tools, to prevent theft? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       d. Does the owner/agent have a written procedure that explains the process for inspecting units? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, review a copy. Identify employee responsible for conducting the inspections: Name and Title:  FORMTEXT       Comments:  FORMTEXT       e. How often are units inspected?  FORMCHECKBOX  Monthly  FORMCHECKBOX  Quarterly  FORMCHECKBOX  Semi-Annually  FORMCHECKBOX  Annually  FORMCHECKBOX  Move-In  FORMCHECKBOX  Move-Out  FORMCHECKBOX  Other (please specify):  FORMTEXT       Comments:  FORMTEXT       f. How are unit inspections documented? Please Describe:  FORMTEXT       g. If deficiencies are noted during a unit inspection, what is the procedure for correction? Please describe:  FORMTEXT       h. What is the average number of days from move-out until the unit is ready for occupancy?  FORMTEXT     Comments:  FORMTEXT       i. Is there a written procedure for completing work orders? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, review a copy. Comments:  FORMTEXT       j. Is there a procedure in place to handle emergency work orders? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, describe the procedure:  FORMTEXT       k. Is there a backlog of work orders? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If a backlog exists, indicate the current number of work orders: Number between 1-3 days:  FORMTEXT     Number between 4-7 days:  FORMTEXT     Number more than one week:  FORMTEXT     Comments:  FORMTEXT       l. Who is provided copies of completed work orders? (check all that apply.)  FORMCHECKBOX  Tenant  FORMCHECKBOX  Tenant File  FORMCHECKBOX  Maintenance Staff  FORMCHECKBOX  Other (please specify)  FORMTEXT       Comments:  FORMTEXT       m. Is there documentation by unit that indicates the date of purchase, manufacturer, model, and serial number for appliance purchases (i.e., ranges, refrigerators, furnaces, air conditioners, hot water heaters, etc.)? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       6. Vacancy and Turnovera. How many units were vacant on the date of the on-site visit? Number of Vacant Units:  FORMTEXT     Number Ready for Occupancy:  FORMTEXT     Average Length of time for unit turnover:  FORMTEXT     Comments:  FORMTEXT       b. Walk through at least two vacant units that are ready for occupancy. Assess and document unit readiness. Number of Units Visited:  FORMTEXT     Number of Units Ready for Occupancy:  FORMTEXT     Number of Units Not Ready for Occupancy:  FORMTEXT     Comments:  FORMTEXT       c. Based on the interview with on-site staff, are any of the factors listed below contributing to vacancy problems? (Below, indicate all that apply.)  FORMCHECKBOX  Security Problems  FORMCHECKBOX  Non-competitive Amenities  FORMCHECKBOX  Inadequate Marketing  FORMCHECKBOX  Project Reputation  FORMCHECKBOX  Poor Maintenance  FORMCHECKBOX  Rents too High  FORMCHECKBOX  Location  FORMCHECKBOX  Lack of Demand  FORMCHECKBOX  Tenant/Management Relations  FORMCHECKBOX  Applicants Do Not Meet Screening Criteria  FORMCHECKBOX  Other (please specify)  FORMTEXT        FORMCHECKBOX  Bedroom Mix/Size (If yes, indicate which bedroom sizes are hard to rent)  FORMTEXT       Comments:  FORMTEXT       d. Based on the responses in questions a, b and c, what actions are being taken by the owner/agent to resolve the issue(s)? If not applicable, proceed to question 7. Please describe:  FORMTEXT       7. Energy Conservation Has management attempted to reduce energy consumption? Yes  FORMCHECKBOX  No  FORMCHECKBOX  (check all that apply.)  FORMCHECKBOX  Caulking and weather-stripping  FORMCHECKBOX  Conversion to individual metering  FORMCHECKBOX  Storm doors and windows  FORMCHECKBOX  Consumer education  FORMCHECKBOX  Water saver devices  FORMCHECKBOX  Extra insulation  FORMCHECKBOX  Assessment of Utility Rate Schedule  FORMCHECKBOX  Energy Efficient Lighting  FORMCHECKBOX  Energy Star Appliances  FORMCHECKBOX  Written Energy Conservation Plan  FORMCHECKBOX  Other (please specify)  FORMTEXT        FORMCHECKBOX  None Comments:  FORMTEXT       CATEGORY D. FINANCIAL MANAGEMENT/PROCUREMENT(This Category applies only to HUD Staff and/or Mortgagees as indicated. CAs may proceed to Category E.) 8. Budget Managementa. Does the owner/agent s staff have access to the current operating budget in order to monitor and control expenses? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       b. Is an operating budget prepared annually and approved by the owner? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If yes, obtain a copy of the current year s budget. Comments:  FORMTEXT       c. Are monthly or quarterly reports prepared by the owner/agent indicating variances between actual income and expenses versus budgeted income and expenses? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       d. If this is a 202 or 811 project, does the owner/agent maintain a current annual budget? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  This question applies only to HUD Staff. If yes, is it available on-site? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       9. Cash Controlsa. Are collections deposited on the day received or, pending deposit, are they secured and properly controlled? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. Are adequate controls in place when cash is accepted? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Check the controls that are used.  FORMCHECKBOX  Pre-numbered rent receipts  FORMCHECKBOX  Bank collections  FORMCHECKBOX  Safe  FORMCHECKBOX  Lock box Comments:  FORMTEXT       c. Do different persons handle bank deposits and accounts receivable, or is an alternative safeguard used? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Indicate Names and Titles:  FORMTEXT       Comments:  FORMTEXT       d. Are all disbursement checks prenumbered, properly identified with account numbers and supported by vouchers or invoices? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       e. Is the supply of unused checks adequately safeguarded, or under the custody of persons who do not sign checks manually, control the use of facsimile signature plates, or operate the facsimile signature machine? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       f. Are funds (receipts, disbursements, petty cash, etc.) periodically checked on a surprise basis by a responsible official, other than site employees? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       g. Are bank statements reconciled promptly upon receipt by someone other than a check signer, and by one who has no cash receipt or disbursement function? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       10. Cost Controlsa. Are bills, including the mortgage payment, paid in sufficient time to avoid late penalties? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. Are operating expenses, including taxes and utilities, periodically reviewed to assure that project is paying the lowest possible rate? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, provide a recent example.  FORMTEXT       11. Procurement Controlsa. What is the procedure used to obtain and award contracts? Describe procedure:  FORMTEXT       b. Are bids obtained prior to awarding contracts? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Review contracts and determine if bids were obtained and, if the lowest bids were not selected, determine the owner s/agent s reasoning for selection. Comments:  FORMTEXT       c. Is there a written procedure for checking the quality of work performed by a contractor prior to authorizing payment? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       d. Is there a procedure to assure that the individual authorizing contracted work or services is not the same individual authorizing payment? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       e. Who is the responsible person charged with inspecting the quality of work performed by contractors prior to payment? Please provide the name and title:  FORMTEXT       f. Does the project maintain a list of outside contractors? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       g. Are vendor bills paid in time to obtain maximum trade discounts? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       h. Is there any indication that real or personal property has been subtracted from the mortgaged premises without the permission of the Department? Comments:  FORMTEXT       i. Below, check services currently contracted with outside contractors and provide the name of the contractor and annual amount of the contract. Indicate (by asterisk) whether there is an identify-of-interest relationship between the contractor and the owner/agent. ServiceName of ContractorAnnual Contract Amount FORMCHECKBOX  Elevator  FORMTEXT      $ FORMTEXT       FORMCHECKBOX  Exterminating  FORMTEXT      $ FORMTEXT       FORMCHECKBOX  Apartment Cleaning  FORMTEXT      $ FORMTEXT       FORMCHECKBOX  Heating and A/C  FORMTEXT      $ FORMTEXT       FORMCHECKBOX  Plumbing  FORMTEXT      $ FORMTEXT       FORMCHECKBOX  Security  FORMTEXT      $ FORMTEXT       FORMCHECKBOX  Trash Collection  FORMTEXT      $ FORMTEXT       FORMCHECKBOX  Decorating  FORMTEXT      $ FORMTEXT       FORMCHECKBOX  Grounds  FORMTEXT      $ FORMTEXT       FORMCHECKBOX  Other  FORMTEXT      $ FORMTEXT       Comments:  FORMTEXT       12. Accounts Receivable/Payablea. Complete the following as of end of last month. Cash $ FORMTEXT       Accounts Receivable $ FORMTEXT       Accounts Payable $ FORMTEXT       Are tenant accounts receivable within acceptable limits of 10% of one month s rent potential? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Amount of receivables above is  FORMTEXT    % of monthly rent potential. Of this amount, $ FORMTEXT     is more than 30 days past due. Comments:  FORMTEXT       b. Does the procedure for write-off of bad debts appear reasonable? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       c. Has annual  write-off of tenants accounts receivable for the last two fiscal years been less than 1% of gross rent potential? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       d. Are accounts payable reasonably current? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Indicate amount of accounts payable more than 60 days old:  FORMTEXT       What are the owner/agent plans to reduce outstanding payables?  FORMTEXT       Comments:  FORMTEXT       13. Accounting and Bookkeepinga. Are books and records maintained as required by HUD Handbook 4370.2 (Chapter 4) and 24 CFR Part 5? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Check books of accounts that are maintained. Indicate where books may be examined. O owners office; A agents office; P project site  FORMCHECKBOX  General Ledger ( FORMTEXT  )  FORMCHECKBOX  Rent Receivable Ledger ( FORMTEXT  )  FORMCHECKBOX  General Journal ( FORMTEXT  )  FORMCHECKBOX  Cash Receipts Journal ( FORMTEXT  )  FORMCHECKBOX  Cash Disbursements Journal ( FORMTEXT  )  FORMCHECKBOX  Accounts Payable Journal ( FORMTEXT  ) Comments:  FORMTEXT       b. Are all required project accounts in the name of the project in a federally insured institution? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       c. Are operating funds, security deposits, reserve funds, and flexible subsidy funds maintained in separate accounts and properly secured for authorized use? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       d. Does the mortgagor make frequent postings (at least monthly) to the ledger accounts? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       e. If applicable is owner adhering to HUD-approved repayment Plan? (loan from reserve for replacement, 236 excess income, capital improvement loan, etc.) Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       f. Is centralized accounting used for disbursements? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, are only HUD-insured projects in the pool? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       g. If centralized accounting is used, has it been approved by HUD Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       h. If centralized accounting is used, is it being administered in accordance with HUD s approval? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       i. If the trust account is part of a centralized disbursement account, are only HUD-insured projects in that account? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, is the project s balance transferred to the project account at least once monthly? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       j. If there are automobiles and/or debit or credit cards charged to the project, are the titles kept in the name of the project? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, do they have HUD approval? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT        PROCEED TO PAGE 8 OF 19 FOR CATEGORY E. LEASING AND OCCUPANCY CATEGORY E. LEASING AND OCCUPANCY (This Category does not apply to Mortgagees) 14. Application Processing and Tenant Selectiona. Does the application form contain sufficient information to determine applicant eligibility? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. Does the application ask whether the applicant or any member of the applicant s household is subject to a liftetime state sex offender registration program in any state? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       c. Does the application ask for a listing of states where the applicant and members of the applicant s household have resided? Yes  FORMCHECKBOX  No  FORMCHECKBOX  d. Is form HUD-92006  Supplement to Application for Federally Assisted Housing , an attachment to the application or part of the application package? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       e. Is there an arms length procedure between the person who denies an application and the application appeal reviewer? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       f. Has the owner/agent leased a Section 8 unit to a police officer or security personnel who is over the income limits for the project? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, has HUD or CA authorized the admission? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       g. Does the owner/agent have a written tenant selection plan? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, does the plan include all required criteria stated in Chapter 4, Handbook 4350.3 REV-1 and all applicable notices? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If no, list the required criteria that the tenant selection plan does not include:  FORMTEXT       Comments:  FORMTEXT       h. Does the project maintain a waiting list of prospective tenants? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If yes, does the list include all required elements stated in Handbook 4350.3 REV-1? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       i. Enter the number of applicants on the waiting list for each type of unit: 0 BR  FORMTEXT     1 BR  FORMTEXT     2 BR  FORMTEXT     3 BR  FORMTEXT     4 BR  FORMTEXT     Other:  FORMTEXT     Comments:  FORMTEXT       j. Were the applicants selected from the waiting list in the proper order, recognizing applicable preferences? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       k. When preferences were applied, were they properly documented? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       l. Is documentation available to show that the owner/agent has leased not less than 40% of the Section 8 units that became available for occupancy in the previous fiscal year to extremely low-income families? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If yes, please review and obtain a copy. Comments:  FORMTEXT       m. What marketing steps has the owner/agent taken to attract extremely low-income families? If not applicable, proceed to question n. Please describe:  FORMTEXT       Comments:  FORMTEXT       n. Does the advertising program comply with the existing Affirmative Fair Housing Marketing Plan? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Request to see copies of advertisements. Comments:  FORMTEXT       o. Is the fair housing sign posted in the rental office? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       p. Is the fair housing logo included in published advertising materials? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       15. Leases and Depositsa. Have modifications been made to the HUD model lease? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  If yes, has the lease and/or lease addenda in use been approved by HUD? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  This does not include lease addenda issued by HUD Comments:  FORMTEXT       b. Aside from rents and security deposits, what other charges are assessed (replacement keys, lockouts, etc.)? List the type and amount of any of these charges.  FORMTEXT       Comments:  FORMTEXT       c If other charges aside from rents and security deposits are assessed, have they been approved by HUD? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       d. Are rents collected in accordance with the provisions of the lease? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       e. Is the policy for late fee assessment in compliance with the Handbook 4350.3 REV-1 or with state/local requirements? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       f. Are damages caused by tenants properly identified and charged to tenants? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       16. Eviction/Termination of Assistance Proceduresa. Are tenants notified of termination of tenancy or assistance in accordance with HUD requirements? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT        b. Has the owner/agent pursued eviction or termination of assistance for all individuals subject to a lifetime sex offender registration requirement who were erroneously admitted after June 25, 2001? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       c. Are eviction procedures initiated timely, when warranted? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Please document the following: Number of evictions completed during the last 12 months.  FORMTEXT     Average cost per eviction $  FORMTEXT       Eviction handled by:  FORMCHECKBOX  Owner/Agent  FORMCHECKBOX  Attorney on staff of Owner/Agent  FORMCHECKBOX  Attorney on contract  FORMCHECKBOX  Attorney on call NOTE: Addendum D must identify any eviction during the last 12 months which was due to a household member being subject to a state lifetime sex offender registration requirement. Comments:  FORMTEXT       d. Is the termination of assistance initiated timely when warranted? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Reason(s) for termination of assistance:  FORMTEXT       Comments:  FORMTEXT       17. Enterprise Income Verification (EIV) System Access and Security Compliance Applies to subsidized properties onlya. Does the owner/agent have access to EIV? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. Does the EIV Coordinator(s) have an owner approval letter(s) authorizing access to EIV? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       c. Does the owner/agent and/or EIV Coordinator have: An initial and currently approved EIV Coordinator Access Authorization Form (CAAF) on file for each person designated by the owner as an EIV Coordinator? Yes  FORMCHECKBOX  No  FORMCHECKBOX  An initial and currently approved EIV User Access Authorization Form (UAAF) on file for each person designated by the EIV Coordinator as an EIV User? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Signed copies of the EIV Rules of Behavior for Individuals without access to the EIV system, who use EIV reports and/or data to perform their job functions? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       d. Is there evidence that staff with access to the EIV system or to EIV reports take annual security awareness training? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       e. Does the owner/agent have security measures in place to limit access to EIV information and reports to only those persons who have proper authorization? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       f. Does the owner/agent have a procedure to review all EIV User IDs to periodically determine if the users still have a valid need to access EIV data? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       g. Does the owner/agent terminate access promptly (within 30 days) of all users who no longer have a valid need to access EIV data? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       h. Does the owner/agent have a procedure to document and report the occurrence of all improper disclosures of EIV data? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Have any improper disclosures been reported to the owner/agent? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       Does the owner/agent have a procedure to report any occurrence of unauthorized EIV access or security breach to the HUD National Help Desk? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Have any occurrences of unauthorized EIV access or security breaches been reported? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       Is there evidence that the owner/agent or any of their employees are sharing IDs and passwords? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       Is EIV data being improperly shared with other entities (e.g., state officials monitoring LIHTC projects, RHS staff, or Service Coordinators not participating in the re-certification process)? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       l. Does the owner/agent keep in the tenant file the Tenant Consent for Disclosure of EIV Information, signed by the tenant and a third party when a third party assists in the re-certification process? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       18. Compliance with Using EIV Data and Reports Applies to subsidized properties only.a. Does the owner/agent have policies and procedures describing the use of EIV employment and income information and the EIV reports? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, do they comply with HUDs usage requirements? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       b. Is the owner/agent using the following EIV reports, and taking appropriate action to correct discrepant data in TRACS, and/or to reduce improper subsidy payments and where applicable, retaining documentation to support the action(s)? Summary Report Yes  FORMCHECKBOX  No  FORMCHECKBOX  New Hires Report Yes  FORMCHECKBOX  No  FORMCHECKBOX  No Income Report Yes  FORMCHECKBOX  No  FORMCHECKBOX  Failed EIV Pre-screening Report Yes  FORMCHECKBOX  No  FORMCHECKBOX  Failed Verification Report (Failed the SSA Identity Test) Yes  FORMCHECKBOX  No  FORMCHECKBOX  Existing Tenant Search Yes  FORMCHECKBOX  No  FORMCHECKBOX  Multiple Subisidy Report Yes  FORMCHECKBOX  No  FORMCHECKBOX  Deceased Tenant Report Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       19. TRACS Monitoring and Compliance (applies to subsidized properties only)a. Is the owner/agent using TRACS queries to review and monitor their transmission? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. Is the owner/agent following up and correcting deficiencies identified in TRACS data? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       20. TRACS Security Requirements (applies to subsidized properties only)a. Is the owner s/agent s  Rules of Behavior for TRACS current (within last 12 months) and on file? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. Is the owner s/agent s completed annual TRACS  Security Training Certificate current, on file and dated within 30 days of the date of the  Rules of Behavior ? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       21. Tenant File Securitya. Are the tenant files, as well as other files that contain EIV reports, if applicable, locked and secured in a confidential manner? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. Is documentation relating to an individual s domestic violence, dating violence, or stalking, kept in a separate file in a secure location from other tenant files? Applicable to Section 8 only. Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       c. Is access to tenant file information limited to only authorized staff? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       d. Who is authorized to have access to the tenant files? Name(s) and Title(s):  FORMTEXT       Comments:  FORMTEXT       e. Is the owner/agent maintaining tenant files according to HUD s document retention requirements? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       f. Is the owner/agent properly disposing of tenant records (shred, burn, pulverize etc.)? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       22. Summary of Tenant File ReviewThis section applies only to subsidized projects and should be completed after the tenant file reviews (See Addendum A.) The minimum file sample should include review of tenant files of new move-ins, re-certifications (annual, interim, initial), at least one applicant reject file, and at least one terminated/move-out file. In order to review specific functions (EIV usage, utility reimbursement, pet rules/deposits, minimum rents, etc.) it may be necessary to target a portion of the files reviewed to specific tenant families. The reviewer should adjust the tenant file sample to meet the needs of the review.Number of UnitsMinimum File Sample100 or fewer5 files plus 1 for each 10 units over 50101-60010 files plus 1 for each 50 units or part of 50 over 100601-200020 files plus 1 for each 100 units or part of 100 over 600Over 200034 files plus 1 for each 200 units or part of 200 over 2,200For each question, only answer Yes if the files reviewed are acceptable. Answer No if the files are not acceptable and note the number of files with deficiencies utilizing the tenant file worksheet, Addendum A Number of Files Reviewed =  FORMTEXT     (Please note: There is no maximum number of files to be sampled) a. Tenant Files and Records i. Are the tenant files organized and properly maintained? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       ii Do the files contain all documentation as required in Handbook 4350.3 REV-1, applicable HUD Notices, and any changes to the CFR? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Documents Missing from Files:  FORMTEXT       Comments:  FORMTEXT       b. Application/Tenant Selection i. Are the applications in the files signed and dated by applicant? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       ii. Is screening conducted in accordance with the Tenant Selection Plan? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iii. Are the unit sizes appropriate for household composition at the time of this tenant file review? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iv. If a household was ineligible at move in, were exceptions granted? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       c. Lease i. Are the correct model leases used? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       ii. Are the leases signed and dated by all required parties? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iii. Are HUD issued lease addenda properly signed and in the file? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iv. Are the applicable addenda attached to the lease? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       v. Are security deposits collected in the correct amount for the program? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       vi. Are pet deposits within acceptable range and payment installments allowed? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       vii. Do the tenant files contain signed acknowledgement(s) and/or copies as required of the following documents indicating receipt by the tenant? HUD-9887 Fact Sheet Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Lead Based Paint Disclosure Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Resident Rights and Responsibilities Brochure Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     EIV & You Brochure Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Fact Sheet How Your Rent is Determined Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Race/Ethnicity Form Yes  FORMCHECKBOX  No  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       d. Certification/Re-Certification Activities: i. Are re-certification notices issued in accordance with HUD requirements? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       ii. Are certifications completed on time? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iii. Are all necessary verifications completed and properly documented? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iv. Are EIV Income Reports used for third party verification of employment and income? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       v. If the tenant disputed the EIV employment and/or income reported in EIV, was a third party verification obtained from the source? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       vi. Are appropriate actions being taken for income discrepancies reported on the EIV Income Discrepancy Report, and is the action documented? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       vii. Are income and deductions calculated correctly prior to data entry? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       viii. Does income information on the tenant certifications agree with verified file information? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       ix. If tenants were granted a hardship exemption as part of the minimum rent, was the exemption applied correctly? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       x. Are Repayment Agreements in accordance with HUD requirements? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       xi. Are notices provided to tenants in accordance with HUD tenant notification requirements when their portion of rent has increased? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       xii. Are the correct contract rents used when determining the subsidy to be paid on behalf of tenants? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       xiii. If tenants are paying their own utilities, are the current certifications reflecting the correct utility allowances? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       xiv. Are utility reimbursement checks distributed within 5 business days of receipt of the housing assistance payments? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       e. Voucher Billing i. Are there any deficiencies noted in the tenant file review that results in over payment or under payment of the subsidy? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       ii. For the move-in/move-out tenant file review, does the owner/agent make appropriate voucher adjustments? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       f. Move-In Files i. Are proper income limits used for determining eligibility at move-in? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       ii. Do the files contain move-in inspections? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iii. If the files contain move-in inspections, have the owner/agent and the tenant signed and dated the inspection? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iv. Do the move-in files created after January 31, 2010 indicate that the owner/agent utilizes the EIV Existing Tenant Search for all household members and applicants? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       g. Move-Out Files i. Do tenants provide written notice of intent to vacate in accordance with the HUD model lease? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       ii. Are move-out inspections conducted? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iii. Are security deposits refunded in 30 days or less if required by state law? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iv. Are tenants provided an itemized list of charges against the security deposits? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       v. If charges exceed the security deposit, are the tenants billed for the balance due? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       h. Application Rejection Files i. Are applicants denied admittance in accordance with the Tenant Selection Plan? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       ii. Do rejection letters provide applicants the right to appeal? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iii. If applicant appealed an application rejection, was the appeal reviewed by someone other than person who made the original decision to reject? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       iv. Were appeals processed and applicants notified of the appeal decision within 5 days of the meeting? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Number of Files with Deficiencies:  FORMTEXT     Comments:  FORMTEXT       CATEGORY F. TENANT/MANAGEMENT RELATIONS (This Category does not apply to Mortgagees)23. Tenant Concerns a. Is there a written procedure for resolving tenant complaints or concerns? If yes, review a copy. Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. Does the procedure adequately cover appeals? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       c. Is there an active tenant organization at this project? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       d. Is tenant involvement in project operations encouraged? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       24. Provision of Tenant Servicesa. What social services are provided by the project, or the neighborhood, which meet the tenants needs? Below, indicate services that are available, and identify the entity providing the service (i.e., city/county/state, church/school, community groups, etc.) and enter the cost to the project, if any. ServiceProviderFinancial Source FORMCHECKBOX  Child Care  FORMTEXT       FORMTEXT       FORMCHECKBOX  Recreation  FORMTEXT       FORMTEXT       FORMCHECKBOX  Health Care FORMTEXT       FORMTEXT       FORMCHECKBOX  Energy Conservation FORMTEXT       FORMTEXT       FORMCHECKBOX  Vocational Training/Job Training  FORMTEXT       FORMTEXT       FORMCHECKBOX  Meals  FORMTEXT       FORMTEXT       FORMCHECKBOX  Financial Counseling FORMTEXT       FORMTEXT       FORMCHECKBOX  Substance Abuse Counseling FORMTEXT       FORMTEXT       FORMCHECKBOX  Service Coordinator FORMTEXT       FORMTEXT       FORMCHECKBOX  Neighborhood Networks Center FORMTEXT       FORMTEXT       FORMCHECKBOX  Other (please specify) FORMTEXT       FORMTEXT       b. Is there a Service Coordinator for the project? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If there is no Service Coordinator, proceed to question 24.f. Comments:  FORMTEXT       c. Is the Service Coordinator s office clearly identifiable and private? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       d. Are the Service Coordinator s files kept secure and confidential? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       e. Does the Service Coordinator maintain a directory of service agencies and contacts, and make the information available to all parties? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       f. If there is a Neighborhood Networks Center as indicated on the Desk Review, what is the status of operations? If there is no Neighborhood Networks Center, proceed to question 24.h.  FORMCHECKBOX  Open for Business  FORMCHECKBOX  Temporarily Closed  State the date the center will reopen:  FORMTEXT        FORMCHECKBOX  Permanently Closed  State the date the center closed:  FORMTEXT       Comments:  FORMTEXT       g. What programs are offered at the Neighborhood Networks Center?  FORMCHECKBOX  GED  FORMCHECKBOX  Adult Basic Education  FORMCHECKBOX  Computer Classes  FORMCHECKBOX  Job Training  FORMCHECKBOX  Job Placement  FORMCHECKBOX  Homework Assistance  FORMCHECKBOX  English as a Second Language  FORMCHECKBOX  Other (please specify)  FORMTEXT       Comments:  FORMTEXT       h. The Department allows owners and their agents to provide services related to renter s insurance products. Does the owner/agent offer such services? 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Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       i. HUD policy prohibits an owner/agent from evicting tenants for delinquent renter s insurance payments. How does the owner/agent deal with unpaid renter s insurance? Please explain the process:  FORMTEXT       Comments:  FORMTEXT       j. Review the renter s insurance information provided to tenants. Does the information provided to tenants clearly indicate that purchasing insurance is optional, and not required as a condition of occupancy? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       CATEGORY G. GENERAL MANAGEMENT PRACTICES25. General Management Operationsa. Have the complaints, as noted on the Desk Review, been satisfactorily resolved? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       b. Is the project staff able to adequately perform management and maintenance functions? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       c. How does the owner/agent implement HUD changes in policies and procedures? Describe the process:  FORMTEXT       d. Does owner/agent have a formal ongoing training program for its staff? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, indicate types of training used and the frequency. TypeFrequencyTypeFrequency FORMCHECKBOX  On-Site FORMTEXT       FORMCHECKBOX  Industry/Association Training FORMTEXT       FORMCHECKBOX  HUD Seminars FORMTEXT       FORMCHECKBOX  Local Colleges FORMTEXT       FORMCHECKBOX  Energy Conservation FORMTEXT       FORMCHECKBOX  Other (please specify) FORMTEXT       Comments:  FORMTEXT       e. Are reports submitted to the owner from the management agent? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  This question applies only to HUD Staff and Mortgagees. Comments:  FORMTEXT       f. Are there signs enabling persons to locate the office? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       g. Are after hours and emergency telephone numbers posted? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       h. List the current insurance coverages (property, liability, Directors and Officers, workman s compensation, automobile). (Check to make sure that HUD is listed as an additional loss payee, if applicable. Also, check to make sure that the insurance policy is in the name of the mortgagor entity.) This question applies only to HUD Staff and Mortgagees. Type Basic CoverageAnnual PremiumProperty  FORMTEXT       FORMTEXT      Liability  FORMTEXT       FORMTEXT      Other (please specify)  FORMTEXT        FORMTEXT       FORMTEXT      Other (please specify)  FORMTEXT        FORMTEXT       FORMTEXT       Comments:  FORMTEXT       i. Does the owner/agent have a fidelity bond? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  This question applies only to HUD Staff and Mortgagees. Comments:  FORMTEXT       26. Owner/Agent Participation This question applies only to HUD Staff and Mortgagees. CAs may proceed to question 27.)a. If the project is owned by a cooperative or a nonprofit entity, does the Board of Directors meet regularly and record minutes? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       b. Review copies of the minutes. Does a review of the minutes indicate compliance with HUD s business agreements? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       c. Does the owner/agent have a system or procedure for providing field supervision of on-site personnel? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A  FORMCHECKBOX  Comments:  FORMTEXT       27. Staffing and Personnel Practicesa. Has management made an effort to employ tenants in accordance with Section 3 of the Housing and Community Development Act of 1968? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       b. List all on-site staff charged to the project. (Use additional sheets if necessary). Staff Person / TitleDate Hired% of Time Charged to SiteAnnual SalaryUnit SizeIs the Employee Receiving Subsidy?Is the Employee occupying a Non-Income Producing Unit? FORMTEXT       /  FORMTEXT       FORMTEXT       FORMTEXT     %  FORMTEXT       FORMTEXT     Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       /  FORMTEXT       FORMTEXT       FORMTEXT     %  FORMTEXT       FORMTEXT     Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       /  FORMTEXT       FORMTEXT       FORMTEXT     %  FORMTEXT       FORMTEXT     Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       /  FORMTEXT       FORMTEXT       FORMTEXT     %  FORMTEXT       FORMTEXT     Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       /  FORMTEXT       FORMTEXT       FORMTEXT     %  FORMTEXT       FORMTEXT     Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX   Comments:  FORMTEXT       c. Does the staffing chart above match Part D of the Rent Schedule, form HUD-92458 as it relates to non-income producing units? HUD staff only. Yes  FORMCHECKBOX  No  FORMCHECKBOX  Comments:  FORMTEXT       Tenant File Review Worksheet Instructions: Review the appropriate number of tenant files and complete a copy of this worksheet for each file reviewed. Indicate the initial move-in date in the appropriate box. Indicate by marking the appropriate box (Yes, No, or N/A) for each document available in the tenant file. For move-out and applicant rejections files, reviewer should only complete the pertinent sections. Name of Reviewer:  FORMTEXT       Type of Review:  FORMCHECKBOX  Applicant Rejection  FORMCHECKBOX  Tenant Move-In  FORMCHECKBOX  Tenant Move-Out  FORMCHECKBOX  Certification/Recertification Effective date of certification(s) reviewed:  FORMTEXT       If this is a Certification or Recertification, check the certification type: Certification Type  FORMCHECKBOX Initial  FORMCHECKBOX Annual  FORMCHECKBOX Interim  FORMCHECKBOX Corrections  FORMCHECKBOX Other  Family Name:  FORMTEXT       Unit Number:  FORMTEXT       Move-in Date:  FORMTEXT       Bedroom Size:  FORMCHECKBOX  0 Bedroom  FORMCHECKBOX  1 Bedroom  FORMCHECKBOX  2 Bedroom  FORMCHECKBOX  3 Bedroom  FORMCHECKBOX  4 Bedroom  FORMCHECKBOX  5 or more Bedrooms  A. HOUSEHOLD INFORMATIONComments1. Is the application complete, including the date and time received by the owner/agent?Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       2. Is there a form HUD-92006,  Supplement to Application for Federally Assisted Housing in the files of tenants who applied after 12/14/2009? Tenant completion of this form is optional. Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       3. Are the EIV Existing Tenant Search results in the file along with contacts made as a result of the search? Applicable to move-ins after January 31, 2010 Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       4. Are the household members identified correctly? (as head, spouse, dependent, co-head, other adult(s), live-in aide, foster child and foster adult) Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       5. Is the unit size appropriate for household?Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       6. Was this household s income eligible at move-in? This question applies only to a tenant file move-in review.Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       Over income?  FORMCHECKBOX  Low income?  FORMCHECKBOX  Very low income?  FORMCHECKBOX  Extremely low income?  FORMCHECKBOX 7. If household was not income eligible at move-in, was an exception or waiver granted?Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       8. Does the file contain the ethnicity and racial Data Certification as provided to the owner/agent? Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       9. Is there current HUD 9887/9887A Consent Form signed and dated by head, spouse, co-head regardless of age, and family members at least 18 years of age?Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       10. Is there an acknowledgement and/or signed document as required in the file indicating receipt by the tenant? Lead based paint Resident Rights and Responsibilities Brochure EIV & You Brochure Fact Sheet on How Your Rent is Determined  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX    FORMTEXT       11. Does the tenant file indicate that the owner /agent has taken necessary steps to address any EIV reported receipt of multiple subsidies? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       12. Does the file contain documentation to verify discrepant personal identifiers, and/or subsidy paid, as reported on: EIV Multiple Subsidy report? EIV Deceased Tenant Report?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX    FORMTEXT      B. VERIFICATION Have the following items been properly verified and documented?Comments1. Social Security numbers (except for those exempted by 24 CFR 5.216)? EIV Summary Report in file to validate SSNs? Exemption from SSN disclosure? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       2. Eligible immigration status or citizenship status?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       3. Criminal and drug screening?Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       4. State lifetime sex offender registration check in each state where household members reported they have resided, and/or background checks conducted using a database that checks against all state registries?  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       5. Other screening as disclosed in Tenant Selection Plan?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       6. Verification of: Disability status? Student status? Ages of occupants?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX    FORMTEXT       C. LEASEComments1. Is the correct HUD model lease used? Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       2. Is the original lease and subsequent leases or addenda signed and dated by the owner/agent, head, spouse, co-head, and all other adult members of the household?  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       3. Are applicable attachments attached to the lease, e.g. house rules, pet rules, unit inspection report?  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT        4. If security deposit is required, is it in the correct amount? If required, enter the amount here: $ FORMTEXT       Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       5. If pet deposit is required, is it in the correct amount? If required, enter the amount here: $ FORMTEXT       Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       6. If a pet deposit was paid in installments, was the payment schedule in accordance with the pet regulations?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       7. Are there inspections in the file: Move-in (dated and signed by tenant and owner/agent)? Annual unit inspections? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       D. CERTIFICATION/RECERTIFICATION ACTIVITIESComments1. Are re-certification notices provided within the required timeframes?  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       2. Are re-certifications completed on time? Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       3. Is the certification signed and dated by the appropriate parties?  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       4. Has a 30-day notice of increase in rent been provided to the tenant?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       NOTE: If necessary, use additional sheets to complete applicable income information.CommentsAll reported income and deductions verified and calculated correctly?3rd Party Verification?Amount Reported on 50059Did income information on the 50059 agree with verified file information? If no, comment on discrepancies identified5. WagesEIV Income Report  FORMCHECKBOX  Traditional 3rd party  FORMCHECKBOX  Other  FORMCHECKBOX  Not verified  FORMCHECKBOX  N/A  FORMCHECKBOX  $ FORMTEXT       FORMTEXT       6. Social Security benefitsEIV Income Report  FORMCHECKBOX  Traditional 3rd party  FORMCHECKBOX  Other  FORMCHECKBOX  Not verified  FORMCHECKBOX  N/A  FORMCHECKBOX  $ FORMTEXT       FORMTEXT       7. Unemployment benefits EIV Income Report  FORMCHECKBOX  Traditional 3rd party  FORMCHECKBOX  Other  FORMCHECKBOX  Not verified  FORMCHECKBOX  N/A  FORMCHECKBOX  $ FORMTEXT       FORMTEXT        8. Other Income Welfare/Public Assistance/TANF Child Support Pensions Other ________________________ _____________________________  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       FORMTEXT       9. Actual Income from Assets Checking Account Savings Account Certificates of Deposit 40lK/Keogh/Retirement Accounts Real Estate Other ________________________ _____________________________  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       $ FORMTEXT      Cash Value $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       FORMTEXT       10. Imputed income when assets are greater than $5,000  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX $ FORMTEXT       FORMTEXT       11. Allowances/Expenses Dependent Allowance Elderly/Disabled Household Allowance Medical Expenses Disability Expenses Childcare Expenses Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       $ FORMTEXT       FORMTEXT       12. Are all expenses and allowances that are claimed eligible under the HUD Handbook 4350.3 REV-1?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT       13. Has the household certified whether or not they disposed of assets during the past two years?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT       14. Is the correct unit rent being used for subsidy determination?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  FORMTEXT       Enter the reviewer verified amounts for the following:Amount Reported on the 50059Did income information on the 50059 agree with the verified file information? If not, comment on any discrepancies identified. 15. Contract Rent $ FORMTEXT       Utility Allowance $ FORMTEXT       Gross Rent $ FORMTEXT       Total Tenant Payment $ FORMTEXT       Tenant Rent $ FORMTEXT       Utility Reimbursement $ FORMTEXT       Assistance Payment $ FORMTEXT        $  FORMTEXT       $  FORMTEXT       $  FORMTEXT       $  FORMTEXT       $  FORMTEXT       $  FORMTEXT       $  FORMTEXT        FORMTEXT       16. Is the tenant paying minimum rent? If yes, was a hardship exception granted? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT       17. Were income discrepancies reported on the EIV Income Discrepancy Report investigated and the file documented with the resolution?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT       18. Has tenant entered into a written repayment agreement for monies due to the project? If yes, does the plan contain the required information?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT       19. Does file contain a re-certification as a result of new employment reported on the EIV New Hires Report? If yes, is the new employment income included in the reported annual income?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT       E. BILLINGComments1. Does the assistance payment requested on the monthly billing (HUD-52670-A, Part 1) agree with the assistance payment on the applicable form HUD-50059?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT       2. If required, have adjustments been made to the monthly billing?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT       F. MOVE-OUT FILE REVIEW ONLYComments1. Is there a move-out notice from tenant? If yes, Date of Notice  FORMTEXT       Move-out date  FORMTEXT       Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       2. Is there a move-out inspection? If yes, enter the date of the inspection  FORMTEXT       Yes  FORMCHECKBOX  No  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       3. Was the security deposit refunded to the tenant within 30 days, or in accordance with state or local laws, whichever is shorter?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       4. Was an itemized list of damages and charges provided to the tenant?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       5. Were any additional charges paid by tenant? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX   FORMTEXT       6. Does the tenant move-out date on the voucher match the date the tenant vacated?  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       G. APPLICANT REJECTION REVIEW ONLYComments1. Was the reason the applicant was denied admittance in accordance with the Tenant Selection Plan?  Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMTEXT       2. Was the reason for rejection provided in specific terms and in plain language?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT      3. Did the rejection letter provide the applicant the right to appeal?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  FORMTEXT       4. If the applicant appealed, was the appeal reviewed by someone other than the person who made the original decision?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT       5. Was the appeal processed and applicant notified of the appeal decision within five days of the meeting?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  FORMTEXT        Multifamily Housing (Housing) staff or Performance-Based Contract Administrators and Traditional Contract Administrators (CA) must complete this Checklist when conducting on-site management reviews of subsidized and unsubsidized multifamily housing projects. The questions on this checklist cover topics that the Housing staff or CA can be expected to answer and is not intended to cover the full range of civil rights concerns. NOTE: This document does not require the reviewer to make a determination of civil rights or Section 504 compliance. The Checklist is divided into four parts. Part A: Occupancy/Accessible Units/Program Accessibility  This section, along with instructions, must be forwarded to the owner/agent for completion prior to the on-site review. This document must be included with the Documents Reviewer Should Obtain from Owner. See Part D. Part B: Limited On-Site Monitoring Review  The reviewer must complete this section during the on-site management review of all projects. Part C: Section 504 Review  The reviewer must complete this section during the on-site management review for all federally-assisted projects. Part D: Documents Reviewer Should Obtain from the Owner/Agent during the on-site management review. Please Note that a  No response to any question does not necessarily mean there is a fair housing or civil rights or a Section 504 violation. Project Name:  FORMTEXT      FHA /Project Number:  FORMTEXT      Section 8/PAC/PRAC Number:  FORMTEXT      Owner/General Partner Name:  FORMTEXT      Management Agent Name: FORMTEXT      Owner/General Partner Address:  FORMTEXT      Management Agent Address: FORMTEXT       Type of Development:  FORMCHECKBOX  Cooperative  FORMCHECKBOX  Elderly Only  FORMCHECKBOX  Disabled Only  FORMCHECKBOX  Elderly/Disabled  FORMCHECKBOX  Family  FORMCHECKBOX  Other(Specify) FORMTEXT       Total Number of Units:  FORMTEXT       Total Subsidized Units:  FORMTEXT       Type of Federal Financial Assistance (check all that apply):  FORMCHECKBOX  Section 8  FORMCHECKBOX  Section 202  FORMCHECKBOX  Section 202/8  FORMCHECKBOX  Section 202/PAC  FORMCHECKBOX  Section 202 PRAC  FORMCHECKBOX  Section 811  FORMCHECKBOX  Section 221(d)(3)BMIR  FORMCHECKBOX  Section 236  FORMCHECKBOX  Other  FORMTEXT       Number of Units of Each Size: 0 BR  FORMTEXT       1 BR  FORMTEXT       2 BR  FORMTEXT       3 BR  FORMTEXT       4 BR  FORMTEXT       5 BR  FORMTEXT       Other (Specify) FORMTEXT       Resident Manager s Unit: Yes  FORMCHECKBOX  No  FORMCHECKBOX  Date of First Occupancy:  FORMTEXT       Service Coordinator Employed By Project? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Reviewed by:  FORMCHECKBOX  Housing  FORMCHECKBOX  PBCA  FORMCHECKBOX  CA  FORMCHECKBOX  Mortgagee Reviewer:  FORMTEXT       Date:  FORMTEXT       Phone:  FORMTEXT       This Section is for Multifamily Housing Staff only: After a review of the information provided by the owner/agent in Part A, the following as been determined:  FORMCHECKBOX  The owner/agent is in compliance with Title VI, Subpart D of the Housing and Community Development Act of 1992.  FORMCHECKBOX  Possible noncompliance with Title VI, Subpart D of the Housing and Community Development Act of 1992. Referred to the local Office of Fair Housing and Equal Opportunity for additional review and appropriate action.  FORMCHECKBOX  Title VI, Subpart D of the Housing and Community Development Act of 1992 - Not Applicable Reviewed By:  FORMTEXT       (Name and Title) Project Name:  REF ProjName \h   FHA/Project#  REF ProjNo \h   Section 8/PAC/PRAC#  REF ProjContractNo \h    PART A OCCUPANCY/ACCESSIBLE UNITS/PROGRAM ACCESSIBILITY Authority: Section 504 of the Rehabilitation Act of 1973 (24CFR Part 8) Fair Housing Act/Title VIII Regulations (24 CFR Part 100.200) Uniform Federal Accessibility Standards (UFAS) (24 CFR Part 40) Regulatory Agreement For this Part A, the reviewer must forward the form along with the instructions for completion to the owner/agent prior to the on-site review. For subsidized projects, the owner/agent must complete the project information above and the information in Sections I, II, and III below. (See attached instructions.) For unsubsidized projects, the owner/agent must complete the project information above and Sections I and II only. Section III consists of Section 504 compliance, which does not apply to projects that do not receive federal financial assistance. The reviewer will retrieve the completed form from the owner/agent during the on-site review. SECTION I  OCCUPANCY 1. This property was designed primarily for:  FORMCHECKBOX  Exclusively Elderly  FORMCHECKBOX  Exclusively Disabled  FORMCHECKBOX  Elderly and Disabled  FORMCHECKBOX  Near Elderly and Disabled  FORMCHECKBOX  Family2. Indicate the number of units currently occupied by client groups below Exclusively Elderly -  FORMTEXT       Exclusively Disabled -  FORMTEXT       Elderly/Disabled -  FORMTEXT       Near-Elderly Disabled -  FORMTEXT       Family -  FORMTEXT       3. Is there a use agreement or any other document that indicates that this project must serve only elderly tenants? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Unknown FORMCHECKBOX  If yes, specify type of document:  FORMTEXT       Effective Date:  FORMTEXT       Please attach a copy of the document(s) indicated above. 4. If this project is a  covered Section 8 housing project (see instructions), is there an occupancy preference for the elderly in accordance with Section 651 of Title VI, Subpart D of the Housing and Community Development Act of 1992? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Refer to HUD Handbook 4350.3, REV-1. If No, proceed to question 5. If yes, please enter: a. the date of the elderly preference:  FORMTEXT       b. the number of units that must be reserved for occupancy by non-elderly persons with disabilities  FORMTEXT    , and, c. the date used to determine the number of units reserved for non-elderly persons with disabilities  FORMTEXT       5. Is there an occupancy restriction for the elderly in accordance with Section 658 of Title VI, Subpart D of the Housing and Community Development Act of 1992? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Refer to HUD Handbook 4350.3, REV-1 6. Total Number of Units exclusively for the Elderly  FORMTEXT     7. Total Number of Units exclusively for Persons with Disabilities  FORMTEXT    8. Total Number of Units exclusively for Non-Elderly Persons with Disabilities  FORMTEXT    I certify that this information is true and accurate.Warning: HUD will prosecute false claims and statements. Convictions may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)Signature of Owner Date:  FORMTEXT      Project Name:  REF ProjName \h   FHA/Project#  REF ProjNo \h   Section 8/PAC/PRAC#  REF ProjContractNo \h   SECTION II  ACCESSIBLE UNITS Distribution of all wheelchair and other accessible units in the project. Bedroom Size012345Other Total1. All units  FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    2. Total units with project-based rental assistance  FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    3. Mobility accessible units  FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    4. Vision and/or Hearing accessible units  FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    *5. (Total Accessible Units)  FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    6. Number of persons on waiting list who have requested accessible units  FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    7. Number of accessible units occupied by elderly or family tenants  FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    8. Number of accessible units occupied by non-elderly tenants with disabilities who require the features of the unit  FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    9. Number of accessible units occupied by elderly tenants with disabilities who require the features of the unit  FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT     FORMTEXT    10. Percentage of Total Units with Project-Based Rental Assistance Total line 2  QUOTE   Total line 1 x 100)  FORMTEXT    % 11. Percentage of Total Units that are mobility accessible Total line 3  QUOTE   Total line 1 x 100)  FORMTEXT    % 12. Percentage of Total Units that are vision and/or hearing accessible Total line 4  QUOTE   Total line 1 x 100)  FORMTEXT    % * If a unit is both mobility accessible and vision or hearing accessible, count the unit only once in line 5. I certify that this information is true and accurate.Warning: HUD will prosecute false claims and statements. Convictions may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)Signature of Owner Date:  FORMTEXT       Project Name:  REF ProjName \h   FHA/Project#  REF ProjNo \h   Section 8/PAC/PRAC#  REF ProjContractNo \h   SECTION III  PROGRAM ACCESSIBILITY Section 504 of the Rehabilitation Act of 1973 Section 504 Coordinator [24 CFR 8.53 (a)] 1. Does the recipient (as defined in 24 CFR 8.3) employ at least 15 employees? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If Yes, answer Question 2.; if No skip to Question 3. 2. Is at least one person designated to coordinate its Section 504 responsibilities? Yes  FORMCHECKBOX  No  FORMCHECKBOX  N/A FORMCHECKBOX  If Yes, provide the person s name and telephone number below. Name:  FORMTEXT       Telephone Number:  FORMTEXT       Program Accessibility Under Section 504, a federally assisted Housing Development is required to ensure that its program is usable by and accessible to persons with disabilities. This includes, but is not limited to, maintaining housing and non-housing facilities that are structurally accessible for persons with disabilities. The extent to which facilities must be structurally accessible depends in part, on whether they are new, altered, or existing. In addition, owner/agents are required to ensure that appropriate and effective communication methods are used while communicating with persons with disabilities. YESNOCOMMENTS3. Has the owner/agent taken steps to ensure effective communication using: a. Qualified sign language and oral interpreters?  FORMCHECKBOX   FORMCHECKBOX  FORMTEXT      b. Readers? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      c. Use of tapes?  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      d. Braille materials? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      Other (Describe): FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      I certify that this information is true and accurate.Warning: HUD will prosecute false claims and statements. Convictions may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)Signature of Owner Date:  FORMTEXT       Instructions for completing part a General instructions: Complete the project name, FHA/project number, and section 8/pac/prac information in the form header for each page: section i - Owner/Agent must respond to all questions in this section. 1. Check the appropriate box that the project was designed to serve. (Check only one box. Do not leave blank.) Exclusively Elderly - defined as a person 62 years of age or older. (This option is for projects that were designed to serve only elderly persons/families, i.e. Section 202 PRAC properties) Exclusively Disabled  Refer to HUD Handbook 4350.3, REV-1, Figure 3-6 for the applicable definition of disability. (This option is for projects that were designed to serve only persons with disabilities, i.e., Section 202/8 Projects for the Disabled and Section 811 projects. Please note that Section 202/8 Projects for the Disabled were developed to serve only non-elderly persons with disabilities. However, the Section 811 Projects were developed to serve persons with disabilities regardless of age as long as the minimum age requirement (age 18) is met.) Elderly and Disabled  defined as a property that serves the elderly and non-elderly persons with disabilities. (This option is for projects that were originally designed to serve only elderly persons/families, however the owner may have elected a preference under Section 651 of Title VI, Subpart D of the Housing and Community Development Act of 1992 ( Title VI Subpart D) to reserve a percentage of units for non-elderly persons with disabilities in accordance with the provisions of Section 652, Title VI Subpart D. See instruction 4 below for Section 651 definition.) Family  defined as all persons regardless of age or disability. (This option is for projects that serve all families with no restrictions or preferences as long as the minimum age requirement is met. Please note that family projects may have some units that are reserved for persons with mobility/vision/hearing impairments which would require the applicant to meet the accessibility features of the unit.) 2. Enter the number of units occupied by each client group. (Please note that the term  near-elderly disabled is defined as a person who is at least 50 years of age and below the age of 62 with a disability as defined in HUD Handbook 4350.3, REV-1.) Enter zero  0 if there are no units occupied by the listed client group  do not leave blank. 3. If there is a use agreement or other document requiring that the property must serve only elderly persons, answer  Yes , in the space provided, and attach a copy of the document(s). If there is no use agreement or other document requiring that the property must serve only elderly persons, answer  No . If you are unclear on the term  use agreement , or are not able to locate the use agreement or other document that defines the occupancy of your project, the answer is  unknown . Other documents include the regulatory agreement, loan commitment papers, financial documents, bid invitation, owner s management plan, application for funding, and/or application for mortgage insurance. Please refer to HUD Handbook 4350.3, REV-1, paragraphs 3-17 and 3-18. If you do not have a copy of HUD Handbook 4350.3, REV-1, copies can be obtained from  HYPERLINK "http://www.hudclips.org" www.hudclips.org or the HUD Customer Service Center at (800) 767-7468. 4. Section 651 of Title VI Subpart D permits an owner to give preference to elderly families if (1) the project was originally developed to serve the elderly and (2) it is a  covered Section 8 housing project.  Covered Section 8 housing projects are projects that were constructed or substantially rehabilitated pursuant to assistance provided under section 8(b)(2) of the United States Housing Act of 1937, as in effect before October 1, 1983, that are assisted under a contract for assistance under such section. Section 651 of Title VI Subpart D applies to the following programs: The Section 8 New Construction Program, 24 CFR part 880 The Section 8 Substantial Rehabilitation Program, 24 CFR part 881 The State Housing Agencies Program, insofar as it involves new construction and substantial rehabilitation, 24 CFR part 883 The New Construction Set-Aside for Section 515 Rural Rental Housing Projects Program, 24 CFR part 884 The Section 8 Housing Assistance Program for the Disposition of HUD-Owned Projects, insofar as it involves substantial rehabilitation, 24 CFR part 886 subpart C  Covered Section 8 housing projects do not include those developed with funding under the following programs: Section 202; Section 202/8; Section 202 or 811 PRAC; Section 221 (d)(3); and/or Section 236. If an owner elects a Section 651 preference for the elderly, the owner must reserve a number of units for non-elderly persons/families with disabilities. Title VI Subpart D requires that the owner review the occupancy records on January 1, 1992 and October 28, 1992, the date of enactment for Title VI Subpart D, and determine the number of non-elderly persons with disabilities that occupied units on those two dates. Compare the higher of the two numbers with 10 percent of total project units. The lower of the two resulting numbers must be reserved for non-elderly persons with disabilities, or families with disabilities. For example, an owner has a covered Section 8 project that consists of 100 units, and decides to implement an elderly preference under Section 651. The first thing the owner must do is find the occupancy records for January 1992 and see how many units were occupied by non-elderly personswith disabilities, or families with disabilities, on January 1. In this example, it was 10 units. Then the owner must find the occupancy records for October 1992 and see how many units were occupied by non-elderly persons/families with disabilities on October 28th, the date of the enactment of the Act. In this example it was 15 units. To obtain the number of units that must be reserved for non-elderly disabled persons or families, the owner must take the higher number of the two dates, which in this example is 15. Then the owner will then compare that number 15 with a number that is 10 percent of the total project units In this example it s 10. Use the lower number for the number of units that must be reserved. Since 10 is less than 15, for this example the owner must reserve 10 units for non-elderly disabled persons or families. If an owner determines that there were no non-elderly persons or families occupying units on either January 1, 1992 or October 28, 1992, the required number of units to be reserved for non-elderly persons with disabilities would be zero (0). However, owners are encouraged to exceed the number of reserved units for non-elderly persons with disabilities if a need exists in the community. Answer question 4 as follows: If there is an elderly preference in accordance with Section 651 of Title VI Subpart D, answer  Yes . If there is no preference provided to elderly families, answer  No . If yes, answer the following: If there is an occupancy preference in accordance with Section 651, indicate the effective date of the preference. If there is an occupancy preference in accordance with Section 651, indicate the total number of units that must be reserved for non-elderly persons with disabilities based on the two dates above. If there is an occupancy preference in accordance with Section 651, indicate which date (see above) was used to determine the number of units that must be reserved for non-elderly persons with disabilities. 5. Section 658 of Title VI, Subpart D of the Housing and Community Development Act of 1992 ( Title VI Subpart D) permits owners of  other federally assisted housing to continue to restrict occupancy to elderly families in accordance with the rules, standards, and agreements governing occupancy in such housing in effect at the time the housing was developed. If (A) the project was originally developed to serve the elderly and (B) the project has continually served elderly tenants. These projects include: Section 202 Direct Loans (prior to the Section 202 PRAC program) Section 221(d)(3) BMIR properties (New Construction and Substantial Rehabilitation) Section 236 properties Answer question 5 as follows: If there is an elderly restriction in accordance with Section 658 of Title VI Subpart D, answer  Yes . If there is no elderly restriction and occupancy is not limited to elderly applicants, answer  No . 6. If the property designates a number of units that can be occupied only by elderly persons, indicate the number of units. If the property does not have units that can only be occupied by elderly persons, enter zero  0 . 7. If the property designates a number of units that can be occupied only by persons with disabilities, indicate the number of units. If the property does not have units that can only be occupied by persons with disabilities, enter zero  0 . 8. If the property has units that must be occupied by non-elderly persons with disabilities, indicate the number of units. If the property does not have units that must be occupied by non-elderly persons with disabilities, enter zero  0 . CERTIFICATION: Self-Explanatory Must be signed and dated by the owner. SECTION II  Owner/Agent must respond to all questions in this section. 1. Enter the total number of units (by bedroom size) and enter total in the  Total column. Totals must match numbers entered for each bedroom size. 2. Enter the total number of units (by bedroom size) that are receiving project based rental assistance. Totals must match numbers entered for each bedroom size. 3. Enter the number of mobility accessible units by bedroom size, and enter the total in the  Total column. A mobility accessible unit is one that is located on an accessible route, and when designed, constructed, altered, or adapted, can be approached, entered, and used by individuals with physical disabilities, including those who use wheelchairs. Although accessibility features include items such as grab bars, flashing fire alarms, widened doorways, entrance ramps, etc, this question should be answered by stating the number of subsidized units that, when constructed, are fully accessible in accordance with the Uniform Federal Accessibility Standards (UFAS) which is used to ensure compliance with Section 504 of the Rehabilitation Act of 1973. These standards were jointly developed by the General Services Administration, the Department of Housing and Urban Development, the Department of Defense, and the United States Postal Service, under the authority of sections 2, 3, 4, and 4a, respectively, of the Architectural Barriers Act of 1968, as amended, Pub. L. No.90-480, 42 U.S.C. 4151-4157. Copies of the UFAS are available from the Architectural and Transportation Barriers Compliance Board , 1331 F Street, NW, Suite 1000, Washington, D.C. 20004-1111, Telephone: (202) 272-0080, email address:  HYPERLINK "mailto:info@access-board.gov" info@access-board.gov. If the property is accessible in accordance with Minimum Property Standards (MPS), indicate the number of units that are MPS accessible. Unsubsidized units should also be counted if they meet UFAS compliance requirements. Totals must match numbers entered for each bedroom size. 4. Enter the number of units, by bedroom size, that are accessible for vision or hearing disabilities and enter total in the  Total column. Refer to UFAS. See instruction number 3 above. Totals must match numbers entered for each bedroom size. 5. Total the units from rows 3 and 4 for each bedroom size, and enter the total in the  Total column. Totals must match numbers entered for each bedroom size. 6. Enter the number of persons currently on the waiting list for an accessible unit, by bedroom size, requiring the features of the unit and enter total in the  Total column. Total must match numbers entered for each bedroom size. 7. Enter the number of accessible units, by bedroom size, that are currently occupied by elderly or family tenants and enter total in the Total column. Total must match numbers entered for each bedroom size. 8. Enter the number of accessible units. by bedroom size, occupied by non-elderly tenants with disabilities requiring the features of the unit and enter total in the  Total column. These tenants must have a mobility impairment as defined above. Total must match numbers entered for each bedroom size. 9. Enter the number of accessible units, by bedroom size, occupied by elderly tenants with disabilities requiring the features of the unit and enter total in the  Total column. These tenants must have a mobility impairment as defined above. Total must match numbers entered for each bedroom size. 10. Self-explanatory 11. Self-explanatory 12. Self-explanatory CERTIFICATION: Self-Explanatory Must be signed and dated by the owner. SECTION III  Owner/Agent must respond to all questions in this section. This Section is not applicable to unsubsidized projects. The Section 504 Coordinator is required if the owner employs 15 or more people in all its activities. This includes this project combined with other projects they may own and/or manage. Answer Yes or No. If Yes, proceed to question 2; if No, skip to question 3. Answer Yes or No to this question. If Yes, please provide the name and telephone number of the coordinator for Section 504 related activities at the project, and go to question 3. Answer Yes or No to each item and provide comments as necessary. CERTIFICATION: Self-Explanatory Must be signed and dated by the owner. Project Name:  REF ProjName \h   FHA/Project#  REF ProjNo \h   Section 8/PAC/PRAC#  REF ProjContractNo \h   PART B On-Site Limited Monitoring Review Authority: 24 CFR 5, 108, 110 Questions 1 through 5 apply to owners of subsidized and unsubsidized projects. YESNOCOMMENTS1. Was this project built or substantially rehabilitated after February 1972? (If NO, skip to Question 5.) FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      2. Does the owner have an approved Affirmative Fair Housing Marketing Plan (AFHMP)?  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      3. If there is an approved AFHMP as indicated in question 2, is it available on site? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      4. Has the owner/agent reviewed the AFHMP within the last 5 years to ensure that the information is current and applicable? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      5. Date of last AFHMP Update  Date:  FORMTEXT       6. Does the project maintain Project Profile Data which shows the composition of the occupants by the following categories (24 CFR 121):Race  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       National Origin/Ethnicity  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       Sex  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       Disability  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       Familial Status  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       7. Has the owner/agent developed and implemented a written Tenant Selection plan?  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT        Project Name:  REF ProjName \h   FHA/Project#  REF ProjNo \h   Section 8/PAC/PRAC#  REF ProjContractNo \h   YESNOCOMMENTS8. Does the management agent maintain a waiting list of applicants by: (a) Name FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       (b) Bedroom size  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       (c) Application date and time? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       (d) Requests for accommodations and/or accessible units? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       (e) Preferences? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       9. When a tenant/applicant notifies the owner/agent that he/she has been subject to unlawful discrimination, does the owner/agent provide the applicant/tenant with information about how to file a complaint with HUD?  FORMCHECKBOX  FORMCHECKBOX  Unable to Observe  FORMTEXT       10. Does the owner/agent maintain a record of fair housing complaints? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       11. Is there a local residency preference? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT        If yes, was it approved by HUD?  FORMCHECKBOX  FORMCHECKBOX Date of HUD Approval:  FORMTEXT        Project Name:  REF ProjName \h   FHA/Project#  REF ProjNo \h   Section 8/PAC/PRAC#  REF ProjContractNo \h   Part C Section 504 Review The reviewer must complete this section to ensure compliance with Section 504 of the Rehabilitation Act of 1973 (Section 504). Please note that unsubsidized projects are not required to comply with Section 504, therefore if the project is unsubsidized, the reviewer may proceed to Part D. YESNOCOMMENTS1. Is there a formal, written grievance procedure that provides for resolution of complaints alleging discrimination based on disability, as required by Section 8.53(b)?  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT        If Yes, document date procedures were adopted:  Date:  FORMTEXT       2. Does the owner/agent utilize a telecommunications device for the hearing impaired (TTY)? FORMCHECKBOX  FORMCHECKBOX  FORMTEXT        If No, Is there an alternative method? Describe under  Comments  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       3. When necessary, are auxiliary aides used to communicate with persons with disabilities? Describe under  Comments  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT        Project Name:  REF ProjName \h   FHA/Project#  REF ProjNo \h   Section 8/PAC/PRAC#  REF ProjContractNo \h   PART D DOCUMENTS REVIEWER SHOULD OBTAIN FROM OWNER/AGENT The reviewer will only bring back documents upon request from FHEO. If the reviewer receives a request from FHEO to obtain certain documents, indicate in column a. During the on-site review, request the documents and indicate the status in columns b, c, or d. For items checked in column c, the reviewer must provide the owner/agent the FHEO address for forwarding the documents. Document(s) a. FHEO has requested that the reviewer obtain the following documents: b. The document has been gathered and is attached to the Checklistc. The Owner/ Agent agrees to forward the checked document to FHEO within ten (10) business days. d. The document is not available. For Part AAccessible Units/Program Accessibility, Sections I, II, and III (as applicable)  FORMCHECKBOX  FORMCHECKBOX For Part B:Most recent Affirmative Fair Housing Marketing Plan (AFHMP)  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Any of the following documents that are used for outreach as specifically stated in the project s AFHMP or used for other affirmative fair housing marketing. Newspapers/Publications FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Copy of Radio Ads and Announcements FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Copy of TV Ads and Announcements FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Photograph of billboards FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Letterhead FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Handouts FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Brochures and Leaflets FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Photograph and site signs FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Other (Specify):  FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Project Profile showing occupancy data (See Part B, Question 5). FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Written Tenant Selection Plan  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  Project Name:  REF ProjName \h   FHA/Project#  REF ProjNo \h   Section 8/PAC/PRAC#  REF ProjContractNo \h   Please Note: The information below only pertains to Section 504 compliance. If this project is unsubsidized, the reviewer should not complete this section. a. FHEO has requested that the reviewer obtain the following documents:b. The document has been gathered and is attached to the Checklist. c. The Owner/ Agent agrees to forward the checked document to FHEO within ten (10) business days.The document is not available.For Part C: Written Grievance Procedure (Part C, Question 3 and 24 CFR 8.53) FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Application for Occupancy  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Reasonable Accommodation Policy FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FHEO requested that the reviewer observe the following:  FORMTEXT       The result of the observation is:  FORMTEXT       Project Name:  REF ProjName \h   FHA/Project#  REF ProjNo \h   Section 8/PAC/PRAC#  REF ProjContractNo \h   Instructions: Reviewers should place a check mark next to those items that must be available for review. Included in this list are FHEO staff instructions to provide MFH staff a list of requests for documents and special observations each year. General Documents  FORMCHECKBOX  All Tenant Files and records, including rejected, transfer and move-out files  FORMCHECKBOX  Current waiting list `  FORMCHECKBOX  Last advertisement and/or copies of apartment brochures  FORMCHECKBOX  HUD-approved Rent Schedule form HUD-92458  FORMCHECKBOX  Procurement Files  FORMCHECKBOX  Work Order Journals and Logs  FORMCHECKBOX  Cash Disbursement Journal  FORMCHECKBOX  Fidelity Bond  FORMCHECKBOX  Property and Liability Insurance  FORMCHECKBOX  Copies of the form HUD-52670 for the last twelve months, for each subsidy contract  FORMCHECKBOX  Current annual budget  FORMCHECKBOX  Quarterly budget variance reports  FORMCHECKBOX  Reserve for Replacement component analysis  FORMCHECKBOX  Copy of Rent Roll  FORMCHECKBOX  Copy of Application form  FORMCHECKBOX  Copy of lease, lease addenda and house rules  FORMCHECKBOX  Copy of Pet Policy  FORMCHECKBOX  Copy of Applicant Rejection Letter  FORMCHECKBOX  Annual Unit Inspections  FORMCHECKBOX  Fact Sheet  How Your Rent Is Determined  FORMCHECKBOX  Copy of the  Resident Rights & Responsibility  FORMCHECKBOX  Lead Based Paint Certifications  FORMCHECKBOX  EH& S Certifications  FORMCHECKBOX  All Operating Procedure Manuals  FORMCHECKBOX  Documentation for Elderly Preferences Under Sections 651 or 658  FORMCHECKBOX  Income Targeting and Tracking Log  FORMCHECKBOX  List of all current Principals and Board Members  FORMCHECKBOX  EIV Coordinator Access Authorization form(s) (CAAFs)  approved initial and current  FORMCHECKBOX  EIV User Access Authorization form(s) (UAAFs)  approved initial and current  FORMCHECKBOX  EIV Owner Approval Letter(s)  FORMCHECKBOX  EIV Policies and Procedures  FORMCHECKBOX  Rules of Behavior for individuals without access to the EIV system  FORMCHECKBOX  Copy of TRACS Rules of Behavior, signed and dated  FORMCHECKBOX  Copy of TRACS and EIV requested Security Awareness Training Certificate, signed and dated  FORMCHECKBOX  Other Civil Rights Front End Limited Monitoring and Section 504 Review Documents  FORMCHECKBOX  Affirmative Fair Housing Marketing Plan  FORMCHECKBOX  Tenant Selection Plan, including any approved residency preference  FORMCHECKBOX  Recent advertising  FORMCHECKBOX  Fair Housing logo and Fair Housing poster Project Name:  REF ProjName \h  FHA /Project Number:  REF ProjNo \h  Section 8/PAC/PRAC Number:  REF ProjContractNo \h   Instructions: Reviewers should record the below statistics on households that include a household member who is subject to a state lifetime sex offender registration requirement. 1. Number of households where, in accordance with the owner s policies and procedures, a household member subject to a state lifetime sex offender registration requirement was identified at re-certification.  FORMTEXT     Of the households identified at re-certification: a. How many were admitted prior to June 25, 2001, the effective date of the Screening and Eviction for Drug Abuse and Other Criminal Activitiy final rule, and who had a household member subject to a state lifetime sex offender registration requirement at the time of admission?  FORMTEXT     NOTE: These households (admitted prior to June 25, 2001) must not be evicted unless they commit criminal activity while living in the federally assisted housing or have other lease violations. b. How many were erroneously admitted?  FORMTEXT     c. How many households include a member that became subject to a state lifetime sex offender requirement after admission?  FORMTEXT     2. Number of evictions due to the erroneous admission of a household with a member subject to a state lifetime sex offender registration requirement?  FORMTEXT     Number of such evictions upheld in court.  FORMTEXT     3. Number of evictions due to a household member becoming subject to a state lifetime sex offender registration requirement after admission.  FORMTEXT     Number of such evictions upheld in court.  FORMTEXT      A  preference allows an owner to give priority to elderly persons when selecting tenants for occupancy.     Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing Commissioner OMB Approval No. 2502-0178 Exp. 02/28/2015Summary form HUD-9834 (11/2012) Ref. HUD Handbook 4350.1, REV-1 and HUD Handbook 4566.2 Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing Commissioner OMB Approval No. 2502-0178 Exp. 02/28/2015 form HUD-9834 (11/2012) Ref. HUD Handbook 4350.1, REV-1 and HUD Handbook 4566.2 Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing Commissioner OMB Approval No. 2502-0178 Exp. 02/28/2015Desk Review (Continued) form HUD-9834 (11/2012) Ref. HUD Handbook 4350.1, REV-1 and HUD Handbook 4566.2 Page  PAGE 18 of  SECTIONPAGES \* Arabic \* MERGEFORMAT 19 Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing Commissioner OMB Approval No. 2502-0178 Exp. 02/28/2015 Part I Desk Review form HUD-9834 (11/2012) Ref. HUD Handbook 4350.1, REV-1 and HUD Handbook 4566.2 Page  PAGE 1 of 6 Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing Commissioner OMB Approval No. 2502-0178 Exp. 02/28/2015On-Site Review (Continued) Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing Commissioner OMB Approval No. 2502-0178 Exp. 02/28/2015 Part II On-Site Review form HUD-9834 (11/2012) Ref. HUD Handbook 4350.1, REV-1 and HUD Handbook 4566.2 Page  PAGE 1 of  SECTIONPAGES \* Arabic \* MERGEFORMAT 19 ADDENDUM A Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing Commissioner OMB Approval No. 2502-0178 Exp. 02/28/2015Tenant File Review (Continued) ADDENDUM A Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing Commissioner OMB Approval No. 2502-0178 Exp. 02/28/2015 Tenant File Review Worksheet form HUD-9834 (11/2012) Ref. HUD Handbook 4350.1, REV-1 and HUD Handbook 4566.2 Page  PAGE 1 of  SECTIONPAGES \* Arabic \* MERGEFORMAT 5 ADDENDUM B Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing CommissionerOMB Approval No. 2502-0178 Exp. 11/30/2011Checklist for On-Site Limited Monitoring and Section 504 Reviews Continued) form HUD-9834 (11/2012) Ref. HUD Handbook 4350.1, REV-1 and HUD Handbook 4566.2 Page  PAGE 13 of  SECTIONPAGES \* Arabic \* MERGEFORMAT 13 ADDENDUM B Management Review for Multifamily Housing Projects U.S. Department of Housing and Urban Development Office of Housing  Federal Housing Commissioner OMB Approval No. 2502-0178 Exp. 02/28/2015 Office of Fair Housing and Equal Opportunity And Office of Multifamily Housing Checklist for On-Site Limited Monitoring and Section 504 Reviews Page  PAGE \* MERGEFORMAT 1 of  SECTIONPAGES \* Arabic \* MERGEFORMAT 13 ADDENDUM B Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing CommissionerOMB Approval No. 2502-0178 Exp. 02/28/2015Checklist for On-Site Limited Monitoring and Section 504 Reviews (Continued) form HUD-9834 (08/2010) Ref. HUD Handbook 4350.1, REV-1 and HUD Handbook 4566.2 Page 1 of 1 ADDENDUM C Management Review for Multifamily Housing ProjectsU.S. Department of Housing and Urban Development Office of Housing  Federal Housing CommissionerOMB Approval No. 2502-0178 Exp. 02/28/2015 DOCUMENTS TO BE MADE AVAILABLE BY OWNER/AGENT form HUD-9834 (11/2012) Ref. 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DocumentLibraryFormDocumentLibraryFormDocumentLibraryForm   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89qCompObjYrRoot Entry F`7/Ml Data 71Table$ #`WordDocument-l ~                           ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? @ A B C D E F G H I J K L M N O P Q R S T V W X Y Z [ \    !"#$%&'()*+,-./012345689:;<=>?@ABCDFGHJKLMNPQRTUVWXZ\]^_`abcdefghijk X,4 h, 4 _PID_HLINKS_AdHocReviewCycleID_NewReviewCycle_EmailSubject _AuthorEmail_AuthorEmailDisplayName_PreviousAdHocReviewCycleID ContentTypeIdA K.Fmailto:info@access-board.govTHChttp://www.hudclips.org/:ܵL,0x010100648E2DA987CA4F4FBD5FE124772AA99E New 9834Michael.A.Sharkey@hud.govSharkey, Michael ASummaryInformation(U DocumentSummaryInformation8[,MsoDataStore pk^kUPPDJ3EVU2J1==2pk 8ks>  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q՜.+,D՜.+,< hp|  ATS # 9 Management Review Title