Fillable Request for Tenancy Approval (Web Master Pulic Affair)

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Request for Tenancy Approval (Web Master Pulic Affair)

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BROWSE WEB MASTER PULIC AFFAIR (DC) FORMS

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form HUD-52517 (09/2014)
ref. Handbook 7420.8
Previous editions are obsolete
Page 1 of 2
1. Name of Public Housing Agency (PHA) 2. Address of Unit (street address, apartment number, city, State & zip code)
3. Requested Beginning Date of Lease 4. Number of Bedrooms 5. Year Constructed 6. Proposed Rent 7. Security Deposit Amt. 8. Date Unit Available for Inspection
Request for Tenancy Approval
Housing Choice Voucher Program
U.S. Department of Housing
and Urban Development
Office of Public and Indian Housing
OMB Approval No. 2577-0169
(exp.
09/30/2017)
Public reporting burden for this collection of information is estimated to average .08 hours per response, including the time f or reviewing instructions, searchingexisting data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not conductor sponsor, and a person is not required to
respond to, a collection of information unless that collection displays a valid OMB control number. TheDepartmentofHousingandUrbanDevelopment(HUD)isauthorizedtocollect
informationrequiredonthisformbySection8oftheU.S.HousingActof1937(42U.S.C.1437f).Collectionofthedataonthefamily'sselectedunitismandatory.Theinformationis
usedtodetermineiftheunit is eligibleforrentalassistance. HUDmaydisclosethisinformationtoFederal,State,andlocalagencies whenrelevantcivil,criminal,orregulatory
investigationsandprosecutions.ItwillnotbeotherwisedisclosedorreleasedoursideofHUD,exceptaspermittedorrequiredbylaw.Failuretoprovideanyoftheinformationmay
resultindelayorrejectionoffamilyvoucherassistance.
9. Type of House/Apartment
Single Family Detached Semi-Detached / Row House Manufactured Home Garden / Walkup Elevator / High-Rise
11. Utilities and Appliances
The owner shall provide or pay for the utilities and appliances indicated below by an " O”. The tenant shall provide or pay for the utilities and appliances indicated below
by a “T”. Unless otherwise specified below, the owner shall pay for all utilities and appliances provided by the owner.
Item Specify fuel type Provided by Paid by
Heating Natural gas Bottle gas Oil Electric Coal or Other
Cooking Natural gas Bottle gas Oil Electric Coal or Other
Water Heating Natural gas Bottle gas Oil Electric Coal or Other
Other Electric
Water
Sewer
Trash Collection
Air Conditioning
Refrigerator
Range/Microwave
Other (specify)
10. If this unit is subsidized, indicate type of subsidy
:
Section 202 Section 221(d)(3)(BMIR) Section 236 (Insured or noninsured) Section 515 Rural Development
Home Tax Credit
Other (Describe Other Subsidy, Including Any State or Local Subsidy)
form HUD-52517 (09/2014)
ref. Handbook 7420.8
Previous editions are obsolete
Page 2 of 2
Print or Type Name of Owner/Owner Representative Print or Type Name of Household Head
Signature Signature (Household Head)
Business Address Present Address of Family (street address, apartment no., city, State, & zip code)
Telephone Number Date (mm/dd/yyyy) Telephone Number Date (mm/dd/yyyy)
12. Owner's Certifications.
a. The program regulation requires the PHA to certify that the rent charged
to the housing choice voucher tenant is not more than the rent charged for
other unassisted comparable units. Owners of projects with more than 4
units must complete the following section for most recently leased
comparable unassisted units within the premises.
Address and unit number Date Rented Rental Amount
1.
2.
3.
b. The owner (including a principal or other interested party) is not the
parent, child, grandparent, grandchild, sister or brother of any member of the
family, unless the PHA has determined (and has notified the owner and the
family of such determination) that approving leasing of the unit, notwithstand-
ing such relationship, would provide reasonable accommodation for a family
member who is a person with disabilities.
c. Check one of the following:
_____ Lead-based paint disclosure requirements do not apply because this
property was built on or after January 1, 1978.
_____ The unit, common areas servicing the unit, and exterior painted
surfaces associated with such unit or common areas have been found to be
lead-based paint free by a lead-based paint inspector certified under the
Federal certification program or under a federally accredited State certifica-
tion program.
_____ A completed statement is attached containing disclosure of known
information on lead-based paint and/or lead-based paint hazards in the unit,
common areas or exterior painted surfaces, including a statement that the
owner has provided the lead hazard information pamphlet to the family.
13. The PHA has not screened the family’s behavior or suitability for
tenancy. Such screening is the owner’s own responsibility.
14. The owner’s lease must include word-for-word all provisions of the
HUD tenancy addendum.
15. The PHA will arrange for inspection of the unit and will notify the
owner and family as to whether or not the unit will be approved.
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Request for Tenancy Approval (Web Master Pulic Affair)

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Completed 7 February 2022

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