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Sample Move-In/Move-Out Inspection Form

2. SAMPLE FORMATS

HUD Handbook 4350.3 REV-1 — Occupancy Requirements of Subsidized Multifamily Housing Programs · 2026 edition · updated 2026-07-29 · United States

The two sample formats on the next page can be used to verify an applicant/tenant’s disability status for purposes of eligibility for occupancy in properties/units where occupancy is restricted to disabled families or persons with disabilities, or for income deductions based on disability when determining an applicant/tenant’s adjusted income.

Please note that if Item 4, on either sample format, is checked “YES”, the applicant/tenant does not meet HUD’s definition of disability.

HUD Occupancy Handbook Appendix 6-C: Guidance About Types of Information to Request When Verifying Eligibility and Income

6/07

1

4350.3 REV-1

Appendiix 6-B

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▸Contents — HUD Handbook 4350.3 REV-1 — Occupancy Requirements of Subsidized Multifamily Housing Programs
HUD Handbook 4350.3 REV-1 — Occupancy Requirements of Subsidized Multifamily Housing Programs
  1. HUD Handbook 4350.3: Occupancy Requirements of Subsidized Mult…
  2. Exhibit 3-12: Section 8, RAP, and Rent Supplement Programs – S…
  3. Exhibit 3-13: Section 236 Without Additional Assistance – Spec…
  4. Exhibit 3-14: Section 236 With Benefit of Additional Assistanc…
  5. Document Package for Applicant's/Tenant's Consent to the Relea…
  6. Exhibit 7-2: Sample Annual Recertification First Reminder Notice
  7. Exhibit 7-4: Sample Annual Recertification Third Reminder Noti…
  8. SAMPLE TENANT CONSENT TO DISCLOSE EIV INCOME INFORMATION
  9. Applying the Model Lease for Subsidized Programs to Individual…
  10. Applying the Model Leases for Section 202 PRAC and Section 811…
  11. ▸Sample Move-In/Move-Out Inspection Form
    Overview
    1. Appendix 5: Sample Move-In/Move-Out Inspection Form
    2. APPENDIX 6: VERIFICATION AND CONSENT – GUIDANCE AND SAMPLE FOR…
    3. Appendix 6-A: Guidance for Development of Individual Consent F…
    4. EXAMPLE – Information That Is Not Necessary to Determine Eligi…
    5. 2. SAMPLE VERIFICATION CONSENT FORMAT
    6. SAMPLE VERIFICATION CONSENT
    7. INFORMATION BEING REQUESTED
    8. PENALTIES FOR MISUSING THIS CONSENT:
    9. Appendix 6-B: Verification of Disability – Instructions to Own…
    10. 1. EXPLANATION TO THE APPLICANT
    11. 2. SAMPLE FORMATS
    12. FOR USE WITH SECTION 202/8 , SECTION 202 PAC , Section 202 PRA…
    13. Appendix 6-C: Guidance About Types of Information to Request W…
    14. 1. Relevant information to verify with third party:
    15. 2. Acceptable forms of verification:
    16. B. Date Employment Terminated
    17. C. Social Security and Supplementary Security Income (SSI)
    18. 2) Acceptable forms of verification:
    19. D. Pensions and Disability Income Other Than from the Social S…
    20. 1. Relevant information to verify with third party:
    21. E. Unemployment Compensation
    22. 2. Acceptable forms of verification:
    23. G. Alimony or Child Support Payments
    24. H. Net Income from a Business
    25. Recurring Gifts
    26. K. Assets Disposed of for Less than Fair Market Value During T…
    27. L. Income from Sale of Real Property Pursuant to a Purchase Mo…
    28. M. Rental Income from Property Owned by Applicant/Tenant
    29. Full-Time Student Status
    30. O. Child Care Expenses
    31. S. Family Type and Membership in Family
    32. T. Statutory and HUD Regulatory Preferences – Displacement by …
    33. 1. Relevant information to verify with third party:
  12. Memorandum February 5, 2002: Fact Sheets for Project-Based Ass…

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