HUD 90106 Appendix 5 - Sample Move-In/Move Out Inspection Form

4350.3 REV1

Appendix 5
OMB Approval 2502-0204
Exp. 04/30/2009

Appendix 5: Move-In/Move-Out Inspection Form
[Company name]
[Company address]
Property
Apartment No.

Item

Resident
Unit Size

Move-In Inspection Date

Cost to Correct

Condition
Move-In

Move-Out Inspection Date

Move-Out

ENTRANCE/HALLS
Steps and landings
Handrails
Doors
Hardware/Locks
Floors/Coverings
Walls/Coverings
Ceilings
Windows/Coverings
Lighting1
Electrical Outlets
Closets2
Fire alarms/equipment

LIVING ROOM
Floor/Coverings
Walls/Coverings
Ceiling
Windows/Covering
Lighting1
Electrical outlets

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Form HUD-90106
12/2007

4350.3 REV-1

Appendix 5
OMB Approval 2502-0204
Exp. 04/30/2009

Item

Condition
Move-In

Cost to Correct
Move-Out

DINING ROOM
Floor/Coverings
Walls/Coverings
Ceiling
Windows/Coverings
Lighting1
Electrical outlets

KITCHEN
Range
Refrigerator
Sink/Faucets3
Floor/Coverings
Walls/Coverings
Ceiling
Windows/Coverings
Lighting1
Electrical outlets
Cabinets
Closets/Pantry2
Exhaust fan
Fire alarms/equipment

BEDROOM(S)
Doors and locks
Floor/Coverings
Walls/Coverings
Ceiling
Windows/Covering
Closets2
Lighting1
Electrical outlets

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Form HUD-90106
12/2007

4350.3 REV-1

Appendix 5
OMB Approval 2502-0204
Exp. 04/30/2009

Item

Cost to Correct

Condition
Move-In

Move-Out

BATHROOM(S)
Sink/Faucets3
Shower/Tub3
Curtain rack/Door
Towel rack
Toilet
Doors/Locks
Floor/Coverings
Walls/Coverings
Ceiling
Windows/Coverings
Closets2
Cabinets
Exhaust fan
Lighting1
Electrical outlets

OTHER EQUIPMENT
Heating Equipment
Air-conditioning unit(s)
Hot-water heater
Smoke/Fire alarms
Thermostat
Door bell

TOTAL
1. Fixtures, Bulbs, Switches, and Timers
2. Floor/Walls/Ceiling, Shelves/Rods, Lighting
3. Water pressure and Hot water

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Form HUD-90106
12/2007

4350.3 REV-1

Appendix 5
OMB Approval 2502-0204
Exp. 04/30/2009

Move-In

Move-Out

This unit is in decent, safe and
sanitary condition. Any deficiencies
identified in this report will be remedied
within 30 days of the date the tenant
moves into the unit.

_______________________________
Manag er's Signature

_______________________________
Manag
er's Signature

Agree with move-out inspection
Disagree with move-out inspection

I have inspected the apartment and
found this unit to be in decent, safe
and sanitary condition. Any deficiencies
are noted above. I recognize that I am
responsible for keeping the apartment
in good condition, with the exception of
normal wear. In the event of damage, I
agree to pay the cost to restore the
apartment to its original condition.

If disagree, list specific items of
disa greement.

_______________________________
Re
sident's Signature

_______________________________
Re sident's Signature

_______________________________
Re
sident's Signature

_______________________________
Re sident's Signature

By

Date

By

Prepared

Prepared

Reviewed

Reviewed

Prepared

Prepared

Reviewed

Reviewed

Date

Public reporting burden - HUD is not requesting approval of any burden hours for the move-in/move-out inspection report since use of movein/move-out inspection reports are a standard business practice in the housing rental industry. This information is required to obtain benefits and
is voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB
control number. The owner/management agent and tenant together conduct a move-in/move-out inspection to document the condition of the unit
at the time of move-in/move-out. Conducting move-in/move-out inspections are a standard business practice in the housing rental industry and
are used for determining damages caused by the tenant during tenancy and allowable deductions from the tenant’s security deposit held by the
owner. This information is authorized by 24 CFR 5.703 and 5.705, 886.123, 886.223 cover unit inspections. This information is considered nonsensitive and does not require any special protection.

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Form HUD-90106
12/2007