Form HUD-52306 Request for Technical Review (TR) or Database Adjustment

EXHIBIT E OMB No.2577-0257; Expires / /

Office of Public Housing Real Estate Assessment Center
Request for Technical Review (TR) or Database Adjustment (DBA) of Physical Inspection Report

­­Public Reporting Burden for this information collection is estimated to average 8 hours per respondent, including time for reviewing the inspection, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection. This information is being collected to fulfill regulatory requirements that allow public housing agencies and multifamily property owners/agents to submit a technical review or database adjustment for the purpose of reviewing a physical inspection report and ensure accurate assessments and scores. Responses are required to obtain or retain benefits. Respondents are not required to respond to this information collection unless a current, valid OMB control number is displayed on this form.

Inspection Number_________________________

Inspection Date____________________________

Project/Property Name ______________________

Date of Request ___________________________

TR or DBA ________________________________

Project ID Number ___________________________

Address of Property___________________________

City, State, Zip_______________________________

Contact Name________________________________

Issue #

Location (Inspectable Area) Building Number Unit Number Documentation Type (photo, text, video)

Item and Deficiency /Observation

Reason for Request

Additional Comments

Issue #

Location (Inspectable Area) Building Number Unit Number Documentation Type (photo, text, video)

Item and Deficiency /Observation

Reason for Request

Additional Comments

Issue #

Location (Inspectable Area) Building Number Unit Number Documentation Type (photo, text, video)

Item and Deficiency /Observation

Reason for Request

Additional Comments

Form-HUD 52306