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

EXHIBIT E

OMB No.2577-0257; Expires 04 /30/2021

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 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_________________________

Project ID Number ___________________________

Inspection Date____________________________

Address of Property___________________________

Project/Property Name ______________________

City, State, Zip_______________________________

Date of Request ___________________________

Contact Name________________________________

TR or DBA ________________________________
Issue #
Location (Inspectable Area)

Building Number

Unit Number

Documentation Type (photo, text, video)

Unit Number

Documentation Type (photo, text, video)

Unit Number

Documentation Type (photo, text, video)

Item and Deficiency /Observation

Reason for Request

Additional Comments

Issue #
Location (Inspectable Area)

Building Number

Item and Deficiency /Observation

Reason for Request

Additional Comments

Issue #
Location (Inspectable Area)

Building Number

Item and Deficiency /Observation

Reason for Request

Additional Comments

Form-HUD 52306