LEAD SAFE HOUSING REQUIREMENTS SCREENING WORKSHEET

**This worksheet should be placed in the project file for any
residential property that is assisted with Federal funds. Parts 1 and 2
should be completed for all projects. Parts 3 and 4 should be completed
for rehabilitation projects.**

Property Owner and Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Part 1: Exemptions from All Requirements of 24 CFR Part 35

*If the answer to any of the following questions is yes, the property is
exempt from the requirements of 24CFR Part 35. The regulatory citation
of each exemption is cited as additional guidance.*

-   Was the property constructed after January 1, 1978? \[35.115(a)(1)\]
    YES NO

-   Is this a zero-bedroom unit? (e.g. SRO, efficiency) \[35.115(a)(2)\]
    YES NO

-   Is this dedicated elderly [^1] housing? (i.e. over age 62)
    \[35.115(a)(3)\] YES NO

-   Is this housing dedicated for the disabled [^2]? \[35.115(a)(3)\]
    YES NO

-   Has a paint inspection conducted in accordance with 35.1320(a)
    established

> that the property is free of lead-based paint? \[35.115(a)(4)\] YES NO

-   The date of the original paint inspection was \_\_\_\_\_\_\_\_\_. An
    optional paint

> inspection conducted on\_\_\_\_\_\_\_\_ confirmed this prior finding.

-   Has all lead-based paint in the property been identified and
    removed, and

has clearance been achieved as cited below? \[35.115(a)(5)\] YES NO

-   Clearance was achieved prior to September 15, 2000, and the work was

> done in accordance with 40CFR Part 745.227(b). YES NO

-   Clearance was achieved after September 15, 2000, and the work was

> done in accordance with 24CFR Part 35.1320, 1325 and 1340. YES NO

-   Will a currently vacant unit remain vacant until it is demolished?
    YES NO

> \[35.115(a)(6)\]

-   Is the property used for non-residential purposes? [^3]
    \[35.115(a)(7)\] YES NO

-   Will any rehab **exclude** disturbing painted surfaces?
    \[35.115(a)(8)\] YES NO

-   Are emergency actions immediately necessary to safeguard against
    imminent

> danger to human life, health or safety, or, to protect the property
> from further
>
> structural damage? (e.g. after natural disaster or fire)
> \[35.115(a)(9)\] YES NO

-   Will the unit be occupied for less than 100 days under emergency
    leasing

assistance to an eligible household? [^4] \[35.115(a)(11)\] YES NO

## Part 2: Limited Exemptions from Specific Hazard Reduction Requirements

The HUD Final Rule allows for limited exemptions from specific
requirements due to the characteristics of the rehabilitation work, the
structure or the occupants. If the answer to any of the following
questions is yes, the grantee and/or occupant [may]{.underline} waive
certain requirements as described below.

-   Is the amount of painted surface that is being disturbed below "de
    minimis" levels, as defined below? If so, safe work practices and
    clearance are not required in that work area.

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-   Less than 20 square feet on an exterior surface \[35.1350(d)(1)\]
    YES NO

-   Less than 2 square feet in any single interior room
    \[35.1350(d)(2)\] YES NO

-   Less than 10% of surface area of an interior/exterior component YES
    NO

> \[35.1350(d)(3)\]

-   Is the unit occupied by an elderly person(s)? If so, relocation of
    the elderly

> occupant(s) is not required if complete disclosure of the nature of
> the work
>
> is provided and informed consent is obtained prior to
> rehabilitation.[^5] YES NO

-   Is a unit that is subject to abatement requirements listed or
    eligible for listing on

the National Register of Historic Places, or does it contribute to a
National

Register Historic District? If so, the State Historic Preservation
Office may

request that interim controls be implemented rather than abatement.
On-going

maintenance and re-evaluation is required. \[35.115(13)\] YES NO

*I have evaluated the site and property, the work specifications, and
interviewed the occupants. In my professional opinion, this unit
qualifies for the indicated exemption(s).*

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature Date

[^1]: Defined as retirement communities or similar types of housing
    reserved for households composed of one or more persons over age 62,
    or other age if recognized by a specific Federal housing assistance
    program. However, if a child under age 6 resides or is expected to
    reside in such a unit, the unit is not exempt.

[^2]: The housing must be a residential property designated exclusively
    for persons with disabilities, defined as any person who has a
    physical or mental impairment that substantially limits one or more
    major life activities, has a record of impairment, or is regarded by
    others as having such an impairment. However, if a child under age 6
    resides or is expected to reside in such a unit, the unit is not
    exempt.

[^3]: Except that spaces such as entryways, hallways, stairways, etc.
    serving both residential and non-residential uses in a mixed-use
    property are not exempt.

[^4]: When a household is provided short-term emergency leasing
    assistance and will occupy a unit for less than 100 days, the unit
    is exempt from lead paint regulations. This emergency leasing
    exemption is attached to the unit, not the family, and is a one-time
    exemption. After being assisted for a total of 100 consecutive days,
    the unit becomes subject to regular Subpart K requirements. Multiple
    families cannot be cycled through the same unit at intervals of less
    than 100 days under this exemption.

[^5]: HUD Interpretive Guidance, April 16, 2001, question \# J-24.