**PART A**

**OCCUPANCY/ACCESSIBLE UNITS/PROGRAM ACCESSIBILITY**

Authority:

Section 504 of the Rehabilitation Act of 1973 (24CFR Part 8)

Fair Housing Act/Title VIII Regulations (24 CFR Part 100.200)

Uniform Federal Accessibility Standards (UFAS) (24 CFR Part 40)

For this Section, the reviewer must forward the form along with the
instructions for completion to the owner/agent prior to the on-site
review. For subsidized projects, the owner/agent must complete the
project information above and the information in Sections I, II, and III
below. (See attached instructions.) For unsubsidized projects, the
owner/agent must complete the project information above and Sections I
and II only. Section III consists of Section 504 compliance, which does
not apply to projects that do not receive federal financial assistance.
The reviewer will obtain the completed form from the owner/agent during
the on-site review.

**SECTION I -- OCCUPANCY**

+----------------------+----------+---+---------+------------------------+
| 1\. This property    |          | 2 |         |                        |
| was designed         |          | \ |         |                        |
| primarily for:       |          | . |         |                        |
|                      |          | I |         |                        |
| Exclusively Elderly  |          | n |         |                        |
|                      |          | d |         |                        |
| Exclusively Disabled |          | i |         |                        |
|                      |          | c |         |                        |
| Elderly and Disabled |          | a |         |                        |
|                      |          | t |         |                        |
| Family               |          | e |         |                        |
|                      |          | t |         |                        |
|                      |          | h |         |                        |
|                      |          | e |         |                        |
|                      |          | n |         |                        |
|                      |          | u |         |                        |
|                      |          | m |         |                        |
|                      |          | b |         |                        |
|                      |          | e |         |                        |
|                      |          | r |         |                        |
|                      |          | o |         |                        |
|                      |          | f |         |                        |
|                      |          | u |         |                        |
|                      |          | n |         |                        |
|                      |          | i |         |                        |
|                      |          | t |         |                        |
|                      |          | s |         |                        |
|                      |          | c |         |                        |
|                      |          | u |         |                        |
|                      |          | r |         |                        |
|                      |          | r |         |                        |
|                      |          | e |         |                        |
|                      |          | n |         |                        |
|                      |          | t |         |                        |
|                      |          | l |         |                        |
|                      |          | y |         |                        |
|                      |          | o |         |                        |
|                      |          | c |         |                        |
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|                      |          | F |         |                        |
|                      |          | a |         |                        |
|                      |          | m |         |                        |
|                      |          | i |         |                        |
|                      |          | l |         |                        |
|                      |          | y |         |                        |
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|                      |          | . |         |                        |
|                      |          | u |         |                        |
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|                      |          | l |         |                        |
|                      |          | i |         |                        |
|                      |          | n |         |                        |
|                      |          | e |         |                        |
|                      |          | } |         |                        |
+----------------------+----------+---+---------+------------------------+
| 3\. Is there a use   |          |   |         |                        |
| agreement or any     |          |   |         |                        |
| other document that  |          |   |         |                        |
| indicates that this  |          |   |         |                        |
| project must serve   |          |   |         |                        |
| only elderly         |          |   |         |                        |
| tenants?             |          |   |         |                        |
|                      |          |   |         |                        |
| Yes No Unknown       |          |   |         |                        |
|                      |          |   |         |                        |
| If yes, specify type |          |   |         |                        |
| of document: [       |          |   |         |                        |
|    ]{.underline}     |          |   |         |                        |
| Effective Date:      |          |   |         |                        |
| [     ]{.underline}  |          |   |         |                        |
|                      |          |   |         |                        |
| **(Please attach a   |          |   |         |                        |
| copy of the          |          |   |         |                        |
| document(s)          |          |   |         |                        |
| indicated above.)**  |          |   |         |                        |
+----------------------+----------+---+---------+------------------------+
| 4\. If this project  |          |   |         |                        |
| is a "covered        |          |   |         |                        |
| Section 8 housing    |          |   |         |                        |
| project" (see        |          |   |         |                        |
| instructions), is    |          |   |         |                        |
| there an occupancy   |          |   |         |                        |
| preference for the   |          |   |         |                        |
| elderly in           |          |   |         |                        |
| accordance with      |          |   |         |                        |
| **Section 651** of   |          |   |         |                        |
| Title VI, Subtitle D |          |   |         |                        |
| of the Housing and   |          |   |         |                        |
| Community            |          |   |         |                        |
| Development Act of   |          |   |         |                        |
| 1992? (**Refer to    |          |   |         |                        |
| HUD Handbook 4350.3, |          |   |         |                        |
| REV-1**)             |          |   |         |                        |
|                      |          |   |         |                        |
| Yes No               |          |   |         |                        |
|                      |          |   |         |                        |
| If No, proceed to    |          |   |         |                        |
| question 5.          |          |   |         |                        |
+----------------------+----------+---+---------+------------------------+
| If yes, please       |          |   |         |                        |
| indicate:            |          |   |         |                        |
|                      |          |   |         |                        |
| a\. the date of the  |          |   |         |                        |
| elderly preference:  |          |   |         |                        |
| [                    |          |   |         |                        |
|  \_\_\_]{.underline} |          |   |         |                        |
|                      |          |   |         |                        |
| b\. the number of    |          |   |         |                        |
| units that must be   |          |   |         |                        |
| reserved for         |          |   |         |                        |
| occupancy by         |          |   |         |                        |
| non-elderly persons  |          |   |         |                        |
| with disabilities    |          |   |         |                        |
| [                    |          |   |         |                        |
| \_\_\_]{.underline}, |          |   |         |                        |
| and,                 |          |   |         |                        |
|                      |          |   |         |                        |
| c\. the date used to |          |   |         |                        |
| determine the number |          |   |         |                        |
| of units reserved    |          |   |         |                        |
| for non-elderly      |          |   |         |                        |
| persons with         |          |   |         |                        |
| disabilities         |          |   |         |                        |
| [                    |          |   |         |                        |
|  \_\_\_]{.underline} |          |   |         |                        |
+----------------------+----------+---+---------+------------------------+
| 5\. Is there an      |          |   |         |                        |
| occupancy            |          |   |         |                        |
| restriction for the  |          |   |         |                        |
| elderly in           |          |   |         |                        |
| accordance with      |          |   |         |                        |
| **Section 658** of   |          |   |         |                        |
| Title VI, Subtitle D |          |   |         |                        |
| of the Housing and   |          |   |         |                        |
| Community            |          |   |         |                        |
| Development Act of   |          |   |         |                        |
| 1992? (**Refer to    |          |   |         |                        |
| HUD Handbook 4350.3, |          |   |         |                        |
| REV-1**)             |          |   |         |                        |
|                      |          |   |         |                        |
| Yes No               |          |   |         |                        |
+----------------------+----------+---+---------+------------------------+
| Total Number of      | Total    |   |         | Total Number of Units  |
| Units Exclusively    | Number   |   |         | that must be occupied  |
| for the Elderly      | of Units |   |         | only by Non-Elderly    |
|                      | Exc      |   |         | Persons with           |
| [     ]{.underline}  | lusively |   |         | Disabilities           |
|                      | for      |   |         |                        |
|                      | Persons  |   |         | [     ]{.underline}    |
|                      | with     |   |         |                        |
|                      | Disa     |   |         |                        |
|                      | bilities |   |         |                        |
|                      |          |   |         |                        |
|                      | [        |   |         |                        |
|                      |    ]{.un |   |         |                        |
|                      | derline} |   |         |                        |
+----------------------+----------+---+---------+------------------------+
| I certify that this  |          |   |         |                        |
| information is true  |          |   |         |                        |
| and accurate.        |          |   |         |                        |
+----------------------+----------+---+---------+------------------------+
| **Warning:** HUD     |          |   |         |                        |
| will prosecute false |          |   |         |                        |
| claims and           |          |   |         |                        |
| statements.          |          |   |         |                        |
| Convictions may      |          |   |         |                        |
| result in criminal   |          |   |         |                        |
| and/or civil         |          |   |         |                        |
| penalties. (18       |          |   |         |                        |
| U.S.C. 1001, 1010,   |          |   |         |                        |
| 1012; 31 U.S.C.      |          |   |         |                        |
| 3729, 3802)          |          |   |         |                        |
+----------------------+----------+---+---------+------------------------+
| Signature of         |          |   | Date:   |                        |
| Owner/Agent          |          |   |         |                        |
|                      |          |   |         |                        |
+----------------------+----------+---+---------+------------------------+

**SECTION II -- ACCESSIBLE UNITS**

Distribution of all wheelchair and other accessible units in the
project.

+---------------------+----+----+---+---+---+----+------+------------+
| **Bedroom Size**    | *  | *  | * | * | * | *  | *    | **Total**  |
|                     | *0 | *1 | * | * | * | *5 | *Oth |            |
|                     | ** | ** | 2 | 3 | 4 | ** | er** |            |
|                     |    |    | * | * | * |    |      |            |
|                     |    |    | * | * | * |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 1\. All units       |    |    |   |   |   |    |      |            |
|                     |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 2\. Total units     |    |    |   |   |   |    |      |            |
| with project-based  |    |    |   |   |   |    |      |            |
| rental assistance   |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 3\. Mobility        |    |    |   |   |   |    |      |            |
| *accessible* units  |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 4\. Vision and/or   |    |    |   |   |   |    |      |            |
| Hearing             |    |    |   |   |   |    |      |            |
|                     |    |    |   |   |   |    |      |            |
| *accessible* units  |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| **\***5. (Total     |    |    |   |   |   |    |      |            |
| Accessible Units)   |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 6\. Number of       |    |    |   |   |   |    |      |            |
| persons on waiting  |    |    |   |   |   |    |      |            |
| list who have       |    |    |   |   |   |    |      |            |
| requested           |    |    |   |   |   |    |      |            |
| *accessible* units  |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 7\. Number of       |    |    |   |   |   |    |      |            |
| accessible units    |    |    |   |   |   |    |      |            |
| *occupied* by       |    |    |   |   |   |    |      |            |
| elderly or family   |    |    |   |   |   |    |      |            |
| tenants             |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 8\. Number of       |    |    |   |   |   |    |      |            |
| *accessible* units  |    |    |   |   |   |    |      |            |
| occupied by         |    |    |   |   |   |    |      |            |
| non-elderly tenants |    |    |   |   |   |    |      |            |
| with disabilities   |    |    |   |   |   |    |      |            |
| who require the     |    |    |   |   |   |    |      |            |
| features of the     |    |    |   |   |   |    |      |            |
| unit                |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 9\. Number of       |    |    |   |   |   |    |      |            |
| *accessible* units  |    |    |   |   |   |    |      |            |
| occupied by elderly |    |    |   |   |   |    |      |            |
| tenants with        |    |    |   |   |   |    |      |            |
| disabilities who    |    |    |   |   |   |    |      |            |
| require the         |    |    |   |   |   |    |      |            |
| features of the     |    |    |   |   |   |    |      |            |
| unit                |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 10\. Percentage of  |    |    |   |   |   |    |      |            |
| Total Units with    |    |    |   |   |   |    |      |            |
| Project-Based       |    |    |   |   |   |    |      |            |
| Rental Assistance   |    |    |   |   |   |    |      |            |
|                     |    |    |   |   |   |    |      |            |
| (Total line 2       |    |    |   |   |   |    |      |            |
| divided by Total    |    |    |   |   |   |    |      |            |
| line 1 x 100) [     |    |    |   |   |   |    |      |            |
|  ]{.underline}%     |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 11\. Percentage of  |    |    |   |   |   |    |      |            |
| Total Units that    |    |    |   |   |   |    |      |            |
| are mobility        |    |    |   |   |   |    |      |            |
| accessible          |    |    |   |   |   |    |      |            |
|                     |    |    |   |   |   |    |      |            |
| (Total line 3       |    |    |   |   |   |    |      |            |
| divided by Total    |    |    |   |   |   |    |      |            |
| line 1 x 100) [     |    |    |   |   |   |    |      |            |
|     ]{.underline}%  |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+
| 12\. Percentage of  |    |    |   |   |   |    |      |            |
| Total Units that    |    |    |   |   |   |    |      |            |
| are vision and/or   |    |    |   |   |   |    |      |            |
| hearing accessible  |    |    |   |   |   |    |      |            |
|                     |    |    |   |   |   |    |      |            |
| (Total line 4       |    |    |   |   |   |    |      |            |
| divided by Total    |    |    |   |   |   |    |      |            |
| line 1 x 100) [     |    |    |   |   |   |    |      |            |
|     ]{.underline}%  |    |    |   |   |   |    |      |            |
+---------------------+----+----+---+---+---+----+------+------------+

**\*If a unit is both mobility accessible and vision or hearing
accessible, count the unit only once in line 5.**

+-----------------------------------+----------------------------------+
| I certify that this information   |                                  |
| is true and accurate.             |                                  |
+-----------------------------------+----------------------------------+
| **Warning:** HUD will prosecute   |                                  |
| false claims and statements.      |                                  |
| Convictions may result in         |                                  |
| criminal and/or civil penalties.  |                                  |
| (18 U.S.C. 1001, 1010, 1012; 31   |                                  |
| U.S.C. 3729, 3802)                |                                  |
+-----------------------------------+----------------------------------+
| Signature of Owner/Agent          | Date:                            |
|                                   |                                  |
|                                   |                                  |
+-----------------------------------+----------------------------------+

**SECTION III -- PROGRAM ACCESSIBILITY**

Section 504 of the Rehabilitation Act of 1973

Section 504 Coordinator \[24 CFR 8.53 (a)\]

1\. Does the recipient (as defined in 24 CFR 8.3) employ at least 15
employees?

Yes No

If "Yes", answer Question 2.; If "No" skip to Question 3.

2\. Is at least one person designated to coordinate its Section 504
responsibilities?

> Yes No N/A

**If YES,** provide the person's name and telephone number below.

Name: [      ]{.underline}

Telephone Number: [      ]{.underline}

[Program Accessibility]{.underline} Under Section 504, a federally
assisted Housing Development is required to ensure that its program is
usable by and accessible to persons with disabilities. This includes,
but is not limited to, maintaining housing and non-housing facilities
that are structurally accessible for persons with disabilities. The
extent to which facilities must be structurally accessible depends in
part, on whether they are new, altered, or existing. In addition,
owner/agents are required to ensure that effective communication methods
are used while communicating with persons with disabilities.

+------------------------------+---+-----+-------+---------------------+
|                              | * |     | # NO  | # COMMENTS          |
|                              | * |     |       |                     |
|                              | Y |     |       |                     |
|                              | E |     |       |                     |
|                              | S |     |       |                     |
|                              | * |     |       |                     |
|                              | * |     |       |                     |
+------------------------------+---+-----+-------+---------------------+
| 3\. Has the owner/agent      |   |     |       |                     |
| taken steps to ensure        |   |     |       |                     |
| effective communication      |   |     |       |                     |
| using:                       |   |     |       |                     |
+------------------------------+---+-----+-------+---------------------+
| > a\. Qualified sign         |   |     |       |                     |
| > language and oral          |   |     |       |                     |
| > interpreters?              |   |     |       |                     |
+------------------------------+---+-----+-------+---------------------+
| b\. Readers?                 |   |     |       |                     |
+------------------------------+---+-----+-------+---------------------+
| c\. Use of tapes?            |   |     |       |                     |
+------------------------------+---+-----+-------+---------------------+
| d\. Braille materials?       |   |     |       |                     |
+------------------------------+---+-----+-------+---------------------+
| > Other (Describe):          |   |     |       |                     |
+------------------------------+---+-----+-------+---------------------+
| I certify that this          |   |     |       |                     |
| information is true and      |   |     |       |                     |
| accurate.                    |   |     |       |                     |
+------------------------------+---+-----+-------+---------------------+
| **Warning:** HUD will        |   |     |       |                     |
| prosecute false claims and   |   |     |       |                     |
| statements. Convictions may  |   |     |       |                     |
| result in criminal and/or    |   |     |       |                     |
| civil penalties. (18 U.S.C.  |   |     |       |                     |
| 1001, 1010, 1012; 31 U.S.C.  |   |     |       |                     |
| 3729, 3802)                  |   |     |       |                     |
+------------------------------+---+-----+-------+---------------------+
| Signature of Owner/Agent     |   | Da  |       |                     |
|                              |   | te: |       |                     |
|                              |   |     |       |                     |
|                              |   |     |       |                     |
|                              |   |     |       |                     |
+------------------------------+---+-----+-------+---------------------+

#  

**Instructions for completing part a**

**General instructions:** Complete the project name, FHA/project number,
and section 8/pac/prac information in the form header for each page:

***section i - Owner/Agent must respond to all questions in this
section.***

1\. Check the appropriate box that the project was designed to serve.
**(Check only one box. Do not leave blank.)**

> **Exclusively Elderly** - defined as a person 62 years of age or
> older. (This option is for projects that were designed to serve only
> elderly persons/families, i.e. Section 202 PRAC properties)
>
> **Exclusively Disabled** -- Refer to HUD Handbook 4350.3, REV-1,
> Figure 3-6 for the applicable definition of disability. (This option
> is for projects that were designed to serve only persons with
> disabilities, i.e., Section 202/8 Projects for the Disabled and
> Section 811 projects. Please note that Section 202-8 Projects for the
> Disabled were developed to serve only nonelderly persons with
> disabilities. However, the Section 811 Projects were developed to
> serve persons with disabilities regardless of age as long as the
> minium age requirement (age 18) is met.)
>
> **Elderly and Disabled** -- defined as a property that serves the
> elderly and nonelderly persons with disabilities. (This option is for
> projects that were originally designed to serve only elderly
> persons/families, however the owner may have elected a preference
> under Section 651 of Title VI, Subtitle D of the Housing and Community
> Development Act of 1992 (Title VI-D) to reserve a percentage of units
> for nonelderly persons with disabilities in accordance with the
> provisions of Section 652, Title VI-D. See instruction 4 below for
> Section 651 definition.)
>
> **Family** -- defined as all persons regardless of age or disability.
> (This option is for projects that serve all families with no
> restrictions or preferences as long as the minimum age requirement is
> met. Please note that family projects may have some units that are
> reserved for persons with mobility/vision/hearing impairments which
> would require the applicant to meet the needs of the unit.)

2\. Enter the number of units occupied by each client group. (Please
note that the term "near-elderly disabled" is defined as a person who is
at least 50 years of age and below the age of 61 with a disability as
defined in HUD Handbook 4350.3, REV-1.) **(Enter zero "0" if there are
no units occupied by the listed client group -- do not leave blank)**

3\. If there is a use agreement or other document that references that
the property must serve only elderly persons, answer "Yes", indicate in
the space provided, and attach a copy of the document(s) listed. If
there is no use agreement or other document that references that the
property must serve only elderly persons, answer "No". If you are
unclear on the term "use agreement," or are not able to locate the "use
agreement" or any other document that defines the occupancy of your
project, the answer is "unknown". Other documents include the regulatory
agreement, loan commitment papers, financial documents, bid invitation,
owner's management plan, application for funding, and/or application for
mortgage insurance. Please refer to HUD Handbook 4350.3, REV-1,
paragraphs 3-17 and 3-18. If you do not have a copy of HUD Handbook
4350.3, REV-1, copies can be obtained from
[www.hudclips.org](http://www.hudclips.org/) or the HUD Customer Service
Center at (800) 767-7468. (**Do not leave blank).**

4\. Section 651 of Title VI-D permits an owner to give \*preference to
elderly families if (1) the project was originally developed to serve
the elderly and (2) it is a "covered Section 8 housing project."
"Covered Section 8 housing projects" are projects that were constructed
or substantially rehabilitated pursuant to assistance provided under
section 8(b)(2) of the United States Housing Act of 1937, as in effect
before October 1, 1983, that are assisted under a contract for
assistance under such section.

\*A "preference" allows an owner to give priority to elderly persons
when selecting tenants for occupancy.

Section 651 of Title VI-D applies to the following programs:

-   The Section 8 New Construction Program, 24 CFR part 880

-   The Section 8 Substantial Rehabilitation Program, 24 CFR part 881

-   The State Housing Agencies Program (insofar as it involves new
    construction and substantial rehabilitation) , 24 CFR part 883

-   The New Construction Set-Aside for Section 515 Rural Rental Housing
    Projects Program, 24 CFR part 884

-   The Section 8 Housing Assistance Program for the Disposition of
    HUD-Owned Projects (insofar as it involves substantial
    rehabilitation), 24 CFR part 886 subpart C

"Covered Section 8 housing projects" **do not** include those developed
with funding under the following programs:

Section 202;

> Section 202/8;

Section 202 or 811 PRAC;

Section 221 (d)(3); and/or

Section 236.

If an owner elects a Section 651 preference for the elderly, the owner
must reserve a number of units for non-elderly persons/families with
disabilities. Title VI-D requires that the owner review the occupancy
records on January 1, 1992 and October 28, 1992 (the date of enactment
for Title VI-D), determine the number of non-elderly persons with
disabilities that occupied units on those two dates, take the higher of
the two numbers and then take the lesser of that number and 10 percent.

> For example, an owner has a "covered Section 8 project" that consists
> of 100 units and decides to implement an elderly preference under
> Section 651. The first thing the owner has to do is find the occupancy
> records for January 1992 and see how many units were occupied by
> non-elderly persons or families with disabilities on January 1. In
> this example, it was 10 units.

Then the owner must find the occupancy records for October 1992 and see
how many units were occupied by non-elderly persons/families with
disabilities on October 28^th^ (the date of the enactment of the Act).
In this example it was 15 units.

To obtain the number of units that must be reserved for non-elderly
disabled persons or families, the owner must take the higher number of
the two dates (January 1, 1992 and October 28, 1992), which, in this
example is 15.

Then the owner must compare that number with 10 percent of the total
project units (in this example, it's 10) and use the lower number for
the number of units that must be reserved. Since 10 is less than 15, for
this example the owner must reserve 10 units for non-elderly disabled
persons or families.

If an owner determines that there were no non-elderly persons or
families occupying units on either January 1, 1992 or October 28, 1992,
the required number of units to be reserved for non-elderly persons with
disabilities would be zero (0). However, owners are encouraged to exceed
the number of reserved units for non-elderly persons with disabilities
if the need exists in the community.

> Answer question 4 as follows:
>
> If there is an elderly preference in accordance with Section 651 of
> Title VI-D, answer "Yes". If there is no preference provided to
> elderly families, answer "No". (**Do not leave blank).**
>
> If yes, answer the following:

(a) If there is an occupancy preference in accordance with Section 651,
    indicate the effective date of the preference.

(b) If there is an occupancy preference in accordance with Section 651,
    indicate the total number of units that must be reserved for
    non-elderly persons with disabilities based on the two dates above.

(c) If there is an occupancy preference in accordance with Section 651,
    indicate which date (see above) was used to determine the number of
    units that must be reserved for non-elderly persons with
    disabilities.

5\. Section 658 of Title VI, Subtitle D of the Housing and Community
Development Act of 1992 (Title VI-D) permits owners of "other federally
assisted housing" to continue to restrict occupancy to elderly families
in accordance with the rules, standards, and agreements governing
occupancy in such housing in effect at the time the housing was
developed. If (A) the project was originally developed to serve the
elderly and (B) the project has continually served elderly tenants.
These projects include:

Section 202 Direct Loans (prior to the Section 202 PRAC program)

> Section 221(d)(3) BMIR properties (New Construction and Substantial
> Rehabilitation)

Section 236 properties

Answer question 5 as follows:

> If there is an elderly restriction in accordance with Section 658 of
> Title VI-D, answer "Yes." If there is no elderly restriction and
> occupancy is not limited to elderly applicants, answer "No." (**Do not
> leave blank).**

6\. If the property designates a number of units that can be occupied
**only** by elderly persons, indicate the number of units. If the
property does not have units that can only be occupied by elderly
persons, enter zero "0". (**Do not leave blank).**

7\. If the property designates a number of units that can be occupied
**only** by persons with disabilities, indicate the number of units. If
the property does not have units that can only be occupied by persons
with disabilities, enter zero "0". (**Do not leave blank).**

8\. If the property has units that must be occupied by **non-elderly**
persons with disabilities, indicate the number of units. If the property
does not have units that must be occupied by non-elderly persons with
disabilities, enter zero "0". (**Do not leave blank).**

**CERTIFICATION:**

Self-Explanatory **(Must be signed and dated)**

######## 

######## SECTION II - Owner/Agent must respond to all questions in this section. 

1\. Enter the total number of units (by bedroom size) and enter total in
the "Total" column. **(Total must match numbers entered for each bedroom
size. Do not leave blank.)**

2\. Enter the total number of units (by bedroom size) that are receiving
project based rental assistance. **(Total must match numbers entered for
each bedroom size. Do not leave blank.)**

3\. Enter the number of mobility accessible units (by bedroom size) and
enter total in the "Total" column. A mobility accessible unit is one
that is located on an accessible route, and when designed, constructed,
altered, or adapted, can be approached, entered, and used by individuals
with physical disabilities, including those who use wheelchairs.
(Although accessibility features include items such as grab bars,
flashing fire alarms, widened doorways, entrance ramps, etc, this
question should be answered by stating the number of subsidized units
that (when constructed) are fully accessible in accordance with the
Uniform Federal Accessibility Standards (UFAS) which is used to ensure
compliance with Section 504 of the Rehabilitation Act of 1973. These
standards were jointly developed by the General Services Administration,
the Department of Housing and Urban Development, the Department of
Defense, and the United States Postal Service, under the authority of
sections 2, 3, 4, and 4a, respectively, of the Architectural Barriers
Act of 1968, as amended, Pub. L. No.90-480, 42 U.S.C. 4151-4157. Copies
of the UFAS are available from the Architectural and Transportation
Barriers Compliance Board , 1331 F Street, NW, Suite 1000, Washington,
D.C. 20004-1111, Telephone: (202) 272-0080, email address:
<info@access-board.gov>. If the property is accessible in accordance
with Minimum Property Standards (MPS), indicate the number of units that
are MPS accessible. Non-subsidized units are not required to meet the
requirements of UFAS, however those units should be counted if they are
fully accessible to persons who use wheelchairs.) **(Total must match
numbers entered for each bedroom size. Do not leave blank)**

4\. Enter the number of units (by bedroom size) that are accessible for
vision or hearing impairments and enter total in the "Total" column.
(Refer to UFAS. See instruction number 3 above) **(Total must match
numbers entered for each bedroom size. Do not leave blank)**

5\. Total the units from rows 3 and 4 for each bedroom size and enter
total in the "Total" column. **(Total must match numbers entered for
each bedroom size. Do not leave blank.)**

6\. Enter the number of persons currently on the waiting list for an
accessible unit (by bedroom size) requiring the features of the unit and
enter total in the "Total" column. **(Total must match numbers entered
for each bedroom size. Do not leave blank.)**

7\. Enter the number of units (by bedroom size) that are currently
occupied only by elderly tenants and enter total in the Total column.
**(Total must match numbers entered for each bedroom size. Do not leave
blank.)**

8\. Enter the number of accessible units (by bedroom size) occupied by
non-elderly tenants with disabilities requiring the features of the unit
and enter total in the "Total" column. **(Total must match numbers
entered for each bedroom size. Do not leave blank.)**

(These tenants must have a mobility impairment as defined above.)

9\. Enter the number of accessible units (by bedroom size) occupied by
elderly tenants with disabilities requiring the features of the unit and
enter total in the "Total" column. **(Total must match numbers entered
for each bedroom size. Do not leave blank.)**

(These tenants must have a mobility impairment as defined above.)

10\. Self-explanatory **(Do not leave blank.)**

11\. Self-explanatory **(Do not leave blank.)**

12\. Self-explanatory **(Do not leave blank.)**

**CERTIFICATION:**

Self-Explanatory **(Must be signed and dated)**

######## SECTION III -- Owner/Agent must respond to all questions in this section. (Not applicable to unsubsidized projects)

1.  The Section 504 Coordinator is required if the owner employs 15 or
    more employees in all its activities. This includes this project
    combined with other projects they may own and/or manage. Answer Yes
    or No. If yes, proceed to Question 2; if no skip to Question 3.

2.  Answer Yes or No to this Question. If yes, please provide the name
    and telephone number of the coordinator for Section 504 related
    activities at the project and go to Question 3.

3.Answer Yes or No to each item and provide comments as necessary.

**CERTIFICATION:**

Self-Explanatory **(Must be signed and dated)**

**PART B**

> **On-Site Limited Monitoring Review**

### Authority: 24 CFR 5, 108, 110

+--------------------------+------+------+----------------------------+
|                          | ##   | #    | ## COMMENTS                |
|                          |  YES | # NO |                            |
+--------------------------+------+------+----------------------------+
| 1\. Was this project     |      |      |                            |
| built or substantially   |      |      |                            |
| rehabilitated after      |      |      |                            |
| February 1972?           |      |      |                            |
|                          |      |      |                            |
| (If NO, skip to Question |      |      |                            |
| 5.)                      |      |      |                            |
+--------------------------+------+------+----------------------------+
| 2\. Does the owner have  |      |      |                            |
| an approved Affirmative  |      |      |                            |
| Fair Housing Marketing   |      |      |                            |
| Plan (AFHMP) on site?    |      |      |                            |
|                          |      |      |                            |
| If Yes, proceed to       |      |      |                            |
| question 3.              |      |      |                            |
|                          |      |      |                            |
| If No, proceed to        |      |      |                            |
| question 5.              |      |      |                            |
+--------------------------+------+------+----------------------------+
| 3\. Has the owner/agent  |      |      |                            |
| reviewed the AFHMP       |      |      |                            |
| within the last 5 years  |      |      |                            |
| to ensure that the       |      |      |                            |
| information is current   |      |      |                            |
| and applicable?          |      |      |                            |
+--------------------------+------+------+----------------------------+
| 4\. Date of last AFHMP   |      |      | Date: [      ]{.underline} |
| Update                   |      |      |                            |
+--------------------------+------+------+----------------------------+
| 5\. Does the project     |      |      |                            |
| maintain Project Profile |      |      |                            |
| Data which shows the     |      |      |                            |
| composition of the       |      |      |                            |
| occupants by the         |      |      |                            |
| following categories (24 |      |      |                            |
| CFR 121):                |      |      |                            |
+--------------------------+------+------+----------------------------+
| a.  Race                 |      |      |                            |
+--------------------------+------+------+----------------------------+
| b.  National             |      |      |                            |
|     Origin/Ethnicity     |      |      |                            |
+--------------------------+------+------+----------------------------+
| c.  Sex                  |      |      |                            |
+--------------------------+------+------+----------------------------+
| d.  Disability           |      |      |                            |
+--------------------------+------+------+----------------------------+
| e.  Familial Status      |      |      |                            |
+--------------------------+------+------+----------------------------+
| 6\. Has the owner/agent  |      |      |                            |
| developed and            |      |      |                            |
| implemented a written    |      |      |                            |
| Tenant Selection Plan?   |      |      |                            |
+--------------------------+------+------+----------------------------+

+-------------------------+------+------+----------------------------+
|                         | ##   | #    | ## COMMENTS                |
|                         |  YES | # NO |                            |
+-------------------------+------+------+----------------------------+
| 7\. Does the management |      |      |                            |
| agent maintain a        |      |      |                            |
| waiting list of         |      |      |                            |
| applicants by:          |      |      |                            |
+-------------------------+------+------+----------------------------+
| \(a\) Name              |      |      |                            |
+-------------------------+------+------+----------------------------+
| \(b\) Bedroom size      |      |      |                            |
+-------------------------+------+------+----------------------------+
| \(c\) Application date  |      |      |                            |
| and time?               |      |      |                            |
+-------------------------+------+------+----------------------------+
| \(d\) Requests for      |      |      |                            |
| accommodations and/or   |      |      |                            |
| accessible units?       |      |      |                            |
+-------------------------+------+------+----------------------------+
| \(e\) Preferences?      |      |      |                            |
+-------------------------+------+------+----------------------------+
| 8\. When a              |      |      | Unable to Observe [        |
| tenant/applicant        |      |      |   ]{.underline}            |
| notifies the            |      |      |                            |
| owner/agent that he/she |      |      |                            |
| has been subject to     |      |      |                            |
| unlawful                |      |      |                            |
| discrimination, does    |      |      |                            |
| the owner/agent provide |      |      |                            |
| the applicant/tenant    |      |      |                            |
| with information about  |      |      |                            |
| how to file a complaint |      |      |                            |
| with HUD?               |      |      |                            |
+-------------------------+------+------+----------------------------+
| 9\. Does the            |      |      |                            |
| owner/agent maintain a  |      |      |                            |
| record of fair housing  |      |      |                            |
| complaints?             |      |      |                            |
+-------------------------+------+------+----------------------------+
| 10\. Is there a local   |      |      |                            |
| residency preference?   |      |      |                            |
+-------------------------+------+------+----------------------------+
| If yes, was it approved |      |      | Date of HUD Approval:      |
| by HUD?                 |      |      |                            |
|                         |      |      |                            |
+-------------------------+------+------+----------------------------+

**Part C**

####### Section 504 Review

The Reviewer must complete this section to ensure compliance with
Section 504 of the Rehabilitation Act of 1973 (Section 504). **Please
note that non-subsidized projects are not required to comply with
Section 504, therefore if the project is non-subsidized, the Reviewer
may proceed to Part D.**

+-------------------------+-------+-------+---------------------------+
|                         | # YES | *     | **COMMENTS**              |
|                         |       | *NO** |                           |
+-------------------------+-------+-------+---------------------------+
| 1.  Was this project    |       |       | Date of the Plan:         |
|     completed prior to  |       |       |                           |
|     1989?               |       |       |                           |
|                         |       |       |                           |
| If "yes," does this     |       |       |                           |
| project have a Section  |       |       |                           |
| 504 Self-Evaluation and |       |       |                           |
| Transition Plan (Plan)? |       |       |                           |
|                         |       |       |                           |
| If "No," Skip to        |       |       |                           |
| Questions 3, 4, and 5   |       |       |                           |
| (every year).           |       |       |                           |
|                         |       |       |                           |
| If "Yes," Answer        |       |       |                           |
| Question 2.             |       |       |                           |
+-------------------------+-------+-------+---------------------------+
| 2\. If "Yes," Has the   |       |       | Date of any Updates:      |
| Plan been updated since |       |       |                           |
| last review?            |       |       |                           |
+-------------------------+-------+-------+---------------------------+
| 3\. Is there a formal,  |       |       |                           |
| written grievance       |       |       |                           |
| procedure that provides |       |       |                           |
| for resolution of       |       |       |                           |
| complaints alleging     |       |       |                           |
| discrimination based on |       |       |                           |
| disability, as required |       |       |                           |
| by Section 8.53(b)?     |       |       |                           |
+-------------------------+-------+-------+---------------------------+
| If Yes**,** document    |       |       | Date:                     |
| date procedures were    |       |       |                           |
| adopted:                |       |       | [      ]{.underline}      |
+-------------------------+-------+-------+---------------------------+
| 4\. Does the            |       |       |                           |
| owner/agent utilize a   |       |       |                           |
| telecommunications      |       |       |                           |
| device for the hearing  |       |       |                           |
| impaired (TTY)?         |       |       |                           |
+-------------------------+-------+-------+---------------------------+
| If No**:** Is there an  |       |       |                           |
| alternative procedure?  |       |       |                           |
|                         |       |       |                           |
| Describe under          |       |       |                           |
| "Comments"              |       |       |                           |
+-------------------------+-------+-------+---------------------------+
| 5\. When necessary, are |       |       |                           |
| auxiliary aides used to |       |       |                           |
| communicate with        |       |       |                           |
| persons with            |       |       |                           |
| disabilities?           |       |       |                           |
|                         |       |       |                           |
| Describe under          |       |       |                           |
| "Comments"              |       |       |                           |
+-------------------------+-------+-------+---------------------------+

## PART D

**DOCUMENTS REVIEWER SHOULD OBTAIN FROM OWNER/AGENT**

All documents for this section are to be brought back during the initial
use of this form. For subsequent reviews, the Reviewer will only bring
back documents upon request from FHEO. If the Reviewer receives a
request from FHEO to obtain certain documents, indicate in column a.
During the on-site review, request the documents and indicate the status
in columns b, c, or d. For items checked in column c, the Reviewer must
provide the owner/agent the FHEO address for forwarding the documents.

+---------------------+---+----------+------------+---------+------------+
| Document(s)         | a |          | b\. The    | c\. The | d\. The    |
|                     | \ |          | document   | Owner/  | document   |
|                     | . |          | has been   |         | is not     |
|                     | F |          | gathered   | Agent   | available. |
|                     | H |          | and is     | agrees  |            |
|                     | E |          | attached   | to      |            |
|                     | O |          | to the     | forward |            |
|                     | h |          | Checklist  | the     |            |
|                     | a |          |            | checked |            |
|                     | s |          |            | d       |            |
|                     | r |          |            | ocument |            |
|                     | e |          |            | to FHEO |            |
|                     | q |          |            | within  |            |
|                     | u |          |            | ten     |            |
|                     | e |          |            | (10)    |            |
|                     | s |          |            | b       |            |
|                     | t |          |            | usiness |            |
|                     | e |          |            | days.   |            |
|                     | d |          |            |         |            |
|                     | t |          |            |         |            |
|                     | h |          |            |         |            |
|                     | a |          |            |         |            |
|                     | t |          |            |         |            |
|                     | t |          |            |         |            |
|                     | h |          |            |         |            |
|                     | e |          |            |         |            |
|                     | R |          |            |         |            |
|                     | e |          |            |         |            |
|                     | v |          |            |         |            |
|                     | i |          |            |         |            |
|                     | e |          |            |         |            |
|                     | w |          |            |         |            |
|                     | e |          |            |         |            |
|                     | r |          |            |         |            |
|                     | o |          |            |         |            |
|                     | b |          |            |         |            |
|                     | t |          |            |         |            |
|                     | a |          |            |         |            |
|                     | i |          |            |         |            |
|                     | n |          |            |         |            |
|                     | t |          |            |         |            |
|                     | h |          |            |         |            |
|                     | e |          |            |         |            |
|                     | f |          |            |         |            |
|                     | o |          |            |         |            |
|                     | l |          |            |         |            |
|                     | l |          |            |         |            |
|                     | o |          |            |         |            |
|                     | w |          |            |         |            |
|                     | i |          |            |         |            |
|                     | n |          |            |         |            |
|                     | g |          |            |         |            |
|                     | d |          |            |         |            |
|                     | o |          |            |         |            |
|                     | c |          |            |         |            |
|                     | u |          |            |         |            |
|                     | m |          |            |         |            |
|                     | e |          |            |         |            |
|                     | n |          |            |         |            |
|                     | t |          |            |         |            |
|                     | s |          |            |         |            |
|                     | : |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| #                   |   |          |            |         |            |
| ######## For Part A |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| 1\. Accessible      |   |          |            |         |            |
| Units/Program       |   |          |            |         |            |
| Accessibility,      |   |          |            |         |            |
| Sections I, II, and |   |          |            |         |            |
| III (as applicable) |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| **For Part B:**     |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| 2\. Most recent     |   |          |            |         |            |
| Affirmative Fair    |   |          |            |         |            |
| Housing Marketing   |   |          |            |         |            |
| Plan (AFHMP)        |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| 3\. Any of the      |   |          |            |         |            |
| following documents |   |          |            |         |            |
| that are used for   |   |          |            |         |            |
| outreach as         |   |          |            |         |            |
| specifically stated |   |          |            |         |            |
| in the project's    |   |          |            |         |            |
| AFHMP or used for   |   |          |            |         |            |
| other affirmative   |   |          |            |         |            |
| fair housing        |   |          |            |         |            |
| marketing.          |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| News                |   |          |            |         |            |
| papers/Publications |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| Copy of Radio Ads   |   |          |            |         |            |
| and Announcements   |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| Copy of TV Ads and  |   |          |            |         |            |
| Announcements       |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| Photograph of       |   |          |            |         |            |
| billboards          |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| Letterhead          |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| Handouts            |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| Brochures and       |   |          |            |         |            |
| Leaflets            |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| Photograph and site |   |          |            |         |            |
| signs               |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| Other (Specify):    |   |          |            |         |            |
|                     |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| 4\. Project Profile |   |          |            |         |            |
| showing occupancy   |   |          |            |         |            |
| data (See Part B,   |   |          |            |         |            |
| Question 5).        |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+
| 5\. Written Tenant  |   |          |            |         |            |
| Selection Plan      |   |          |            |         |            |
+---------------------+---+----------+------------+---------+------------+

+---------------------+----------+------------+---------+------------+
| **Please Note:**    | a\. FHEO | b\. The    | c\. The | The        |
| The information     | has      | document   | Owner/  | document   |
| below only pertains | r        | has been   |         | is not     |
| to Section 504      | equested | gathered   | Agent   | available. |
| compliance. **If    | that the | and is     | agrees  |            |
| this project is     | Reviewer | attached   | to      |            |
| non-subsidized, the | obtain   | to the     | forward |            |
| Reviewer should not | the      | Checklist. | the     |            |
| complete this       | f        |            | checked |            |
| section.**          | ollowing |            | d       |            |
|                     | do       |            | ocument |            |
|                     | cuments: |            | to FHEO |            |
|                     |          |            | within  |            |
|                     |          |            | ten     |            |
|                     |          |            | (10)    |            |
|                     |          |            | b       |            |
|                     |          |            | usiness |            |
|                     |          |            | days.   |            |
+---------------------+----------+------------+---------+------------+
| **For Part C:**     |          |            |         |            |
+---------------------+----------+------------+---------+------------+
| 6\. Written         |          |            |         |            |
| Grievance Procedure |          |            |         |            |
| (Part C, Question 3 |          |            |         |            |
| and 24 CFR 8.53)    |          |            |         |            |
+---------------------+----------+------------+---------+------------+
| 7\. Application for |          |            |         |            |
| Occupancy           |          |            |         |            |
+---------------------+----------+------------+---------+------------+
| 8\. Copy of the     |          |            |         |            |
| Section 504         |          |            |         |            |
| Self-Evaluation     |          |            |         |            |
| Form and Transition |          |            |         |            |
| Plan, if available  |          |            |         |            |
| **(Does not apply   |          |            |         |            |
| to non-subsidized   |          |            |         |            |
| projects)**         |          |            |         |            |
+---------------------+----------+------------+---------+------------+
| 9\. Reasonable      |          |            |         |            |
| Accommodation       |          |            |         |            |
| Policy              |          |            |         |            |
+---------------------+----------+------------+---------+------------+

FHEO requested that the reviewer observe the following:

     

The result of the observation is: