Compliance Information and 
Administrative Records Review

Property:      	D#:      

I.	Inspection Contact and Site Units
1.	List the person to contact for inspection scheduling and communication during the inspection process.  
Name of Inspection Contact:	     		
Organization Name:	     		
Telephone Number: 	     		
Email Address:	     		
2.		Are any units currently used as non-rental (e.g., model, office, occupied by site staff or other reason)?	
	Yes      No 	
	If yes, provide building address(es), unit number(s), and describe the unit(s) use and duties of staff:	
	     	
3.	Site Manager Name: 	     	Site Manager Telephone Number:	     	
	Site Manager Email Address:	     	

II.	Other Inspections
1.		This property is not subject to any governmental inspections.
2.	In the grid below, indicate physical inspection(s) to which the property is subject, including contact information of inspector, if known. Provide a copy of the inspection report if the inspection occurred in the current year.

Physical Inspection Type	Inspection Occurs Every ___ Years	List the Date of the Last Inspection	Inspection Will Occur this Year: Y/N (enter date if known)	Name of Inspector	Email Address of Inspector	
Rental License	     	     	     	     	     	
Local Habitability Code	     	     	     	     	     	
Fire Marshal	     	     	     	     	     	
REAC	     	     	     	     	     	
USDA	     	     	     	     	     	
Board and lodge licensing 	     	     	     	     	     	
Other government inspections	     	     	     	     	     	

III.	Physical Condition and Certificates
1.	Are all buildings and units currently suitable for occupancy, taking into account local health, safety, and building codes? 	
Yes      No  	If no, list building(s) and unit(s), explain why, and what actions owner is taking to make them suitable for occupancy:      	
2.	Building has current inspection certificates for (submit copies): 	
	Boiler inspection 		Property does not have boiler heat	
	Fire alarm system inspection 		Property does not have a fire alarm system	
	Elevator inspection 		Property does not have an elevator	
	Inspection certificate for  boiler,  fire alarm,  elevator is older than 12 months. An inspection with the appropriate authority or authorities is scheduled for:      
	
IV.	Property Information
1.	Housing Type (check all that apply):
  Family housing	  Emergency shelter
  General occupancy	  Group home
  Single room occupancy	  Service enriched/supportive housing
  Transitional housing (24 months or less)	  Public housing or publicly owned 
  Senior housing   55+ or  62+ (check one)            Assisted Living  55+ or  62+ (check one)           

Is this different from what was originally funded or otherwise approved by Minnesota Housing?        
Yes      No 	If yes, explain:       

2.	Clientele Served (check all that apply):
	Victims of domestic violence		Single men only	
	Families with children		Single women only	
	Single parents with children		People with behavioral health needs	
	Homeless youth       (indicate age range)		People with chemical dependency	
	People who are mobility impaired		People with developmental disabilities	
	People experiencing long-term homelessness		People meeting the definition of HPH*	
	People with HIV/AIDS		MFIP** or former MFIP recipient	
	People previously without shelter		Other (explain)      	
*HPH = high priority homeless; **MFIP = Minnesota Family Investment Program	
Is the clientele currently being served different from what was originally stated in the application or otherwise approved by Minnesota Housing?                            	Yes       No 	
If yes, explain: 	     	

3.	Available Services (check all that apply):
	Property does not offer services		Health/wellness screening	
	Job training/education		Chemical dependency counseling	
	Employment counseling		Finding permanent housing	
	Social service referral only		Shopping	
	Transportation		Legal	
	Computer/internet		Medication management	
	Meals		Other (explain)      	
	Housekeeping		
	
Name of service provider(s):      	
Is a separate fee charged for any services?  Yes       No  	
If yes, describe which services require a fee and list the charges:      	
	Are the services required as a condition of occupancy?  Yes   No   
V.	 Utility Allowance
a.	 Owner pays all utilities or   resident pays utilities (indicate how they are metered below)

Utility Type	Check if Resident Pays for the Utility	Individually Metered (resident is billed by utility supplier)	Sub-Metered (resident is billed by owner or 3rd party billing)	Determined and billed on a Ratio Utility Billing System (RUBS)*	
Unit Heat					
Water Heat					
Unit Electric					
Cooking					
Water					
Sewer					
Trash					

b.	If resident-paid utilities, indicate the source of the utility allowance below and submit the Utility Allowance Information form showing calculations of the utility allowance currently in effect along with the previous two years (three years total). Include all source documentation**.  If sub-metered, also submit a copy of each master meter bill showing the rates the owner is charged and any third-party billing charges.  If the property consists of townhouse units and you are using the PHA utility allowance, you must supply the PHA’s policy as to whether the townhouse/duplex or apt/multi utility allowance is used, as PHA policies may differ.

	Local Public Housing Agency (PHA) that administers Housing Choice Vouchers in the area.  Enter the name of the PHA:        	
	HUD Utility Schedule Model		Energy Consumption Model	
	Project-based Section 8		USDA	

*RUBS is a formula that allocates a property's utility bill among its units based on the units’ relative floor space, number of occupants, or some other quantitative measure, but not based on actual consumption and any payments are considered rent. The gross rent must include these amounts and must be below the applicable rent limit.
**If Minnesota Housing approves the utility allowance for project-based Section 8, it is not necessary to submit source documentation.  	

VI.	Marketing, Resident Selection, and Occupancy	
Submit copies of recent brochures and advertisements with this form. 
Enter the URL(s) where the property is advertised/marketed on the internet:       	
	 The property is not advertised/marketed on the internet. 	
Affirmative Marketing:
If you cannot check box a, b, or c, below, you must submit a completed Affirmative Fair Housing Marketing Plan (AFHMP) including HUD Form 935.2A and Minnesota Housing’s AFHMP Addendum along with evidence of review/updates.  Click here to find forms, guidance, and a Fair Housing Toolkit to assist you in creating or updating your AFHMP.

	a.	Property’s AFHMP is regularly reviewed by staff at: 
  HUD - Date of last HUD review:      
   USDA Rural Development – Date of last USDA review      
   Minnesota Housing (e.g., for Section 8 contract administration or asset management) – Date of last review      	
	b.	Property is not required to have an AFHMP because it has four units or fewer; is operated as an emergency shelter; is transitional housing or 100% supportive housing with funding that requires applicants to be referred through Coordinated Entry or other approved homeless referral system(s) or where service providers do outreach to homeless through service programs (e.g., at shelters, encampments, rehabilitation facilities, etc.); is public housing or is publicly owned.	
	c.	Property is not required to have an AFHMP because it is on land located within the limits of an Indian reservation, dependent Indian community, or Indian allotment. 	
  
Resident Selection:
	Submit a copy of the property’s Tenant Selection Plan (TSP) unless the TSP has been reviewed by staff from: 
   HUD 
   USDA Rural Development
   Minnesota Housing (for Section 8 contract administration or asset management)
If none of the above boxes are checked, check a or b, below: 	
	  a. The property has a written tenant selection plan, waiting list policy, house rules, and/or occupancy policy. The tenant selection plan was last updated on      .  Submit a copy of the property’s TSP with this form. 
      The plan   does  does not follow Minnesota Housing’s Tenant Selection Plan Guidelines. If the plan does not follow Minnesota Housing’s Tenant Selection Plan Guidelines, explain what part of the guidelines is not followed and why:       
  b. The property does not have a written tenant selection plan (describe how residents/clients are selected)       
	
Occupancy:	
1.		The property is currently experiencing vacancy issues. Yes       No 
If yes, explain why and what actions the owner/agent is taking to resolve:       	
2.		We notify the local housing authority when there are vacancies. Yes       No 
If no, explain why:       	
3.		We list vacancies at www.HousingLink.org. Yes       No 
If no, explain why:       	
4.		Initial leases for this property are for a term of       months. Submit a blank lease form including all addenda, riders, and attachments. 
Applicable to HOME and NHTF units monitored by Minnesota Housing:  If less than 12 months, describe how applicants are informed of lease options:        
 Property has no HOME or NHTF units monitored by Minnesota Housing.	
5.		Number of fully accessible units:      	
6.		Number of units that are adaptable or have features for people with visual or hearing impairments:      	
7.		Are all unit(s) in the property designed for people with mobility or other impairments    Yes       No 
occupied by households that require these features?
If no, is the lease or addendum in conformance with Minnesota state law offering            Yes        No 
non-disabled households a comparable unit if a household that needs 
these features applies and a comparable unit is available?
If no, explain why and what action owner is taking to comply:      	
8.		Does the loan declaration or tax credit LURA require the owner to have a 	Yes        No   smoke free policy? If yes, submit copy of policy.	
9.		In the past three years, have you rejected any applicants with a Section 8                           Yes        No  
housing choice voucher (HCV)?
If yes, explain the reason(s):       	
10.		How many units are currently occupied by households with a Section 8 housing choice voucher (HCV) (not including project-based vouchers)?         If you entered zero (0), check the applicable box:
 N/A – property is subject to a rental assistance contract for 100% of the units
 N/A – property is an emergency shelter or transitional housing
 N/A – property is public housing
 Other reason.  Provide explanation:      	

VII.	Additional Information for Housing Tax Credit (HTC) Properties Monitored by Minnesota Housing
1.	Number of garages:      	No garages 
Is a separate fee charged for garages or parking? Yes   No 
If yes, what is the monthly fee?	$       Garages  were /  were not included in tax credit eligible basis (if you are unsure, confirm with the owner or investor partner).
2.	Number of storage lockers:       	No storage lockers 
Is a separate fee charged for storage lockers?  Yes   No 	
If yes, what is the monthly fee?	$       Storage lockers  were /  were not included in tax credit eligible basis (if you are unsure, confirm with the owner or investor partner).  
3.	List all resident amenities/facilities including pool, community room, playground, computer lab, etc.      

Is a nonrefundable fee charged for any resident facilities? Yes   No   	   No resident facilities 
If yes, how much is the fee?   $       Resident facilities   were /  were not included in tax credit eligible basis (if you are unsure, confirm with the owner or investor partner).  	
VIII.	Information for Properties that Operate as Transitional Housing
Describe the process or submit a written plan (if available) to move residents/clients to permanent housing:      

IX.	Information for Properties that are Publicly Owned
	Property is not operated under a master lease, memorandum of understanding or other agreement
	Property is operated under a master lease, memorandum of understanding, and/or other agreement (submit copies)

X.	Lead Based Paint Information (applies to all properties under NSPIRE Inspection Standards)
 	Property was built in 1978 or later 
	Property was built before 1978 and has a lead-free certificate
	Property was built before 1978 and does not have a lead-free certificate  
	NOTE: If the last box is checked, lead based paint monitoring records must be made available upon 	request.

XI.	Violence Against Women Act (VAWA) for Properties Financed with Minnesota Housing’s HOME, NHTF, and/or HTC
1.	HOME and NHTF Properties (check a or b, whichever applies):
 	a. Owner is in compliance with statutory and regulatory provisions of VAWA (including establishment of an emergency transfer plan for HOME properties with written agreements on or after 12/16/2016 and all NHTF properties) and owner/agent distributes the following forms to applicants/residents when an application has been denied, at the time the household is admitted and approved for occupancy, with any notice of eviction or with any notice of tenancy termination (required for all HOME and NHTF properties):
•	HUD Form 5380 – Notice of Occupancy Rights under the Violence Against Women Act; and 
•	HUD Form 5382 – Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking, and Alternate Documentation

	b. Owner is not in compliance with statutory and regulatory provisions of VAWA. Explain why and what actions owner is taking or will take to comply:       

2.	Housing Tax Credit Properties (check a or b, whichever applies):
 	a. Owner is in compliance with statutory provisions of VAWA and owner/agent distributes the following forms to applicants/residents when an application has been denied, at the time the household is admitted and approved for occupancy, with any notice of eviction or with any notice of tenancy termination:
•	HUD Form 5380 – Notice of Occupancy Rights under the Violence Against Women Act; and 
•	HUD Form 5382 – Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking, and Alternate Documentation
	b. Owner is not in compliance with statutory provisions of VAWA. Explain why and what actions owner is taking or will take to comply:       

Administrative Records Checklist
On Enter date admin records were sent to Minnesota Housing, the following Administrative Records were submitted for review (check all that apply):

Section II – Other Inspections
	Copy of physical inspection report (e.g., from HUD REAC, USDA, city, county) 
Section III – Physical Condition and Checklists
  Elevator inspection certificate
  Fire alarm inspection certificate
  Boiler inspection certificate
Section V – Utility Allowances
	Utility allowance and supporting documentation for current year and prior 2 years
Section VI – Marketing, Resident Selection and Occupancy
	Marketing brochures and advertisements
	Affirmative Fair Housing Marketing Plan and Minnesota Addendum 
	Tenant selection plan, house rules, and/or occupancy policy
	Copy of current form of lease and all addenda, riders, and attachments
	Smoke free policy
Section VII – Transitional Housing
	Written plan to move residents
Section IX - Publicly owned
	Copy of master lease, MOU, or other agreement

This form was completed by:

Name:	      		
Telephone Number: 	     	
Email Address:	      	Date Completed: