Control Number
Tester ID
Available Unit Form Sequence:
Tester Type
Site
City
State
Zip Code (00000)
What type of unit did you inspect?
Did you inspect a unit during your site visit?
Date available  (mm/dd/yyyy)
How much is the rent? ($__/month)
Number of bedrooms
Number of bathrooms
How many floors in building?
On which floor is the available unit located?
Month-to-month
Three Month
Six month
One year
Two year
Other
If Other, specify
Is a security deposit and/or surety bond required?
Security deposit amount
Noise
Safety
Schools
Maintenance/ Services
This form is complete
Type of Building
Broken plaster or peeling paint
Discoloration of a floor, wall or ceiling due to water leakage
Exposed wiring
Sagging roof
Broken window
Boarded up windows
Surety bond amount
Were you told about any additional mandatory fees?
Name of first mandatory fee:
If other, please specify:
Is this a one-time/annual or monthly fee?
Amount of fee
Name of second mandatory fee:
Name of third mandatory fee:
Name of fourth mandatory fee:
Were you told about any incentives available to you if you decide to apply and r
Name of first incentive:
Is this a one-time/annual or monthly incentive?
Amount of incentive:
Name of second incentive:
Name of third incentive:
Name of fourth incentive:
Any other comments about this particular unit/building?
General comments
If yes, what was the comment?
Name of fifth mandatory fee: