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Habitability Inspection Form Group Residential Housing – Supportive Housing Setting

  1. Group Residential Housing (GRH) supportive housing settings must have an approved habitability inspection. The habitability inspection will determine whether the housing occupied by the GRH recipients meets the Department of Human Services’ habitability standards.

  2. Inspector:

        Check “Approved” or “Deficient” for each standard on the back of this form, and describe any deficiencies in comments section at the bottom of the page.

        Complete the certification statement below.

        Assist GRH applicant as needed in submitting this form to the financial worker listed above.

        Give a copy of this completed form to the GRH applicant.

  3. Certification Statement:

    I certify that I have evaluated the property located at the address above, and to the best of my ability find: 

        Property meets all of the habitability standards. Unit is approved for GRH funding.

        Property does not meet all of the habitability standards. Unit is not approved for GRH funding.

  4. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  5. When this form will be emailed to the Housing Program Team upon submission, it will be provided to the financial worker listed above. GRH benefits cannot be approved until this form is received. 

  6. Habitability Inspection Standards:
  7. 651-431-3941

    Attention. If you need free help interpreting this document, call the above number.

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    Thov ua twb zoo nyeem. Yog hais tias koj xav tau kev pab txhais lus rau tsab ntaub ntawv no pub dawb, 

    ces hu rau tus najnpawb xov tooj saum toj no. 

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    Digniin. Haddii aad u baahantahay caawimaad lacag-la’aan ah ee tarjumaadda qoraalkan, lambarka kore wac.

    Atención. Si desea recibir asistencia gratuita para interpretar este documento, llame al número indicado arriba.

    Chú ý. Nếu quý vị cần được giúp đỡ dịch tài liệu này miễn phí, xin gọi số bên trên.

    This information is available in accessible formats for individuals with disabilities by calling 651-431-3941 or by using your preferred relay service. For other information on disability rights and protections, contact the agency’s ADA coordinator.

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