Federal law requires landlords to inform tenants about known lead-based paint or related hazards in residential properties built before 1978. This form is designed to meet those disclosure requirements and ensure that all parties—landlords, tenants, and agents—document their responsibilities and acknowledgments properly before signing a lease. It also confirms whether tenants have received the official EPA pamphlet Protect Your Family from Lead in Your Home.
Lead-Based Paint Disclosure Form
How to Complete This Form
This form serves as a legal record confirming that lead-related disclosures were made before the lease began. It should be completed with care, as incorrect or missing details can lead to compliance issues.
Lead Warning Statement
This section is mandatory and should not be edited. It explains the health risks associated with lead-based paint in homes built before 1978. It also outlines the legal requirement for landlords to disclose any known lead-based paint or related hazards before a lease is signed.
Lessor’s Disclosure (Landlord’s Section)
In this section, the landlord confirms their knowledge of any lead-based paint or hazards in the property and shares relevant documentation. This disclosure is required under 42 U.S.C. § 4852d, the federal statute governing lead hazard communication in housing built before 1978. The first part asks if the landlord is aware of any such hazards—only one option should be initialed. If hazards are known, a short explanation must be added. The second part addresses whether any reports or records are available. If so, those documents must be listed or attached. If not, the landlord should indicate that no records exist. Accuracy here is critical, as this part reflects the landlord’s due diligence.
Lessee’s Acknowledgment (Tenant’s Section)
This section confirms what the tenant has received from the landlord. The first part asks the tenant to acknowledge whether they received any records or reports related to lead-based paint. Only one option should be initialed to indicate if documents were provided or not. The second part requires the tenant to confirm receipt of the EPA pamphlet titled Protect Your Family from Lead in Your Home. This pamphlet is a federal requirement and must be provided in all cases, even when no known hazards exist. Tenant initials serve as formal acknowledgment that they were informed properly before signing the lease.
Agent’s Acknowledgment (If Applicable)
If a real estate agent is involved in the transaction—representing either the landlord or the tenant—this section must be completed. The agent must confirm that they have informed their client about the legal responsibilities outlined in federal law. The landlord’s agent acknowledges informing the landlord of the disclosure requirements, while the tenant’s agent does the same for the tenant. Each agent must initial the appropriate line. If no agents are involved in the lease process, this section can be marked as “N/A” or simply left blank, depending on your documentation preferences.
Certificate of Accuracy
This closing section finalizes the form. All involved parties—landlord, tenant, and agents (if applicable)—must sign and date this part to confirm that the information provided throughout the form is true and complete to the best of their knowledge. These signatures create a formal record that disclosures were made properly before the lease was executed. The date should reflect the actual day the form is signed, typically aligning with or preceding the lease agreement date.
FAQs
No. The federal lead-based paint disclosure requirement only applies to residential properties built before 1978.
Yes. Federal law requires landlords to provide tenants with the EPA’s pamphlet titled Protect Your Family from Lead in Your Home in all cases, even when no hazards are known.
Yes, as long as electronic signatures are legally recognized in your state and meet your lease agreement requirements.
Omitting this form may lead to legal consequences, including fines or tenant claims. It’s considered a violation of federal disclosure rules.
This disclosure form is a required part of renting out residential properties constructed before 1978. It documents what was disclosed about lead-based paint, confirms that required information was shared with the tenant, and provides a signed record for future reference. Once completed, it should be kept with the lease agreement, and each party should retain a copy for their records. The requirement is based on the Residential Lead-Based Paint Hazard Reduction Act of 1992 (Title X). For step-by-step guidance, visit the EPA’s official lead disclosure page.
This template and guide are intended for general informational purposes only and do not constitute legal advice. Federal and state laws may vary, and it is strongly recommended that you consult a qualified attorney to ensure full compliance with applicable regulations before using this form.