How to Fill Out the HPD Dismissal Request Form (DR-1)

The HPD Dismissal Request Form (DR-1) is used to request an inspection of corrected HPD violations so they can be removed from HPD’s records. Fixing a violation does not automatically close it—you must follow HPD’s dismissal procedure.

Before completing the form

Confirm that:

• The conditions listed in the violations have been fully corrected.

• The building has a current and valid HPD Property Registration, when registration is required.

• There are no unpaid HPD Emergency Repair Program charges.

• The building, owner, or managing agent is not involved in pending HPD litigation or an unpaid HPD-related judgment.

• You have the documentation required for lead paint, mold, alterations, or other special violations.

• You are prepared to provide HPD inspectors access to all affected apartments and public areas.

HPD can reject the request when these requirements are not satisfied.

Page 1: Dismissal Request Form

Docket Number

At the top of the form, you will see:

Docket No.: DR __________

Leave this blank. HPD will assign the docket number after receiving the application.

Section 1: Building to Be Inspected

Building Address

Enter the complete address of the building where the violations were issued.

Example:

123 Main Street

Use the building address shown in HPD Online and on the violation records.

Borough

Enter or select the borough:

• Manhattan

• Bronx

• Brooklyn

• Queens

• Staten Island

Number of Dwelling Units

Enter the total number of legal residential dwelling units in the building.

Examples:

• A one-family house: 1

• A two-family house: 2

• A six-unit apartment building: 6

• A building with 24 apartments: 24

Do not include stores, offices, garages, or other commercial spaces unless HPD specifically classifies them as dwelling units.

Property Registration Number

Enter the building’s HPD Property Registration Number.

The number should match the current HPD Property Registration record.

A Property Registration Number is generally required when:

• The building has three or more residential units; or

• The building has two units and neither the owner nor the owner’s family resides there.

Owners who may not have a Property Registration Number

You may need to complete the Dismissal Request Affidavit of Ownership on page 7 when:

• You own and occupy a one- or two-family house that is exempt from registration.

• You own an individual condominium apartment.

• You own cooperative shares associated with an individual apartment.

Do not invent a Property Registration Number. Attach the ownership affidavit when applicable.

Violation Numbers to Be Inspected

You must choose between ALL and ONLY.

Check “ALL”

Check ALL when you want HPD to inspect every open violation currently listed against the property.

This is appropriate when:

• All open violations have been corrected.

• You want to clean up the entire HPD violation record.

• You can provide access to all affected apartments and public areas.

Check “ONLY”

Check ONLY when you want HPD to inspect specific violations.

Next to “ONLY,” write every violation number you want inspected.

Example:

12345678, 12345679, 12345685

Use the actual violation identification numbers shown in HPD Online or on the Notices of Violation. Do not use only the violation class, such as “A,” “B,” or “C.”

You can attach a separate typed list when there is not enough space. Write the building address and Property Registration Number on the attachment.

Important

Unless you identify specific violations under “ONLY,” HPD’s instructions state that all violations on record will be inspected.

Section 2: Requestor Information

The requestor must generally be a person identified on the current Property Registration as:

• The owner; or

• The managing agent.

A superintendent, contractor, employee, tenant, expediter, or family member should not sign the form unless that person is officially authorized and meets HPD’s requirements.

Name — Print

Enter the requestor’s full legal name clearly.

Example:

David Cohen

Use the same name shown on the Property Registration whenever registration is required.

Requestor Is

Check the applicable box:

• Owner

• Managing Agent

Select only the role that accurately describes the person signing the application.

Address

Enter the requestor’s mailing address.

This is important because HPD states that the inspection results will be mailed by first-class mail to the address entered in this section.

Example:

150 Broadway, Suite 400

City, State and ZIP Code

Complete all three fields.

Example:

New York, NY 10038

Telephone Number

Enter a working daytime telephone number.

Example:

(212) 555-1234

Use a number where HPD can reasonably reach the requestor.

Email

Enter a frequently monitored email address.

Example:

manager@example.com

Requestor Certification

The certification explains that:

• You are requesting an inspection of the selected violations.

• The property should comply with the Housing Maintenance Code and Multiple Dwelling Law.

• HPD inspectors may issue new violations if they observe other unlawful or hazardous conditions during the inspection.

Before signing, inspect the entire property—not only the conditions associated with the old violations.

Name Printed

Print the requestor’s full name again.

The printed name should match the name entered at the beginning of Section 2.

Signature

The owner or managing agent must personally sign the form.

Do not use the name of someone who is not authorized under the Property Registration.

Date

Enter the date the form was signed.

Example:

July 26, 2026

Section 3: Contact Information to Schedule the Inspection

This section identifies the person HPD should contact to coordinate access.

The scheduling contact may be different from the owner or managing agent.

Examples include:

• Building superintendent

• Property manager

• Authorized building employee

• Owner’s representative

• Managing agent’s staff member

Name

Enter the full name of the person who can arrange access.

Example:

Samuel Green

Phone

Enter the person’s direct telephone number.

The person should be available to respond to HPD and coordinate entry into apartments and public areas.

Email

Enter the scheduling contact’s email address.

When the requestor is also the scheduling contact

Repeat the requestor’s information in Section 3 rather than writing only “same.”

This reduces the chance of processing or scheduling confusion.

Code Enforcement Use Only

Do not complete the section labeled:

THIS SECTION IS FOR CODE ENFORCEMENT USE ONLY

Leave all of the following blank:

• Date received

• Number of violations pending

• Inspection Report Due Date

• Mail/Walk-In

• Accepted/Rejected

• Processed by

HPD staff completes this section.

Page 2: Conditions HPD May Inspect

Page 2 is informational and does not need to be completed.

However, you should review the property for the conditions listed before submitting the request. HPD may issue new violations during the dismissal inspection for conditions including:

• Immediately hazardous conditions

• Inadequate heat or hot water

• Missing or defective smoke detectors

• Missing or defective carbon monoxide detectors

• Missing or defective window guards

• Peeling lead-based paint where a child under six resides

• Illegal window gates

• Double-cylinder locks

• Defective or improper means of egress

• Missing required public-area signage

• Rodent or pest infestation

• Mold

• Apartment entrance or public-area doors that do not self-close

This list is not exhaustive. An inspector can issue violations for other conditions that violate the Housing Maintenance Code or Multiple Dwelling Law.

Pages 3–4: Fees and Submission

The version of the form you uploaded lists the following fees:

Because this form is marked Revised March 2018, verify the current fee and submission requirements with HPD before purchasing the certified check or money order.

Payment method stated on the form

The form instructs applicants to submit:

• A certified check or

• A money order

It should be payable to:

NYC Department of Finance

Write the building’s Property Registration Number on the certified check or money order when a registration number applies.

Do not send cash.

Where to submit it

For a building that is not in the Alternative Enforcement Program, mail or hand-deliver the application to the HPD Code Enforcement Borough Office for the borough where the property is located.

The uploaded form lists these offices:

Manhattan

94 Old Broadway, 7th Floor
New York, NY 10027

Bronx

1932 Arthur Avenue, 3rd Floor
Bronx, NY 10457

Brooklyn

The form lists two Brooklyn locations:

701 Euclid Avenue
Brooklyn, NY 11208

and

210 Joralemon Street, Room 809
Brooklyn, NY 11201

Confirm the correct current office before mailing or visiting.

Queens

120-55 Queens Boulevard, 1st Floor
Kew Gardens, NY 11424

Staten Island

Borough Hall
10 Richmond Terrace, 2nd Floor
St. George, NY 10301

Alternative Enforcement Program buildings

A building active in AEP requires a different application. The uploaded instructions state that an AEP request should be submitted to:

Alternative Enforcement Program
100 Gold Street, 4th Floor
New York, NY 10038

The form lists the AEP telephone number as:

(212) 863-8262

Pages 5–6: Violations Requiring Documentation

Some violations cannot be dismissed based only on a visual inspection. Supporting paperwork may be required.

Lead-Based Paint Violations

Lead violations generally require:

• Proper correction of the lead hazard

• Appropriate work practices and qualified workers

• Documents showing how the work was performed

• HPD inspection verifying that the condition was corrected

The uploaded form identifies:

• AF-5 for qualifying work completed after August 1, 2004

• AF-3 for qualifying work completed before August 1, 2004

Read the affidavit instructions carefully because additional records may be required, such as proof of contractor qualifications, test results, invoices, or work-practice documentation.

Do not assume that painting over peeling paint is sufficient to dismiss a lead violation.

Order Number 780: Property Registration

The form states that a Property Registration must be filed.

The uploaded instructions mention a $13 registration fee, but this amount is from the 2018 form and should be verified before payment.

Orders 491, 494, 495 or 741: Alterations

When an alteration was legalized, provide applicable Department of Buildings-approved:

• Plans

• Permits

• Approvals or sign-offs

When the illegal alteration was completely removed and the area restored to its lawful condition, the form states that documents may not be required. Nevertheless, retain dated photographs, invoices, and contractor records.

Order 550: Mold

For qualifying Class B or Class C mold violations issued after March 1, 2018, the form requires an:

Affidavit of Mold Assessment and Remediation

Additional documentation depends on who performed the assessment and remediation. AEP buildings may have additional requirements.

Page 7: Affidavit of Ownership

Complete page 7 only when it applies to your ownership situation.

This affidavit is intended for:

1. An owner-occupied private dwelling that is exempt from Property Registration.

2. An individual condominium unit owner requesting dismissal of violations in that apartment.

3. A cooperative shareholder requesting dismissal of violations in that apartment.

County

Enter the New York county where the affidavit is signed or notarized.

Examples:

• New York County

• Kings County

• Queens County

• Bronx County

• Richmond County

• Nassau County

This is not necessarily the borough where the building is located. It is normally the county where you physically appear before the notary.

Name

Enter the full legal name of the person making the sworn statement.

Example:

David Cohen

Check One Ownership Category

Select only one applicable box.

Private-dwelling owner

Check this box when:

• You own the one- or two-family dwelling.

• You or a qualifying family member resides there.

• The property is exempt from HPD Property Registration.

Enter the full building address.

Condominium owner

Check this box when you own an individual condominium unit.

Enter:

• Building address

• Apartment number

Cooperative shareholder

Check this box when you own shares in the cooperative corporation associated with the apartment.

Enter:

• Building address

• Apartment number

Signature and Notarization

Sign the affidavit in front of a notary public.

Do not sign it beforehand unless the notary instructs you to do so.

The notary completes:

• Date sworn

• Notary signature

• Notary stamp or seal

The ownership affidavit is signed under penalty of perjury.

Suggested Submission Package

Organize the application in this order:

1. Completed and signed DR-1 page 1.

2. Separate list of selected violation numbers, when necessary.

3. Dismissal Request Affidavit of Ownership, when applicable.

4. Lead, mold, alteration, registration, or other required documents.

5. Certified check or money order for the applicable fee.

6. A brief cover letter identifying the building and enclosed materials.

7. Copies of relevant violation records.

8. Photographs and repair records for your own file.

Keep a complete copy of everything submitted. When mailing, use a trackable delivery service and retain the delivery confirmation.

What Happens After Submission

According to the uploaded instructions, HPD stated that it would use its best efforts to inspect and mail results within:

• 45 business days for requests submitted from June 1 through September 30.

• 90 business days for requests submitted from October 1 through May 31.

The form says HPD may make a maximum of two inspection attempts. These timeframes come from the March 2018 form and should not be treated as guaranteed current processing times.

You must make every reasonable effort to provide access. A corrected violation that HPD cannot inspect may remain open.

Important Warning

A Dismissal Request is not a limited inspection of only the old repair. HPD inspectors may examine the building and issue new violations for other conditions they observe.

Before requesting the inspection, review:

• Apartments included in the request

• Hallways and stairs

• Entrance and vestibule

• Basement and cellar

• Roof and yard

• Fire-safety conditions

• Self-closing doors

• Required HPD signage

• Smoke and carbon monoxide detectors

• Window guards

• Mold, pests, leaks, and peeling paint

Disclaimer

This explanation is general educational information and is not legal advice or an official HPD determination. The DR-1 form is an official government form that may be available free of charge through the New York City HPD website or an HPD borough office. Fees relate to HPD’s Dismissal Request process—not to downloading the blank form. Because the uploaded version is dated March 2018, confirm current forms, fees, addresses, eligibility rules, and required documentation directly with HPD before submitting it.