Improving Local Lead Hazard Disclosure: A Case Study Analysis

Prepared for the United States Environmental Protection Agency, Region 5

By Ruanda McFerren Brandon Senger Cameron Smith

Anna Wright

Workshop in Public Affairs Spring 2018

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©2018 Board of Regents of the University of Wisconsin System All rights reserved.

For an online copy, see

www.lafollette.wisc.edu/research-public-service/workshops-in-public-affairs publications@lafollette.wisc.edu

The Robert M. La Follette School of Public Affairs is a teaching and research department

of the University of Wisconsin–Madison. The school takes no stand on policy issues; opinions expressed in these pages reflect the views of the authors.

The University of Wisconsin–Madison is an equal opportunity and affirmative-action educator

and employer. We promote excellence through diversity in all programs.

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Table of Contents Foreword v

Acknowledgements vi

List of Abbreviations vii

Glossary viii

Executive Summary ix

Introduction 1

Methodology 1

Definitions 2

Testing and Inspection 2

Lead Hazards and Lead-Based Paint Threat 2

Disclosure 3

Case Studies 3

Case Study #1: Rochester, NY 3

Lessons from Rochester, NY 5

Case Study #2: Washington, DC 6

Lessons from Washington, DC 7

Case Study #3: Buffalo, NY 7

Lessons from Buffalo, NY 9

Case Study #4: Maryland 9

Lessons from Maryland 10

Case Study #5: Massachusetts 11

Lessons from Massachusetts 12

Comparative Analysis of Best Practices 13

Table 1: Summary of Best Practices by Category 13

Best Practice #1: Inspections and Testing 14

Table 2: Inspections and Testing 14

Best Practice #2: Changes to Existing Law 15

Table 3: Changes to the Law 16

Best Practice #3: Documenting Properties: Registries and Property Certification 16

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Table 4: Registries and Certification 17

Best Practice #4: Education 18

Table 5: Education 19

Best Practice #5: Community Partnerships 19

Best Practice #6: Implementation and Timing 19

Table 6: Frequency of Testing/Inspection (Compliance with Certificate of Occupancy Lead-Related Requirements) 20

Recommended Approaches to Improve Disclosure 20

Certification Program for Residential Property 21

Legal Support for Discretionary Enforcement 21

Additional Considerations for Local Governments 21

Development of Entertainment-Based Education 21

Privacy Concerns 22

Environmental Justice 22

Enhanced Disclosure Requirements and the Number of Children with Lead Poisoning 23

Conclusion 23

Works Cited 24

Appendix A: Interview Questions 29

Appendix B: Additional Resources 31

Education Resources 31

Policy Guidance 31

Appendix C: Locations Researched 32

Table A1: Summary of Research Locations 32

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Foreword

This report is the result of a collaboration between the La Follette School of Public Affairs at the University of Wisconsin–Madison and the Environmental Protection Agency (EPA), Region 5 based in Chicago, IL. Our objective is to provide graduate students at the La Follette School with the opportunity to apply their policy analysis skills while providing the EPA with an analysis of best practices they can use to better assist state and local governments interested in implementing lead-based testing and disclosure rules.

The La Follette School offers a two-year graduate program leading to a master’s degree in public affairs. Students study policy analysis and public management, and they can choose to pursue a concentration in a policy focus area. They spend the first year and a half of the program taking courses in which they develop the expertise needed to analyze public policies. The authors of this report all are in the final semester of their degree program and are enrolled in Public Affairs 869 Workshop in Public Affairs. Although learning a set of skills in the classroom is important, there is no substitute for doing actual policy analysis as a means of developing these abilities. Public Affairs 869 gives graduate students that opportunity.

This year, workshop students were divided into eleven teams. Other teams completed projects for the U.S. Department of the Treasury, Wisconsin Department of Public Instruction, Wisconsin Bureau of Assisted Living, Wisconsin Department of Health-Division of Medicaid Services, Wisconsin Medical Society, B-Local Wisconsin/Always B Sustaining LLC, National Council on Crime and Delinquency, UNICEF, the Moravian Church, and Daayitwa (Nepal).

Exposure to lead can have lasting and permanent consequences for the health and cognitive development of children. Drawing on case studies of states and localities with innovative residential lead disclosure strategies, this report provides an analysis of best practices for local governments and public health authorities interested in mandating or encouraging disclosure beyond what is required by Federal law. From changing legal requirements for property owners to education campaigns to the creation of property registries of certified lead-free homes, this report offers state and local officials with concrete steps they can take help prevent children in their communities from being exposed to this toxin.

Rourke O’Brien Assistant Professor of Public Affairs

May 2018 Madison, Wisconsin

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Acknowledgements We would like to thank the United States Environmental Protection Agency, Region 5 for the opportunity to engage in this project. A special thanks to Jennifer Tyler and Maryann Suero for submitting a project proposal to the La Follette School and for all of their assistance throughout the creation of this report. Thank you to the city lead program employees who took the time to share the lessons they have learned from years of working to reduce lead poisoning across the country: Gary Kirkmire and Len Merritt at the Department of Buildings and Zoning for the City of Rochester, NY; Joseph Grande at the Madison Water Utility in the City of Madison, WI; Scott Henry, Pat Onetti, and Luanne Martino at the Erie Redevelopment Authority of Erie, PA; Eddy Kaka at the Department of Public Health in Chicago, IL; and Louis Petrucci at the Department of Permit and Inspection Services for the City of Buffalo, NY. We would also like to thank Dr. David Jacobs at the National Center for Healthy Housing for sharing his expert knowledge. Finally, we would like to thank our advisor, Rourke O’Brien, for his invaluable insight and guidance.

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List of Abbreviations BLL: Blood Lead Levels CDC: U.S. Centers for Disease Control and Prevention CPLP: Coalition to Prevent Lead Poisoning (Rochester) EPA: U.S. Environmental Protection Agency HUD: U.S. Department of Housing and Urban Development LBP: Lead-Based Paint NCHH: National Center for Healthy Housing

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Glossary Abatement: an activity that permanently eliminates lead-based paint threats. Disclosure: sharing specific information or providing notice about lead-based paint and/or a lead-based paint threat. Disclosure Rule: The Residential Lead-Based Paint Disclosure Rule Elevated Blood Lead Levels: Blood lead levels that are higher than acceptable as defined by local health officials.1 Inspection: a procedure for determining whether or not there are lead hazards in a property. Inspector: a certified professional who inspects and/or tests a home for lead-based paint threats. Law: a government’s statutory or regulatory standards. Lead-Based Paint Threats: characteristics of a building that are known to contain lead. Lead Hazards: characteristics of a building that are indicative, but not conclusive, of the presence of lead. Lead-Safe: inspection finds no lead hazards. Lead-Free: formal testing has confirmed there is no lead. Property: residential property. Residential Property: a building that is used as a dwelling. We use this term to describe aspects of laws that may not use the term “residential property” to remain consistent in our analysis. Testing: a procedure for determining whether or not there is lead in a property.

1 The Centers for Disease Control and Prevention defines a “reference level” of 5 micrograms per deciliter to identify children with blood lead levels that are much higher than most children’s levels (National Center for Environmental Health n.d.).

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Executive Summary Lead exposure continues to cause serious and permanent health problems, even though lead poisoning is completely preventable. The Residential Lead-Based Paint Disclosure Rule, which establishes a federal minimum standard for disclosure of lead, has been criticized because the standard requires property owners disclose only “known lead-based paint, or any known lead-based paint hazards” to new tenants or purchasers. Critics point out that the federal law’s strict focus on actual knowledge of lead leads to inadequate disclosure. By requiring actual knowledge, property owners are required to disclose information about lead only if there has been a formal test that confirms its presence. In turn, it is common to avoid testing altogether to skirt this disclosure requirement. Some local and state governments have passed laws and implemented procedures that aim to close the gap that is left by the federal rule. To guide future local government decision-making, this report analyzes state and local government initiatives that have developed more protective testing and disclosure standards for lead-based paint. These standards create more robust disclosure practices that support primary prevention activities, which are the preferred option to prevent lead poisoning. Five case studies provide on-the-ground context for this analysis. The practices analyzed in the case studies showcase some of the best strategies to improve lead testing and disclosure. The state and local governments featured all sought to address lead hazards before children were exposed. When selecting the most informative case studies, we prioritized cases from cities and states facing large-scale challenges in terms of quantity of old housing stock and percentage of children with elevated blood lead levels. In selecting the case studies, we also were interested in concentrated efforts for improving testing and disclosure. A comparative analysis of the case studies reveals six major elements present in the most successful disclosure programs: education; community partnerships; codified changes to state or local laws that directly address lead and support inspection and testing; increased inspection and testing; documentation of properties through registries and property certification; and incremental implementation.

The five case studies follow one of two program approaches: requiring that residential properties pass a property inspection or relying on amended definitions and standards to improve testing and disclosure practices. While either approach can improve disclosure, we recommend using a certification program to improve lead disclosure rates because it allows for semi-systematic and routine testing. By identifying these best practices and recommending a comprehensive plan to improve lead disclosure, this report aims to provide government and local leaders a foundation for understanding how to improve lead disclosure in their community.

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Introduction Even though lead poisoning is completely preventable, lead exposure continues to cause serious and permanent health problems. Children younger than 6 are particularly vulnerable to lead poisoning. Those in low-income and minority communities are at a disproportionately high risk of exposure to lead (White et al. 2016; Wengrovitz and Brown 2009; Sampson and Winter 2016). In 1996, Congress passed the Residential Lead-Based Paint Disclosure Rule (the “Disclosure Rule”). The law requires owners of property built prior to 1978 to disclose to prospective buyers or tenants knowledge about known lead-based paint (LBP) threats and lead hazards. This minimum standard requires property owners disclose only “known lead-based paint and lead-based paint hazards” to tenants or purchasers, creating an incentive for property owners to not test or inspect for lead. This emphasis on formal knowledge of lead has led to a gap in the information provided to tenants and prospective buyers, which prevents them from obtaining complete knowledge about the health risks posed by their prospective home or apartment. In response to this knowledge gap, states and cities across the country have implemented policies and procedures that are more protective than the Disclosure Rule. This report analyzes some of these more protective state and local government initiatives. Case studies from three cities and two states provide on-the-ground context for this analysis. In analyzing these case studies, we identify best practices that support lead disclosure and recommend two broad strategies to improve lead disclosure. By identifying these best practices and recommending approaches to improve disclosure, this document provides introductory guidance for communities that wish to enhance their lead disclosure policies. Methodology To determine the best practices for enhancing disclosure, we first conducted a literature review of disclosure strategies and municipal lead laws. Based on these findings and discussions with professionals connected to lead-related programs, we identified a range of potential case study communities that represent a variety of strategies. When selecting the most informative case studies, we prioritized cases from cities with the most comprehensive approaches to lead testing and disclosure. We then conducted semi-structured interviews with employees working on lead prevention in the city departments of our local government case studies (See Appendix A). Throughout our research, we also interviewed staff from municipalities that do not have enhanced disclosure rules. The scope of this study was on communities that have modified their disclosure rules, so we did not include these municipalities in our case study. Without a specific focus on lead testing and disclosure, they do not represent best practices for improving testing and disclosure. Resources on all state and local governments researched can be found in Appendix C. We also analyzed reports, news articles, and other media that we could pull from city and state websites to understand the effectiveness of their program.

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After analyzing the case studies, we identified common trends and programmatic differences. In doing so, we revealed six categories of best practices to enhance lead disclosure. In addition to these specific best practices, we identified two approaches that we recommend communities follow if they want to do the most to improve lead disclosure practices. Definitions The literature, state laws, and local codes that we examined do not share common definitions. Language is very important when discussing this topic because it can be challenging to compare different practices and requirements. Below are some particularly important distinctions used in this report.

Testing and Inspection In this report, “testing” refers to any evaluation of residential property that confirms the presence or absence of lead. Most cities test properties by submitting paint or dust samples to a science lab or by using X-Ray Fluorescence technology.2 Alternatively, “inspection” denotes a process of identifying sources of potential lead hazards, with or without actual knowledge that lead is present. After an inspection, officials should have more information about the potential risk of lead hazards but will not be certain whether lead is present. This distinction is important because it helps differentiate between the different types of actions that can be taken to improve information sharing about lead and lead hazards.

Lead Hazards and Lead-Based Paint Threat This report makes a distinction between “lead hazards” and “lead-based paint threats.” This distinction is not consistent with the federal Disclosure Rule or the Environmental Protection Agency’s regulations for lead disclosure. The federal law and the EPA use the terms “known lead-based paint and/or lead-based paint hazards” (Federal statute 42 USCA §4852d; EPA regulation 40 CFR §745.107). We use the terms “lead hazards” and “lead-based paint threats” to illustrate different standards found in the case studies. Lead-based paint threats are those elements of a property that contain lead as confirmed through testing. Lead hazards are those elements that likely contain lead but may be lead-free. Lead hazards can be identified in a visual inspection of an aspect of a property that is likely to be a source of lead exposure. Examples of lead hazards include: deteriorating, chipping, or peeling paint on walls; wooden window frames that have been painted over; and exposed soil within three feet of a home. This distinction is used because inspections can identify lead hazards but cannot identify confirm the presence of lead-based paint threats. Testing can identify both.

2 X-Ray Fluorescence (XRF) technology is a handheld device that uses x-ray fluorescence to detect lead on any surface, including soft surfaces like carpets and soils (ThermoFisher 2018).

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Many state and local laws use the term “lead hazards” differently than we do in this report. We will place other uses of the term “lead hazards” in quotation marks to indicate a meaning other than what we have identified here.

Disclosure “Disclosure” refers to the required sharing of information about lead-based paint (LBP) threats or lead hazards. This report is centered around practices that enhance disclosure. “Enhance” means to increase the scope of a disclosure requirement or disclosure rates, or to make other improvements to disclosure that are more protective of human health. Enhanced policies should result in a more accurate understanding about the particular lead-related conditions of a residential property. Case Studies This report begins with an exploration of our five case studies. We explain the policy context that supported changes to lead disclosure, and highlight lessons learned from each case study. We then distill those lessons through a comparative analysis, where we identify best practices for local and state governments. Finally, we recommend two approaches to improving lead disclosure for local and state governments. The following five case studies represent different local government or state efforts to enhance disclosure practices. Massachusetts’ program was implemented in 1971, followed by Maryland’s in 1994, Rochester, NY’s in 2005, Washington, DC’s in 2008, and Buffalo, NY’s in 2016.3

Case Study #1: Rochester, NY The City of Rochester implemented one of the country’s first municipal laws to focus on eliminating lead sources before children are exposed to lead. This policy change included testing, inspection, and disclosure requirements for all rental units constructed before 1978. Over 80 percent of homes in Rochester were built before 1950, constructed from wood, and very likely to contain LBP threats (McGarvey July-August 2010; Coalition to Prevent Childhood Lead Poisoning 2010). In 2000, the city’s rate of children with elevated blood lead levels (BLLs) was more than 10 times the national average. A disproportionate amount of these lead poisoning cases came from neighborhoods of mostly low-income and minority renters (McGarvey July 2010). In response to Rochester’s high number of children with elevated BLLs, community leaders formed the Coalition to Prevent Lead Poisoning (CPLP) in 2000.

3 These state and local efforts are not exclusively focused on lead testing and disclosure. Most testing and disclosure practices are a part of broader lead remediation and abatement programs. For the purpose of this report, we center our case studies around efforts to improve disclosure. Please see Appendix C for more resources on our case studies’ broader lead programs.

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The CPLP connected community experts, local government officials, and partner organizations working to prevent childhood lead poisoning (Coalition to Prevent Lead Poisoning 2002). To attain its goals, the group focused on three strategies: community engagement, science-based solutions, and systemic change achieved through policy and practices (Korfmacher 2013). Because CPLP partnered with medical staff at the University of Rochester, the lead law utilized the best medical knowledge at the time. A cornerstone of the coalition’s community advocacy was educating property owners how to affordably address lead hazards. The CPLP used a house to create a “lead lab,” where it demonstrated to policymakers and community leaders how to make a home lead-safe for less than $500 (McGarvey July-August 2010). The “lead lab” helped the coalition garner community support and helped train local leaders to identify lead hazards (Coalition to Prevent Childhood Lead Poisoning 2010). Rochester passed its lead law in 2005 after five years of advocacy from the CPLP (Coalition to Prevent Lead Poisoning 2002). The lead law amended the city’s Certificate of Occupancy (C of O) program. All rental property owners must receive a C of O to rent properties, and a C of O is valid for three to five years.4 The application for a certificate includes an inspection to ensure that the property complies with all housing codes. Each time a property owner renews a unit’s C of O, their property must be re-inspected. The lead law added lead testing and disclosure requirements to the certification process for all pre-1978 residential properties. During the first years of the program, inspections were prioritized in areas with historically disproportionate rates of lead poisoning (Rochester Resolution No. 2005-23). Landlords in these high-risk areas must renew their C of Os every three years, while the rest of the city’s rental properties must renew every five years (§90-50) The law established a two-step process for lead testing and disclosure (§90-50). First, the city housing inspector’s office conducts a visual inspection. Residential units must meet the U.S. Housing and Urban Development (HUD)’s de minimis standards5 to pass the inspection. Under the law, paint found on interior or exterior walls of pre-1978 units are presumed6 to contain lead paint (Rochester, NY Municipal Code §90-53). If visual lead hazards are identified, the landlord has 60 days for certified professionals to remediate the hazards. If the unit passes the visual inspection, the second step is conducted. Step two is a dust-wipe test performed by a certified

4 Rental units in neighborhoods with historically high lead poisoning rates must renew their C of O every three years. 5 Per HUD’s de minimis levels, areas of deteriorated paint cannot exceed 20 square feet (2 square meters) on exterior surfaces; 2 square feet (0.2 square meters) in any one interior room or space; or 10 percent of the total surface area on an interior or exterior type of component with a small surface area. Examples include window sills, baseboards, and trim. Exposed soil within the home’s dripline is also in violation of HUD standards (Safe Work Practices 1999). 6 If a property does not contain any lead-based paint or fully encapsulates lead-based paint, property owners may opt to conduct a more rigorous lead test and inspection which exempts their property from lead inspections for 20 years (§ 90-53).

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professional (§90-55). If the lead dust-wipe test results exceed standards,7 property owners have 60 days to take extra measures to meet lead-safe standards for the unit and address any potential sources of lead dust. Property owners who fail the visual inspection or the dust-wipe test receive fines for violation of municipal code (Kirkmire and Merritt 2018). To administer the program, Rochester initially hired and trained four inspectors dedicated to lead inspection and testing at the cost of $600,000 annually (§90-50). Since then, the city has consolidated its code enforcement staff and trained housing inspectors to conduct lead inspections (Kirkmire and Merritt 2018). Revenue from municipal code violations is directed to the department and offsets program costs. The program also secures funding through various federal grants (Kirkmire and Merritt 2018). The city maintains a searchable registry of all code-compliant homes on its website to allow the public to monitor the code-compliance status of rental properties. The properties are mapped on an interactive map, and users can choose to display information geographically or in list form. The registry lists the unit’s street address, when the C of O was issued, and when it expires (City of Rochester 2018) Lessons from Rochester, NY Rochester provides many lessons for improving lead inspection, testing, and disclosure. Four are outlined below: Visual Inspections Paired with Testing: The use of visual inspections to identify lead hazards can help reduce testing costs. Rochester’s use of visual inspections to filter out homes that presumptively contain lead helps the city focus testing efforts where they are most needed. Community Groups are a Force for Change: Community groups can advocate and drive efforts to improve lead testing and disclosure. Rochester’s experience demonstrates how community partnerships can support city policy by providing resources and expertise throughout the process. Expand Upon Existing Programs: Rochester built its lead disclosure policy as an amendment to an existing home certification program. The existence of an ongoing certification process made it easier to add lead-related requirements.

7 Per §90-57(d) of Rochester’s Municipal Code, dust sample results shall be less than: (a) For floors: 40 ug/ft2; (b) For windowsills: 250 ug/ft2; and (c) For window troughs: 400 ug/ft2

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Systematic Certification: Monitoring property status allows the city to systematically hold landlords accountable for meeting lead-related property standards. Publishing the information online helps tenants understand their unit’s conditions.

Case Study #2: Washington, DC Washington, DC (“DC,” “the District”) runs a lead program called Lead Safe Washington, which aims to create affordable lead-safe housing for families with children younger than 6. As part of this program, DC provides free testing, grant funding, and other forms of assistance. In addition, DC’s municipal code establishes legal support for testing and inspection. To enforce these standards, DC relies on the discretionary authority of its public health officials.8 Like Rochester, DC has a very old housing stock. Between 75 percent and 90 percent of the homes were built before 1978 (Pekkanen 2008; DC Department of the Environment 2011). To address its history of lead problems, the District passed a lead law in 2008 and developed a strategic plan to address lead and other environmental hazards (DC Municipal Code §8-23). The law prohibits lead-based paint in all residential dwelling units (§8-231.02(a)). The District’s definition of “lead-based paint hazard” presumes that any deteriorating paint in a pre-1978 home is a “lead-based paint hazard,” and thus a violation of the code (§8-231.01(22)). DC does not conduct systematic inspections for lead in homes. Instead, the lead law allows the government to conduct various assessments and examinations under several circumstances. First, a clearance report9 is required when a property is going to be occupied by a pregnant woman or a child (§8-231.01(6)). This report must provide documented proof that the particular rental unit in question was found not to contain any “lead-based paint hazards” (“Lead Related Regulatory and Legislative Affairs | Ddoe” 2018). After abatement activities, a clearance examination is required to ensure that there are no more “lead-based paint hazards.” The District also conducts a visual inspection if there is a “reasonable belief” that a lead-based paint hazard can be found, regardless of whether a child lives in the unit. This reasonable belief can be established by tenant complaints of unsafe work practices or of possible lead hazards. It can also be established through knowledge that a neighborhood contains higher-than-average lead poisoning rates (DC Department of the Environment 2018). Because DC presumes all paint in pre-1978 homes contains lead, a property owner receives a notice from the District that the

8 In addition to the District’s current activities, it appears that there are plans to develop a lead-free certificate and visual inspection program (DC Department of the Environment 2018). These efforts would align the District’s approach to lead poisoning prevention with the other approaches detailed in this report. 9 Clearance report means a report issued by a risk assessor, a lead-based paint inspector, or a dust sampling technician that finds that the area tested has passed a clearance examination, and that specifies the steps taken to ensure the absence of lead-based paint hazards, including confirmation that any encapsulation performed as part of a lead hazard abatement strategy was performed in accordance with the manufacturer's specifications (DC Municipal Code §8-231.01(6)).

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hazard must be fixed if a hazard is found through a visual inspection. In such a case, the property owner also receives a bill for the initial risk assessment. In addition to lead-safe property standards, DC’s lead law sets out various disclosure requirements that go beyond the Disclosure Rule. This includes that property owners must disclose ongoing orders about lead issued by the District and give tenants information about their rights (§8-231.04(e)). The law sets forth a 10-day limit to disclose the presence of LBP threats to tenants (§8-231.04(f)(1)). In addition, DC is the only case study in this report that requires disclosure where the presence of “lead-based paint hazards” is “reasonably known.” DC’s website points out that, “if the owner has not done a paint touch-up job to the unit in more than five years, it is reasonable to expect that paint will be deteriorating, and the owner must indicate this on the disclosure form” (DC Department of the Environment 2018). Together, these requirements create a more rigorous inspection, testing, and disclosure program than is required by the federal Disclosure Rule. Lessons from Washington, DC The District provides two key lessons for improving lead inspection, testing, and disclosure. Legal Support for Government Efforts: Washington, DC’s lead law enhances disclosure by increasing the ability of public officials to test and inspect residential properties. Legal presumptions about certain deteriorating conditions support this authority. These presumptions, combined with efforts to inform tenants of their rights, support the District’s inspection and testing practices. “Reasonably Known” Disclosure Requirement: Washington, DC’s lead law requires disclosure of information about LBP, LBP hazards, and pending actions ordered by the District that are “reasonably known.” This provision explicitly narrows the gap left by the Disclosure Rule.

Case Study #3: Buffalo, NY Buffalo, NY, has one of the oldest housing stocks and the largest concentration of wood-frame housing in the country. In 2016, Buffalo launched its Lead Hazard Control Program to respond to its high proportion of children with elevated BLLs (Buffalo Office of the Mayor 2016). The program takes advantage of the pre-existing landlord rental registry and its Certificate of Occupancy program to enhance disclosure. It also relies on community partnerships. Buffalo’s rental registry is regularly updated, and most information is gathered through annual mailing to landlords. When properties are recorded to the registry, landlords pay an annual rental registration fee. Prior to 2017, this fee was $10 for a single-unit property (i.e. a single-family home) and $20 for a double-unit property (i.e. a two-flat). The Lead Hazard Control Program increased fees to $25 and $50, respectively, and 25 percent of the fees are dedicated to addressing lead issues. It is anticipated that this will yield a minimum of $250,000 annually.

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Buffalo also requires that rental units obtain a Certificate of Occupancy (C of O). This C of O is modeled on Rochester’s program and serves as a baseline for housing quality. To obtain this certificate, the property must pass an inspection by the city. If the property is noncompliant with the housing code, the certificate will be denied (§129-3(f)). A full remediation must occur before a C of O can be issued (Community Foundation of Greater Buffalo 2018). The Lead Hazard Control Program amended the C of O application process in 2016 and now requires that owners of pre-1978 units must consent to testing for lead violations and hazards (§264-14(a)(1)). If the inspector finds an LBP violation on a property’s interior or exterior, a fine of $105 may be issued, and a C of O will not be issued until the violation is addressed.10 City inspectors have begun conducting exterior property inspections in high-priority census tracts that are the most likely to have LBP threats. Along with lead property standards, the Lead Hazard Control Program created new notice and information sharing measures for landlords. As part of the annual property registration, landlords with one- or two-unit properties constructed before 1978 must submit the Landlord Attestation form.11 This document asks owners to certify that tenants were provided with the City’s Lead Paint Notice form, which details that the property is likely to have lead paint and lead hazards (“Lead Hazard Control Program” n.d.). The Landlord Attestation form also asks owners to document how a Lead Paint Notice form was delivered to tenants, to affirm that they are aware of and will use lead-safe practices when making renovations or repairs, and to state that they understand the City of Buffalo may seek to inspect the property and require actions (City of Buffalo 2016). To further carry out and enhance the efforts of the Lead Hazard Control Program, Buffalo’s Urban Renewal Agency and Department of Permits and Inspection Services partnered with several other entities, including the Erie County Department of Health and the Community Foundation for Greater Buffalo’s Green and Healthy Homes Initiative. These partnerships and the program structure are being strengthened as recommended in a report released in Spring 2018 by the Community Foundation of Greater Buffalo (Community Foundation of Greater Buffalo 2018). The City also has plans to hire two additional building inspectors to focus solely on lead and a program administrator to oversee the Lead Hazard Control Program.

10 Landlords have to option to use interim controls for up to two years before remediating hazards. Interim controls are actions to temporarily minimize lead exposure. It includes stabilizing deteriorating paint, thoroughly cleaning all surfaces, lining window frames, and covering bare soil (Office of Healthy Homes and Lead Hazard Control 2012). 11 Properties with more than two units are not monitored under this 2016 Lead Hazard Control Program and their landlords are not required to submit the Landlord Attestation Form (City of Buffalo 2016). Multifamily properties in the city are often newer, thus less likely to have LBP, and account for less than 5 percent of the rental housing stock (Petrucci 2018). A stricter set of regulations is applied to Buffalo’s multifamily housing.

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Education is also part of Buffalo’s plan. A campaign was launched in early 2017 to communicate with residents the dangers of lead exposure, steps to take to ensure that landlords remove LBP threats, and how to identify problems with lead hazards. Additionally, more than half a million printed informational flyers were translated into seven languages and distributed. An extensive online information campaign was also launched in cooperation with Erie County. Lessons from Buffalo, NY Three lessons regarding program expansion and modification and revenue generation are learned from Buffalo. Expand Upon Existing Programs: Buffalo’s Lead Hazard Control Program improves testing and disclosure rates by including LBP threats as part of its existing registry and certification program requirements. Additionally, the Landlord Attestation form helps ensure compliance with the law and serves to spread information at a low cost. Moreover, the increased registration fee provides a steady set of funds to help ensure the program’s longevity. Be Willing to Modify Programs: Although Buffalo’s program was launched in 2016, it is already being modified. Policies do not always operate in the real world as they are intended. Being flexible and making early changes to strengthen partnerships and service delivery, as is the case here, can create more sustainable programs in the long run. Revenue Generation: To help finance its Lead Hazard Control Program, Buffalo increased the annual rental registration fee for one- and two-unit properties. The increases of $15 and $30, respectively, allow for projected revenues of $250,000 to help sustain the program.

Case Study #4: Maryland The state of Maryland operates a lead-safe certification program for all rental units built before 1978 and tracks the properties’ lead hazard status through a statewide registry. All renter-occupied units built before 1978 in Maryland are regulated by the state’s lead paint disclosure laws. These properties must pass a full visual inspection and lead dust-wipe test upon change of tenant occupancy. There are two possible results of the inspection and test. If the property contains no lead contaminants, the property receives “lead-free” certification and is permanently exempt from future inspections. On the other hand, if lead is present in the unit, the property owner must reduce any lead risk to meet HUD’s de minimis standard. Additionally, the property must be inspected and tested for lead at each change of occupancy. The full results of the inspection and test are sent to the occupants within 10 days. Property owners also are required to provide lead paint educational documents to all new tenants and to existing tenants every two years.

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The certificates issued to property owners are tiered. Landlords may receive full risk-reduction certification, limited lead-free certification, and lead-free (exempt) certification. Upon change of occupancy, a pre-1978 property must meet the full risk-reduction standard, which includes passing a lead-dust contamination test for each room in the unit (Full Risk Reduction Standard 1996). In the event that peeling paint or other conditions are reported in a unit, or if a child or a pregnant woman in the unit has an elevated BLL, the property must be re-inspected and tested to confirm the absence of any lead hazards and LBP threats (“Inspections for Rental Housing” 2018). Limited lead-free certification is issued when the interior of a unit is lead-free, but lead is detected on the building’s exterior paint. These certificates must be renewed every two years, and there must be no chipping or deteriorating paint. Finally, lead-free certification is granted when there is no lead found through paint and dust-wipe testing in the interior or exterior of the unit (“Inspections for Rental Housing” 2018). In addition to passing risk inspections at each change of occupancy, owners must register their properties annually with the Maryland Department of the Environment’s Lead Rental Registry database. The registration fee is scaled based on lead risk present in the property. Owners pay an annual registration fee of $30 per property if lead is present. If the property is certified lead-free, property owners pay a one-time $10 processing fee and are exempt from future registration fees. By charging $30 for each rental unit that contains lead, the state covers the cost of inspecting homes and maintaining a registry of all homes. This registry is available for public inspection, but the Department of the Environment does not provide lists of properties owned by specific individuals. The department will disclose, upon request, whether an owner has registered a lead-affected property and whether those properties meet state risk-reduction standards (Reduction of Lead Risk in Housing Act 1994). Maryland’s law also severely limits the liability of landlords when it comes to lead poisoning. Lead-poisoned children cannot seek traditional tort damages for lead poisoning if the unit they live in meets the state’s lead reduction standards. However, if the child’s BLL exceeds 20 μg/dL, the landlord can be required to relocate the child’s family to another housing unit and cover the child’s medical expenses until the child is 18 years old (National Center for Healthy Housing 2018). Lessons from Maryland Maryland provides four lessons about developing and implementing stricter lead disclosure requirements. Incremental Implementation: Maryland’s gradual ramping up of requirements enabled it to create a comprehensive program that now requires lead testing and disclosure for every pre-1978 rental unit in the state.

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Targeted Approach: The program initially focused on pre-1950 rental units, which are the most likely to contain lead hazards, before expanding to require all pre-1978 rental units meet lead reduction standards. Additionally, the program focuses exclusively on rental units because children of renters are more likely to be lead poisoned than those of homeowners. People purchasing a home are more likely to have the resources to pay for a home inspection and lead test. Timing: Repeated testing in rental units with lead hazards allows units to be continually monitored for any paint deteriorations or other sources of dust. One-time inspections are not sufficient when lead hazards are present. Biannual follow-up in rental units keeps tenant and landlord knowledge of lead hazards current. Incentives and Penalties: Maryland provides both a “carrot” and a “stick” to encourage compliance. The “carrot” is the limited tort immunity granted to a landlord if they meet lead reduction standards. The “sticks” are prohibiting landlords from renting non-compliant units and requiring landlords to cover the expenses of any lead-poisoned child should their BLL exceed 20 μg/dL.

Case Study #5: Massachusetts In 1971,12 Massachusetts passed one of the first lead poisoning prevention laws in the United States (National Center for Healthy Housing 2018b). The Massachusetts Child Lead Poisoning Prevention (CLPPP) Act requires property owners or managers of pre-1978 residential property where a child younger than 6 lives test for lead-based paint, disclose results to tenants, and permanently remove or encapsulate lead-based paint (“Learn about Massachusetts Lead Law” 2018; National Center for Healthy Housing 2018). When ownership of pre-1978 properties is transferred and a child younger than 6 lives or will live in the property after the transfer, the new owner must obtain a Letter of Full Compliance or a Letter of Interim Compliance within 90 days of receiving the title for the property (105 CMR 460.100: Lead Poisoning Prevention and Control n.d.). To obtain a Letter of Full Compliance, a licensed inspector must certify that a unit or common area no longer has any LBP threats. Property owners also are required to provide tenants with information about lead risks and the property’s history with lead. A Letter of Full Compliance shields owners from liability as long as they continue to take reasonable care of the unit and the common area remains compliant with the law. However, if a property owner fails to meet the lead disclosure requirements, that individual; is liable for any lead-related harm to a child and can face civil and criminal penalties (§197A(e)). In 2013, several tenants filed complaints against their Boston landlord for violating the State’s lead laws,

12Amended in 1987 and 1993

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including failures to follow disclosure requirements and exhibiting discriminatory behavior against tenants with children. The landlord was ultimately fined $75,000 (“Boston Area Landlord to Pay $75,000 and Delead Units to Resolve Fair Housing Lawsuit” 2013). While landlords can be held liable for violating state lead laws, Massachusetts provides incentives for owners such as state income tax credits13 and deleading grants and loans provided by agencies like HUD and the Massachusetts Executive Office of Communities and Development to comply with requirements the law (“Learn about Financial Assistance for Deleading” 2018). Massachusetts also provides tenant protections. The Act prohibits landlords from avoiding the lead paint laws by evicting or refusing to renew a lease with families who have children younger than 6 (§199A(a)). Moreover, when a tenant is unable to stay in a unit due to identified LBP threats, the landlord must assist with the tenant’s relocation until the lead inspector determines it is safe to move back into the apartment. Massachusetts requires the landlord to pay for the reasonable travel expenses and housing costs of the tenant’s temporary relocation, while the tenant is responsible for paying the normal rent (§197(h)). The law also requires that the temporary housing not cause “undue economic or personal hardship to the tenant” (§197(h)). Finally, Massachusetts provides education for tenants and property owners. The Massachusetts Department of Health provides funds to several local grassroot organizations, supporting educational efforts including toll-free hotlines, websites, pamphlets, and media campaigns (“Massachusetts Strategic Plan to End Lead Poisoning by 2010” 2004). Education is an area Massachusetts has focused on and believes it is one of the most essential preventive actions in the state (“Massachusetts Strategic Plan to End Lead Poisoning by 2010” 2004). To complement its education efforts, Massachusetts shares information through its publicly available database with records of all pre-1978 homes that have been inspected, contain LBP threats, or have been issued a Letter of Compliance by the state (“Lead Safe Homes Search” 2017). Lessons from Massachusetts Lessons related to incentives and penalties, education, and liability were learned from Massachusetts. Incentives and Penalties: Massachusetts provides incentives for compliance by offering tax credits, low- to zero-interest loans, and some liability protection for property owners who are issued Letters of Full Compliance or Letters of Interim Compliance. The lead laws also contain more punitive measures, such as fines and strict liability standards, for failure to comply with disclosure and inspection requirements. 13 Up to $1,500 for each unit deleaded and $500 for each unit for interim control.

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Education: Massachusetts identified education about lead as key to preventing harm. Massachusetts works with community organizations and provides funds for informational materials and media campaigns to help teach property owners and tenants about lead. Property Owner Liability: Massachusetts holds property owners strictly liable for violation of lead disclosure requirements when it affects the health of a child living in that property. Comparative Analysis of Best Practices This section identifies and analyzes the best practices from the above case studies. Some lessons are from multiple case studies, while others are unique to a particular case. The best practices are organized into broad categories so that readers can decide what practices may work best in their particular state or city. The following sections address more general practices that may be predicated on a statutory change. Each section is accompanied by a table that summarizes key findings. These tables are not intended to serve as a comprehensive list of each case study’s strategies; rather, they summarize common trends among case studies.

Table 1: Summary of Best Practices by Category Best Practice Strategies Employed Inspections and Testing ● Require inspections and testing to inform disclosure of lead hazards

and lead-based paint in the home ● Require more frequent testing in high-risk homes ● Use visual inspections as an opportunity to educate occupants on

lead hazards ● Grant discretionary testing authority to city officials

Changes to Existing Law ● Require properties be maintained to a certain visual or lead dust level standard; or

● Require disclosure of “reasonably known” hazards; or ● Change legal presumptions to assume that lead hazards in pre-1978

homes contain lead Documenting Properties through Registries and Certification

● Maintain a registry to monitor the lead status of all properties ● Publish a directory of lead-safe or lead-free homes ● Require properties to apply for a certificate of occupancy that

includes requirements for lead hazard testing and disclosure Education ● Inform tenants of their rights against landlord retaliation

● Train tenant advocacy groups to identify lead hazards ● Educate civic leaders and policymakers on lead hazards

Community Partnerships ● Work with community groups to build trust between the government and residents

● Seek input from community groups that represent minorities and low-income residents

Implementation and Timing ● Implement disclosure, inspection, and testing policies incrementally to allow stakeholders time to adjust to new requirements

Table 1 highlights where cities and counties are acting beyond the Disclosure Rule’s requirements. This serves as a rough summary of the testing and disclosure efforts but misses many of the nuances of each particular program.

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Best Practice #1: Inspections and Testing Inspections can help provide information about lead hazards and identify specific hazards in a home that may require additional attention. If a rigorous program of inspections and testing is not in place, disclosure requirements have little power. Simple, low-cost visual inspections go a long way to increase tenant and homeowner awareness of lead hazards. Visual inspections also have an educational component. They often improve residents’ knowledge of lead risks in their homes. This is information that they can share with friends and family who may live in housing of a similar age and quality. Maryland’s 1994 Reduction of Lead Risk in Housing Act, which introduced visual and dust-wipe inspections, is a model of inspection program success. Since the passage of the Act, the number of new registered cases of children in the state with BLLs above 10 micrograms per deciliter (μg/dL) has decreased from 14,500 to 355 in 2016. This decline is despite the dramatic increase in the number of children tested after 2015 (Maryland Department of the Environment 2016). Testing properties for lead is necessary for effective disclosure practices. Because the Disclosure Rule requires information sharing only when the existence of lead is known, testing is integral to creating the requisite knowledge for disclosure. The case studies in this report take steps to increase testing rates to enhance disclosure. In general, the case studies increase testing rates by using a property certification process (Rochester, Buffalo, Maryland, Massachusetts) and granting discretionary testing authority to public officials (DC). Absent such a requirement, property owners are usually required to test for lead only when a child in their property is found to have an elevated BLL. To reduce costs, visual inspections can be integrated into the testing process. Rochester’s two-step process, which requires a dust-wipe test if no visual hazards are identified, exemplifies an efficient pairing of inspection and testing. This process provides efficient identification of lead hazards and testing for LBP threats. It also demonstrates the importance of identifying the difference between lead hazards and LBP threats. Similarly, DC’s use of risk assessments provides another example of how visual inspections can be used in place of testing.

Table 2: Inspections and Testing

Use visual inspections

Require lead testing as part of certification/registry program

Expand discretionary

testing authority

Required for pre-1978 renter-

occupied homes

Require more frequent testing

in high-risk units

Require testing in high-risk units

Washington, DC X N/A N/A N/A X Rochester, NY X X X X Buffalo, NY X X*

Maryland X X X Massachusetts X X

*Only for one- and two-unit rental properties

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Best Practice #2: Changes to Existing Law Cities and state agencies that aim to improve testing and disclosure need a legal foundation for their proposed requirements. An important first step is making sure property standards explicitly address lead. This can be an explicit requirement that certain properties be free of LBP (e.g. Washington, DC Ch. 20-33 §3300.2) or a prohibition on certain property conditions that present a risk of exposure to lead (e.g. Rochester §90-54). These are important requirements because maintaining property in good condition can prevent the development of lead hazards (Phelps 2004). Most of the case studies in this report provide specific prohibitions for lead in residential property as part of a more comprehensive lead-hazard control law (e.g. Rochester § 90-54; DC §8-231.02), but there is no reason making explicit changes to general property standards could not also be useful. In some cases, the laws and regulations created standards or processes for visual inspections that help identify lead risks and focus testing efforts. For example, Rochester’s Certificate of Occupancy program uses visual inspections before conducting formal lead testing (Article III S90-55). The use of visual inspections can help identify lead hazards at a lower cost than requiring dust-wipe tests for all units. Moreover, provisions that prohibit lead hazards in addition to LBP threats can help reduce costs because lead hazards do not require formal testing. DC’s risk assessment makes use of such a distinction by allowing the District to conduct a visual inspection and order the property owner to address hazards absent a formal test (§8–231.03(b)). Rochester’s use of visual inspections for its certification program also makes use of this distinction. There also are measures that directly address information-sharing and tenant’s rights. These varied greatly by each city and state. Some included requirements that tenants be informed of their rights (e.g. D.C. S8-231.04(e)), others were specific to other aspects of lead-hazard control that relate to the federal rule (e.g. D.C. S8-231.04, Massachusetts 105 CMR 460.745, Buffalo S264.15, Maryland §6-824). For example, DC’s code improves disclosure because it protects and informs tenants of their rights. In fact, DC’s code includes an anti-retaliation provision in addition to information-sharing requirements (8-231.07). The case studies’ requirements focus on a particular housing stock, or on pregnant women and children. For example, Rochester (S90.54) and DC (S8-231.02) focused efforts on pre-1978 properties. Rochester (S90-16(a)(1), Buffalo (Ch 264), and Maryland (S6-811) target rental units with specific testing and certification standards. Moreover, Massachusetts (105 CMR 460.100) has unique requirements for properties where there are children under 6. These measures are useful to help programs run efficiently but are also important because they ease burdens on those who are not likely at risk of lead exposure.

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Designating that certain deteriorating conditions presumably constitute a LBP threat improves disclosure because it informs residents of health risks and can provide sufficient evidence for public officials to access the property for conducting tests. Rochester and DC identify certain deteriorating building conditions as indicative of containing lead (Rochester S90-53; D.C. S8-231.01(32)). The use of definitions and standards that create a presumption of LBP threats for high-risk properties supports discretionary testing practices by government officials. For instance, Washington, DC’s definitions presume that deteriorating paint on a pre-1978 home contains lead. This presumption can support the “reasonable belief” necessary to conduct a risk assessment for the property. Of the cities and states examined in this report, only Washington, DC explicitly changed its standard for disclosure. By requiring property owners to disclose information about “reasonably known” LBP threats, DC’s law directly addresses the problem with the federal rule’s focus on knowledge of lead (S8-231.04(a)(1)). This is an important step because it addresses the perverse incentive to not test property in order to avoid disclosure requirements. It also is common practice to develop legal authority for inspectors to enter a home and compel compliance. Common examples of this are certification programs for properties that require testing, or the use of discretionary testing authority to enforce housing standards. For example, Buffalo requires that property owners consent to lead testing for participation in its property certification program and registry (S264.14). Another example is DC’s municipal code, which grants authority to government officials so that they can conduct inspections and tests (S8-231.05). These requirements are distinct from reactionary testing practices that are based on an elevated BLL because these standards allow, or require, testing before there is evidence of an elevated BLL.

Table 3: Changes to the Law Some LBP property

standard Disclose “reasonably

known” hazards Presume visual

deteriorations contain lead in pre-1978 homes

Washington, DC X X X Rochester, NY X X Buffalo, NY X

Maryland X Massachusetts X

Best Practice #3: Documenting Properties: Registries and Property Certification State or local governments can document and record properties in various ways. Recording whether a property is lead-free or lead-safe can help improve disclosure by sharing information about lead hazards and serving as a part of a larger certification processes. This is the case with Buffalo, NY, where the long-established rental registry was amended to address LBP threats. The additional registry requirement, the Landlord Attestation form, prompts increased disclosure

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of possible lead hazards by landlords. This registry, while not publicly available, allows the City to easily identify which landlords or property managers comply with disclosure efforts. Unlike Buffalo, some municipalities maintain public directories. Omaha, NE, maintains a public online registry of past lead-control activities. This registry does not certify a property as lead-free or lead-safe, but rather uses data from the EPA, the City, and the public to document lead-related activities (City of Omaha Planning Department 2018). Lead-related activities include, but are not limited to: paint, dust, or soil testing; abatement efforts; city-initiated risk assessments; and owner-initiated reporting or information-sharing. Erie, PA, provides another example of a public registry. Its lead-safe registry, maintained by the Erie Redevelopment Authority, documents properties that have been declared hazard-free through dust-wipe testing (Erie Redevelopment Authority 2018). Certification is another way communities can document a property’s lead-free or lead-safe status. Rochester’s policy of requiring Certificates of Occupancy has been instrumental in addressing lead hazards. Since 2005, lead hazard inspection, testing, necessary repair, and disclosure are conditions of receiving a Certificate of Occupancy. Maryland and Massachusetts also include lead testing and/or inspections as a part of their certification processes. When properties are certified, they must meet state-set lead reduction standards,14 which are determined through testing and inspection. In all of these certification programs, properties must be periodically re-certified to ensure that landlords maintain their properties to be lead-safe. This step is critical: lead-based paint deteriorates over time, and if landlords do not maintain their properties, once-safe units become unsafe. Overall, certification is an excellent practice for improving lead disclosure because it provides for routine and semi-systematic testing practices.

Table 4: Registries and Certification Maintain a

registry of all rental

properties

Publish a registry of lead-safe

properties

Require a certificate of occupancy

program for all rental

properties

Require all properties meet LBP standards

to receive certificate for

occupancy

Require only properties with children meet

LBP standards

Washington, DC X X Rochester, NY X X X X Buffalo, NY X X X

Maryland X X X Massachusetts X X X

*Massachusetts requires a Letter of Full Compliance or Interim for pre-1978 homes with children that acts like a certification requirement.

14 These lead reduction standards require property owners to remediate deteriorating or chipping paint and control for any friction generated by windows with lead-based paint.

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Best Practice #4: Education As with any public-facing effort, education is key. Recent news reports and discussion about lead poisoning from drinking water has helped advance the conversation about lead hazards, and it is an opportunity to expand community awareness of other lead poisoning sources, especially lead-based paint. Often, if community members do understand how lead poisoning affects a child’s development and ability to learn, they might not know that lead paint chips are not the only way that children ingest lead. When tenants do not understand the seriousness of the dangers posed by lead, cities can see lower enrollment in preventive actions and less action toward requiring stricter disclosure rules. Education campaigns, led by municipal agencies or community partners, can help residents recognize lead hazards. Often, tenants do not report general or lead-related building issues to city building inspection agents because they fear negative retaliation from their landlords. This was specifically discussed in our interview with the City of Buffalo. When tenants are worried about negative consequences, they will not take action to have their residences improved. This is true even if they are aware of, or suspect, hazards. Buffalo has sought to address this by including tenants’ rights information in its lead hazard educational materials. Washington, DC requires informing tenants about their rights. This educational tool insures that tenants receive information before finalizing a lease or purchase offer. Korfmacher (2013) points out that this procedure also makes tenants “a partner in the municipality’s enforcement scheme” (p. 21). There also is value when landlords, as the distributors of information, know that tenants are aware of their legal rights. This can help induce compliance with local requirements (Korfmacher 2013).

When tenants and tenant advocacy groups are involved in lead hazard identification, they become part of a larger community effort and help spread information about lead hazards. If tenants are not well informed about the risks posed by lead and cannot identify lead hazards, they may be indifferent to the problem (Mares 2003). Having tenants and tenant advocacy groups trained to visually inspect prospective homes can reduce that indifference. This training potentially reduces lead poisoning because tenants might decide not to move in if they see potential lead paint or request to have additional inspections. Educating civic leaders on lead hazards can be another way to share information throughout the community. One of Rochester’s early tools for educating community leaders and policymakers on lead sources and lead remediation techniques was a “lead lab”: a home converted into an interactive teaching space. Experts used the lead lab to demonstrate common areas where lead dust is detected and as well as affordable measures to contain lead hazards (McGarvey 2010). This hands-on approach effectively demonstrated the affordability of reducing lead risks, while showing community leaders where lead dust is generated in a typical home.

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These case studies demonstrate a variety of tools that communities can use to educate residents about lead hazards and tenants’ rights. Doing so enhances lead disclosure by improving community knowledge and supporting testing and inspection efforts. These educational best practices are an excellent short-term goal for every community.

Table 5: Education Case Study Inform tenants of

their rights Involve local

advocacy groups Use visual

inspections to educate tenants

Target education to civic leaders*

Washington, DC X X X Rochester, NY X X X

Buffalo, NY X X Maryland X X

Massachusetts X X * Civic leaders: community leaders and policymakers

Best Practice #5: Community Partnerships Many municipalities are not able to achieve success on their own. Partnerships with other public agencies and nonprofit organizations prove critical to program success. A healthy dialogue can increase trust among the government, and low-income and minority communities (Kaka 2018). This trust is key, because home inspections require public officials to enter private spaces. Inspectors can be viewed as invasive, unwelcome, and even as a threat to a person’s ability to occupy the property. This perception can be changed by collaborative efforts among government agencies and public health community groups. When these entities work together, residents are more likely to support lead disclosure, inspection, and testing initiatives and view inspections in a positive light (Kirkmire and Merritt 2018). When partnerships exist, community groups can serve as the “boots on the ground” actors. Community groups, which often are intimately familiar with the people they serve, can work to mobilize volunteers, engage and educate residents, and garner support for initiatives in ways that government officials cannot. These partnerships can ensure stronger representation from low-income and minority groups, the populations most affected by lead poisoning. Without this representation, local governments may not be able to establish a dialogue that is necessary to best address lead disclosure.

Best Practice #6: Implementation and Timing Incremental steps toward addressing lead disclosure and abatement earns more political support than abrupt change (Kirkmire and Merritt 2018). Rochester officials shared that cities and states that attempt to implement a lead inspection and disclosure requirement while also adding certification requirements could face strong resistance. Almost all of our case studies took an

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incremental approach or explicitly delayed the implementation of some aspects of a comprehensive policy.15 Incremental implementation reduces administrative burden because it allows governments and property owners to adjust to new requirements over time. In Rochester, the Certificate of Occupancy program was in place long before lead paint was a feature of the ordinance. Buffalo also implemented its Lead Hazard Control Program by modifying the way in which an existing program, the city rental registries, was used. Maryland’s law, too, provides an example of incremental expansion of requirements. DC also plans to modify its own occupancy certificates to address lead hazards. In addition, local and state governments should consider how frequently inspections and testing occurs. Paint deteriorates over time, and follow-up testing and inspection is important to ensure continued compliance with lead-safe standards. The case studies in this report show great variability in the frequency with which policies require testing or inspection (see Table 6). For example, Buffalo requires that landlords renew their status on the rental registry every year, whereas Rochester mandates recertification every three years for properties in high-risk areas and every five years for all other rental properties. Other policies may call for testing or certification when a property becomes occupied by a new tenant or owner, as is the case for Massachusetts. Governments should consider a time frame that minimizes the burden on tenants and property owners.

Table 6: Frequency of Testing/Inspection (Compliance with Certificate of Occupancy Lead-Related Requirements)

Case Study Upon request of occupant*

Every 2-5 years Upon change of occupancy

More frequently for high-risk units

Washington, DC T N/A N/A N/A Rochester, NY I, T I, T I, T I, T

Buffalo, NY I I Maryland I, T I I, T

Massachusetts** I, T I, T T=Testing, I=Inspection, N/A=Not Applicable *Regardless of whether the city or state has lead requirements for Certificate of Occupancy program **Only required for units with children

Recommended Approaches to Improve Disclosure Based on our case studies and analysis of their best practices, we recommend local officials work with their cities and states to take at least one of two approaches to improve disclosure. The first option is to use a registry or certificate of occupancy program that requires residential properties

15Massachusetts is the only case study that did not take an incremental approach when implementing lead disclosure rules. It took advantage of the early-1970s environmental agenda to achieve a more holistic policy change.

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pass a property inspection, including lead testing standards. The second is to create legal support for inspection, testing, and disclosure that specifically addresses lead. In addition, many of the best practices, including education and community partnerships, can support lead disclosure efforts without the burdens of a more comprehensive approach.

Certification Program for Residential Property Four out of the five case studies employ some type of property certification requirement that includes testing for lead or identification of lead hazards. Under this approach, homes are required to pass a property inspection that includes testing requirements for LBP and/or exposed soil. When the home passes the property inspection, the state or city issues a Certificate of Occupancy. If it does not pass the property inspection, the property owner must follow specific remediation steps before re-applying for the certificate. We recommend this approach because it allows for systematic and routine testing for lead. Absent testing or inspections, lead hazards and LBP threats cannot be detected.

Legal Support for Discretionary Enforcement A grant of discretionary testing and inspection authority that is supported by legal definitions and standards is the second recommended approach. This includes many of the best practices identified in the Changes to the Law section of the comparative analysis. While all of the case studies adopted some provisions from that section, Washington, DC relies solely on statutory support of its testing and disclosure activities. We recommend this approach because enforcing the law with discretionary testing and inspection can improve the disclosure of LBP threats and lead hazards. Moreover, DC is the only case study with a broader disclosure requirement that helps close the knowledge gap created by the federal rule’s requirement of “known” hazards. These approaches employ a variety of the best practices discussed in the Comparative Analysis section. Importantly, they provide a way to increase the frequency of testing. To achieve comprehensive disclosure, residential properties must be tested and inspected. If it is not feasible to follow these approaches, we recommend starting with educational efforts, community partnerships, and visual inspections which aim to improve community understanding about the risks posed by LBP. Additional Considerations for Local Governments

Development of Entertainment-Based Education The use of entertainment-education can support city and state efforts. Entertainment-education is the practice of teaching a concept through popular entertainment, such as a TV show. Data from the U.S. Centers for Disease Control and Prevention (CDC) found that among minority viewers who regularly watched TV, 70 percent of Hispanic women, 65 percent of Black women, and 64 percent of Black men took some action after hearing about a health issue on TV (Freimuth and Quinn 2004). Because of the access entertainment-education can have on the population that is

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most at risk of lead-related illness, lead education efforts should take advantage of this strategy to improve viewers’ understanding of lead risks.

Privacy Concerns Some of our interviews raised privacy concerns about the government’s use or development of housing registries. Some staff believe that there are legal restrictions on a department’s ability to create registries that identify LBP threats in particular homes. Others’ experiences with lead registries show that no federal law restricts governments from creating registries. This issue is something to be aware of as it may depend on state and local laws. In general, we are unaware of any restriction on gathering this type of information. Because several communities have cited concerns that arise from health privacy regulations, the CDC issued a guidance report for communities navigating requirements in the Health Insurance Portability and Access Act (HIPAA) when developing a registry (see Appendix B). Some non-governmental groups are working to create their own lead-safe housing registries. Cities that expressed privacy concerns did not believe that similar restrictions applied to non-governmental community groups.

Environmental Justice The case studies illustrate the desire of these states and cities to implement methods of lead disclosure as a way to help improve the lives of racial and ethnic minorities and low-income people. Officials in our interviews expressed that their lead laws were formed with the intent of helping all their citizens – especially those who are the most vulnerable and disproportionately affected by lead paint in their homes. Despite these intentions, lead disclosure laws raise two key environmental justice concerns: first, whether local property mandates pass on the cost of compliance to low-income tenants, and second, whether landlords retaliate or discriminate against tenants if local laws require remediation. There are concerns that local property mandates may cause some harm to the communities it intends to protect by reducing housing accessibility, raising rents, and creating retaliatory practices. For example, owners may feel that local property mandates are too costly and burdensome, and they may attempt to pass on the costs of compliance and raise the rent on their tenants (Mares 2003; Gazze 2016). Staff in our case studies expressed this concern and related concerns about ability to pay. Passing on costs to low-income tenants would be especially detrimental for them, because higher rent could put them in a difficult position with few alternatives (e.g. cutting costs or moving out entirely) (Mares 2003). More program evaluation is needed to understand the impacts of certification requirements on housing value and rents. There is also a concern about retaliation or discrimination toward tenants. Staff from two of the case study communities expressed concern that some landlords attempt to evade lead laws by refusing to sell or lease to prospective buyers or tenants who have children younger than 6, an age group that is particularly vulnerable to lead exposure and is protected by statutes. Despite laws that prohibit discrimination and retaliation against tenants, staff communicated that

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discrimination or retaliation still occurs, in part, due to a lack of resources and enforcement. For local and state governments enforcing these laws against retaliation and discrimination, it is important to protect groups that are the most vulnerable to the effects of lead poisoning. This issue should be studied further to determine the extent of the problem in communities and to identify solutions.

Enhanced Disclosure Requirements and the Number of Children with Lead Poisoning Testing and disclosure is a critical first step to preventing lead poisoning. It is also only one facet of most local lead poisoning prevention programs. This means that it is difficult to isolate the effect of disclosure on lead poisoning rates. There is a lot of evidence for the effectiveness of our case study lead programs as a whole, but very little research is available on whether improving lead hazard disclosure reduces lead poisoning rates in a city. The case study states and cities that evaluated their lead programs have seen dramatically lower rates of children with elevated BLLs. Rochester has seen an 80% decline in confirmed childhood lead poisoning cases since the passage of its lead laws (Coalition to Prevent Childhood Lead Poisoning 2010). In Massachusetts, the rate of children confirmed with lead poisoning in the state has declined, from about 0.8% in 2009 to near 0.5% in 2016 in high-risk areas of the state (“Data Brief: Childhood Lead Exposure in Massachusetts” 2016). In Maryland, the rate of confirmed child lead poisoning cases dropped to 0.3% in 2016, the lowest it had been since 1993 (“Lead Poisoning in Maryland Drops to Lowest Recorded Levels, Testing Increases in First Year of State Initiative” 2016). It is difficult to determine how enhanced disclosure alone contributed to these declines in childhood lead poisoning cases. Further research should seek to identify the effect of enhanced inspection, testing and disclosure separately from lead elimination practices.

Conclusion While every case study state and city connected disclosure and testing requirements to remediation requirements, testing and disclosure are only the first steps to addressing lead hazards in homes. This document provides introductory guidance for communities that wish to enhance their lead disclosure policies. Lead poisoning is preventable, and states and cities included in this report have seen encouraging results from their lead prevention programs. Evaluations show that the policies analyzed in this report dramatically reduced lead poisoning rates. Further evaluation is needed to better understand the effects on housing markets, environmental justice, and privacy. Ultimately, the best practices and recommendations in this report provide states and local communities with insights and potential policy models to develop lead disclosure requirements.

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Works Cited

105 CMR 460.100: Lead Poisoning Prevention and Control. Accessed April 19, 2018. https://www.mass.gov/files/documents/2017/12/06/105cmr460.pdf.

“Boston Area Landlord to Pay $75,000 and Delead Units to Resolve Fair H.” 2013. Attorney General of Massachusetts. Attorney General of Massachusetts. February 27, 2013. http://www.mass.gov/ago/news-and-updates/press-releases/2013/2013-02-27-miller-cj.html.

Buffalo Office of the Mayor. 2016. “Lead Hazard Control Program - City of Buffalo.” 2016. https://www.ci.buffalo.ny.us/Mayor/Home/Leadership/Archived_Press_Releases/2016_Archives/LeadHazardControlProgram.

City of Buffalo. n.d. “Landlord Attestation.” Landlord Attestation. Accessed February 3, 2018. https://www.city-buffalo.com/files/1_2_1/city_departments/edpis/RentalRegistration/Attestation.pdf.

City of Buffalo, NY Municipal Code §129-3(f). Retrieved from https://ecode360.com/13581863

City of Buffalo, NY Municipal Code §264-14(a)(1). Retrieved from https://ecode360.com/13556595

City of Rochester, NY Municipal Code § 90-53. Retrieved from https://ecode360.com/8677399

City of Omaha Planning Department. 2018. “Omaha Lead Registry.” City of Omaha Planning Department, Housing and Community Development Division. 2018. https://planninghcd.cityofomaha.org/lead-hazard-information/omahaleadregistry.

“City of Rochester, NY: Violations.” 2013. City of Rochester, NY Code. 2013. https://ecode360.com/8677786.

Coalition to Prevent Childhood Lead Poisoning. 2010. “Coalition to Prevent Childhood Lead Poisoning: Making Lead History in Western New York State - Monroe County, New York.” Prevention Institute. May 2010. https://www.preventioninstitute.org/publications/coalition-prevent-childhood-lead-poisoning-making-lead-history-western-new-york-state.

Coalition to Prevent Lead Poisoning. 2002. “Biographical Information.” Coalition to Prevent Lead Poisoning (CPLP) Collection. Box 1, Series I. University of Rochester Rare Books & Special Collections. Rochester, New York. https://rbscp.lib.rochester.edu/4884.

Community Foundation for Greater Buffalo “Renewing Our Pledge: A Path to Ending Lead Poisoning of Buffalo’s Most Vulnerable Citizens.” Lead Action Plan. March 27, 2018. http://cfgb.org/lead-action-plan.

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“Data Brief: Childhood Lead Exposure in Massachusetts.” 2016. Massachusetts Department of Public Health. https://www.mass.gov/files/documents/2016/07/ww/lead-data-brief-june-2016.pdf.

“DC Code - Subchapter I. Lead-Hazard Prevention and Elimination.” n.d. Accessed April 5, 2018. https://code.dccouncil.us/dc/council/code/titles/8/chapters/2A/subchapters/I/.

D.C. Department of the Environment. n.d. “Lead Related Regulatory and Legislative Affairs.” Accessed May 1, 2018. https://doee.dc.gov/service/lead-related-regulatory-and-legislative-affairs.

Duke, Annette R. 2017. Legal Tactics: Tenants’ Rights in Massachusetts - Private Housing.

Erie Redevelopment Authority. 2018. “Lead Safe Registry.” Erie Redevelopment Authority. 2018. http://www.redeveloperie.org/lead_hazard_reduction/lead_safe_registry/.

Freimuth, Vicki S., and Sandra Crouse Quinn. “The Contributions of Health Communication to Eliminating Health Disparities.” American Journal of Public Health 94, no. 12 (2004): 2053–55.

Full Risk Reduction Standard. 1996. Code of Maryland. http://mgaleg.maryland.gov/webmga/frmStatutesText.aspx?article=gen&section=6-815&ext=html&session=2017RS&tab=subject5.

Gazze, Ludovica. 2016. “Lead Policies, Lead Poisoning, and Government Spending.” Dissertation Chapter, Department of Economics, Massachusetts Institute of Technology. http://home.uchicago.edu/~lgazze/webfiles/LeadPolicies.pdf.

“Lead Poisoning Prevention.” Maryland Department of the Environment. 2018. http://mde.maryland.gov/programs/LAND/LeadPoisoningPrevention/Pages/rentalowners_inspections.aspx.

Kaka, Eddy. Phone interview by Brandon Senger and Anna Wright. March 2018.

Kirkmire, Gary, and Len Merritt. Phone Interview Interview by Anna Wright. March 2018

Korfmacher, Katrina. “Local Approaches to Reducing Lead in Rental Housing.” University of Rochester. Presented to Federal Reserve Bank of Cleveland November 18, 2016. https://www.clevelandfed.org/~/media/content/events/2016/20161118%20lead/korfmacher.pdf?la=en.

“Lead and Healthy Housing - Compliance and Enforcement Frequently Asked Questions | Ddoe.” n.d. Accessed April 17, 2018. https://doee.dc.gov/service/lead-and-healthy-housing-compliance-and-enforcement-frequently-asked-questions.

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“Lead Hazard Control Program.” City of Buffalo. Accessed March 12, 2018. https://www.ci.buffalo.ny.us/Mayor/Home/Leadership/Archived_Press_Releases/2016_Archives/LeadHazardControlProgram.

“Lead Paint Inspection.” Accessed May 1, 2018. https://www.thermofisher.com/us/en/home/industrial/spectroscopy-elemental-isotope-analysis/portable-analysis-material-id/portable-consumer-safety-regulatory-solutions/portable-environmental-safety-analysis/lead-paint-inspection.html.

“Lead Poisoning in Maryland Drops to Lowest Recorded Levels, Testing Increases in First Year of State Initiative.” n.d. Accessed April 17, 2018. http://news.maryland.gov/mde/2017/10/25/lead-poisoning-in-maryland-drops-to-lowest-recorded-levels-testing-increases-in-first-year-of-state-initiative/.

“Lead Related Regulatory and Legislative Affairs | Ddoe.” 2018. 2018. https://doee.dc.gov/service/lead-related-regulatory-and-legislative-affairs.

———. n.d. Accessed May 3, 2018. https://doee.dc.gov/service/lead-related-regulatory-and-legislative-affairs.

“Lead Safe Homes Search.” 2017. https://eohhs.ehs.state.ma.us/leadsafehomes/default.aspx.

“Learn about Financial Assistance for Deleading.” Mass.gov. Accessed April 14, 2018. https://www.mass.gov/service-details/learn-about-financial-assistance-for-deleading.

“Learn about Massachusetts Lead Law.” 2018. Mass.gov. https://www.mass.gov/service-details/learn-about-massachusetts-lead-law.

Mares, Rafael. “Enforcement of the Massachusetts Lead Law and Its Effect on Rental Prices and Abandonment.” Journal of Affordable Housing & Community Development Law (2003): 343–65.

Maryland Department of the Environment. 2016. “Childhood Blood Lead Surveillance in Maryland, Annual Surveillance Report 2016.” http://mde.maryland.gov/programs/LAND/LeadPoisoningPrevention/Documents/Reports/AnnualReportFINAL10_17.pdf.

Massachusetts, General Laws Chapter 111 §189-199B. Retrieved from https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111.

“Massachusetts Strategic Plan to End Lead Poisoning by 2010.” 2004. Massachusetts Department of Public Health. https://www.cdc.gov/nceh/lead/StrategicElimPlans/MAStrategic%20Plan8-04.pdf.

McGarvey, Kathleen. July-August 2010. “Home Work.” Rochester Review 72, no. 6 (July-August 2010): 22-33. http://www.rochester.edu/pr/Review/V72N6/pdf/feature_lead.pdf

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National Center for Environmental Health. n.d. “CDC - Lead - New Blood Lead Level Information.” Accessed April 17, 2018. https://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm.

National Center for Healthy Housing. 2018a. “Maryland Lead Law.” State and Local Lead Laws. 2018. http://nchh.org/information-and-evidence/healthy-housing-policy/state-and-local/lead-laws/md/.

———. 2018b. “Massachusetts Lead Law.” State and Local Lead Laws. 2018. http://nchh.org/information-and-evidence/healthy-housing-policy/state-and-local/lead-laws/ma/.

Office of Healthy Homes and Lead Hazard Control. 2012. “Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing.” Second Edition. U.S. Department of Housing and Urban Development.

Pekkanen, John. 2008. “DC’s Lead Poisoning Problem.” Washingtonian. August 1, 2008. https://www.washingtonian.com/2008/08/01/dcs-lead-poisoning-problem/.

Petrucci, Louis. Phone Interview by Ruanda McFerren and Cameron Smith. April 2018.

Phelps, Anne. 2004. “Lead-Safe Housing Policy Guidance.” Alliance for Healthy Homes. http://www.nchh.org//Portals/0/Contents/Lead_Safe_Housing_Policy_Guidance.pdf.

Reduction of Lead Risk in Housing Act. 1994. Environment. Vol. 6. http://mgaleg.maryland.gov/webmga/frmStatutesText.aspx?article=gen&section=6-801&ext=html&session=2017RS&tab=subject5.

Rochester Lead Law. 2005. Property Code. Vol. 90. https://ecode360.com/8677707.

Sampson, Robert and Winter, Alix. “The Racial Ecology of Lead Poisoning: Toxic Inequality in Chicago Neighborhoods 1995-2013.” Du Bois Review (2016): 1-23. doi:10.1017/S1742058X16000151

Safe Work Practices. 1999. Code of Federal Regulations. Vol. 24. https://www.law.cornell.edu/cfr/text/24/35.1350.

The District of Columbia, Department of the Environment. 2011. “Strategic Plan for Lead‐Safe and Healthy Homes.” https://doee.dc.gov/publication/new-ddoe-strategic-plan-lead-safe-and-healthy-homes.

Wengrovitz, Anne; Brown, Mary Jean. “Recommendations for Blood Lead Screening of Medicaid-Eligible Children Aged 1-5 Years: An Updated Approach to Targeting a Group at High Risk.” Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention (2009). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5809a1.htm

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White, Brandi, Bonilha, Heather, and Ellis, Charles. “Racial/Ethnic Differences in Childhood Blood Lead Levels Among Children <72 Months of Age in the United States: a Systematic Review of the Literature.” Journal of Racial and Ethnic Health Disparities 3, no. 1 (2016): 145-153.

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Appendix A: Interview Questions

1. What does your position involve? 2. Description of efforts to promote lead disclosure

a. Did you model your policy [program] off of other/ previous policies [programs]? b. What does your organization normally do regarding lead disclosure and lead

poisoning prevention? (Testing, disclosure, and remediation). c. When addressing or planning to address lead disclosure, was equity/and or

environmental justice part of the conversation? Are equity considerations built into your wish list/program/policy or other actions related to promoting lead disclosure?

d. History of the program: how did it develop? 3. Describe your housing stock, including age. Are there areas within the community where

you piloted or targeted lead disclosure efforts (based on housing age, presence of children, presence of other vulnerable populations, or other considerations)?

4. Does your state/city/county have specific law/local ordinances associated with your organization’s efforts to promote lead disclosure?

a. What is the scope of the program? Does it involve visual inspections, indoor testing, and/or outdoor testing, and what specifically is being tested?

5. What is the relationship between the government and key stakeholders? a. Does your program depend on any cooperation between agencies/departments? b. Who are your community partners (nonprofit organizations, churches,

volunteers), and what role do they play in the effectiveness of your program? c. Who are the stakeholders and how did they respond to the lead disclosure

requirements? Consider landlords, tenants, affected families, and real estate professionals.

d. How did your program address concerns from the regulated community (people required to have lead testing done) and renters and homeowners? Is there a difference in requirements or feedback from mom and pop / small-scale landlords vs multi-unit / large-scale landlords?

6. How is your program funded? a. What is the cost per home? Per child (annual cost)? b. What is your funding source? c. What was your experience applying for these grants/funding streams?

7. Have you implemented any unique funding mechanisms (fee for landlord registration, tax incentive, etc.)? If yes, where did the ideas for these programs come from?

8. Are there dedicated staff for the program? 9. Do you have any measure of the program’s effectiveness?

a. How do you measure program performance? b. Numbers/percentage of residential units inspected

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c. Have you considered, e.g. return on investment (state v. local) d. How sustainable do you think this program is? e. Have you seen any changes in rates of elevated BLLs or the testing rate

(percentage of kids in the community getting tested)? We’re interested in the trends over the life of your organizations efforts to promote lead disclosure, as well as longer-term trends, if data is available.

f. Other data sources to track program performance? 10. What issues did your organization encounter with efforts to promote lead

testing/disclosure? 11. Have you changed your program over time? If so, why and how? 12. Would you like to see anything done at the state or federal level to help your city address

residential lead testing/disclosure? 13. Any suggestions for cities/localities with programs that we should look into? 14. What would you like to learn from our report? 15. Do you have any additional comments?

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Appendix B: Additional Resources

Education Resources ● CDC “Information about Blood Lead Levels”

https://www.cdc.gov/nceh/lead/acclpp/lead_levels_in_children_fact_sheet.pdf

● EPA Disclosure Rule Web Page https://www.epa.gov/lead/lead-residential-lead-based-paint-disclosure-program-section-1018-title-x

● HUD Disclosure Rule Web Page: https://www.hud.gov/program_offices/healthy_homes/enforcement/disclosure

● HUD Lead-Based Paint Hazard Interim Controls: https://www.hud.gov/sites/documents/LBPH-13.PDF

● NCHH Lead Poisoning Prevention Research: http://nchh.org/information-and-evidence/research/lead-poisoning-prevention/

Policy Guidance ● NCHH “Lead-Safe Housing Policy Guide” (full document):

http://www.nchh.org//Portals/0/Contents/Lead_Safe_Housing_Policy_Guidance.pdf.

● NCHH “Lead-Safe Housing Policy Guide” (summary): http://www.nchh.org//Portals/0/Contents/Lead_Safe_Housing_Policy_Guidance_Summaries.pdf.

● CDC “Overcoming Barriers to Data-Sharing Related to the HIPAA Privacy Rule” https://www.cdc.gov/nceh/lead/policy/HIPAADoc.pdf

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Appendix C: Locations Researched

Table A1: Summary of Research Locations Location Information Available Resources (links)

Washington, DC

Municipal Code http://dcrules.elaws.us/dcmr/t20_ch20-33 Tenant’s rights under DC lead law

https://doee.dc.gov/sites/default/files/dc/sites/ddoe/publication/attachments/DC%20Tenant%20Rights%20Form%20April%202018.pdf

Rochester, NY

Interview with Department of Buildings and Zoning

Gary Kirkmire, Director of Buildings and Zoning Len Merritt, Lead Paint Program Coordinator

Online registry map, list of code compliant properties

http://www.cityofrochester.gov/article.aspx?id=21474837491

City municipal code https://ecode360.com/8677707 Coalition to Prevent Lead Poisoning website

http://www.theleadcoalition.org/resources/

Buffalo, NY Interview with Department of Permit and Inspection Services

Louis Petrucci, Assistant Director, Department of Permit & Inspection Services

City municipal code § 129 (Certificate of Occupancy)

https://ecode360.com/11767278

City municipal code § 264-14(a)(1) (Lead Program)

https://ecode360.com/13556595

City website http://city-buffalo.com/Home/City_Departments/EDPIS/LeadInformation

Landlord Attestation Form https://www.city-buffalo.com/files/1_2_1/city_departments/edpis/RentalRegistration/Attestation.pdf

Lead Paint Notice form https://www.city-buffalo.com/files/1_2_1/city_departments/edpis/RentalRegistration/LeadPaintNoticeForm_New.pdf

Maryland State website

http://mde.maryland.gov/programs/LAND/LeadPoisoningPrevention/Pages/index.aspx

National Center for Healthy Housing (NCHH) website

http://nchh.org/information-and-evidence/healthy-housing-policy/state-and-local/lead-laws/md/

Maryland Statutes http://mgaleg.maryland.gov/webmga/frmStatutesText.aspx?article=gen&section=6-801&ext=html&session=2018RS&tab=subject5

Massachusetts State website (Learn About Massachusetts Lead Law)

https://www.mass.gov/service-details/learn-about-massachusetts-lead-law

Tenant Lead Law Notification http://www.mass.gov/eohhs/docs/dph/environmental/lead/tenant-note.pdf

Property Transfer Lead Paint Notification

https://www.mass.gov/files/documents/2016/07/ud/property-transfer-note.pdf

NCHH website http://nchh.org/information-and-evidence/healthy-housing-policy/state-and-local/lead-laws/ma/

Chicago, IL Interview with Department of Public Health

Eddy Kaka, Lead Program Director

Erie, PA Interview with Erie Redevelopment Authority

Scott Henry, Executive Director

Omaha, NE Interactive Lead Registry Map https://planninghcd.cityofomaha.org/lead-hazard-information/omahaleadregistry

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Madison, WI Interview with Madison Water Utility

Joseph Grande, Water Quality Manager