How to Fill Out the Virginia Tenant Rights and Responsibilities Form

To fill out the Virginia Tenant Rights and Responsibilities form, download the current version from the Department of Housing and Community Development, leave the body of the document untouched, and complete only the acknowledgment page at the end with the delivery date, the rental property address, and signatures from the landlord and each tenant. The completed form must be delivered along with the signed written lease within ten business days of the lease’s effective date.¹

Download the Current Version First

The form is maintained by the Virginia Department of Housing and Community Development (DHCD) and posted on its landlord-tenant resources page at dhcd.virginia.gov. Do not reuse a copy saved from a previous tenancy without checking the revision date printed on the document. DHCD’s Director is authorized to amend the statement whenever the law changes, and an outdated version may omit protections a tenant is entitled to know about.²

The statement itself is a pre-printed, plain-language summary of the Virginia Residential Landlord and Tenant Act (VRLTA), set in at least 14-point type and including the phone number and website for Virginia’s statewide legal aid organization. Landlords cannot alter, delete, or add to the body of the document. The only portion anyone fills in is the acknowledgment page at the end.³

What You Actually Fill In

The acknowledgment page is a single sheet that documents one thing: that the statement was handed to the tenant and received. It does not ask for rent amount, security deposit figure, late fees, or any other lease-specific financial term. Those details belong in the lease itself.

The fields on the acknowledgment page are:

Date provided. Enter the date the landlord gave the statement to the tenant.
Property address. The full street address of the rental unit.
Tenant signed / did not sign. A checkbox pair indicating whether the tenant signed the acknowledgment. If the tenant refuses to sign, the landlord checks the “did not sign” box; the form anticipates this possibility.
Landlord signature, printed name, and date.
Landlord agent signature, printed name, and date, if a property manager or agent handled delivery.
Tenant signatures, printed names, and dates. The form provides space for up to four tenants to sign individually.

That is the entire fillable section.⁴

If a Tenant Refuses to Sign

Check the “did not sign” box, then sign and date the landlord portion yourself. The landlord’s own signature and the record of delivery still serve as evidence of compliance even without the tenant’s signature. Nothing about a tenant’s refusal to sign relieves the landlord of the duty to deliver the document, and nothing about it invalidates the lease.

If More Than Four Tenants Are on the Lease

The form includes space for up to four tenant signatures. For households larger than that, each additional tenant should still sign; attach a continuation sheet rather than leaving anyone off, since the point of the signatures is to document receipt by each tenant.

Delivering the Form on Time

The landlord must deliver both the signed written lease and the statement within ten business days of the lease’s effective date. Most landlords handle the two documents together at the lease signing, either in person during a move-in meeting or as part of a digital lease package. Doing both at once is the simplest way to meet the deadline and generate a clean record.¹

Electronic Signatures

Electronic signatures are valid for this form. The federal ESIGN Act gives electronic signatures the same legal weight as handwritten ones, provided the signer demonstrates intent, affirmatively consents to signing electronically, and the platform maintains an audit trail with timestamps. Platforms such as DocuSign and similar services routinely satisfy these conditions. If you deliver the statement electronically, preserve the full digital record, including delivery confirmation and signing timestamps.

Keep the Signed Acknowledgment

Hold onto the completed acknowledgment page for the entire tenancy and for a reasonable period afterward. The VRLTA does not set a specific retention period for this form, but keeping it at least through the statute of limitations on any landlord-tenant dispute is the safe approach. The acknowledgment is the landlord’s proof of compliance; without it, there is no record that the delivery requirement was met.

Why Getting This Right Matters

A landlord who has not provided the statement cannot file or maintain any court action against the tenant, including an unlawful detainer (eviction) proceeding, for any alleged lease violation. The lease remains valid, but it cannot be enforced in court until the statement has been delivered.⁵

A landlord who discovers mid-tenancy that the statement was never delivered can cure the problem by handing it over and getting a signed acknowledgment, but any delay matters in time-sensitive situations. A nonpayment eviction cannot move forward until the statement is in the tenant’s hands.

Who the Requirement Applies To

The requirement covers every landlord who offers a written rental agreement under the VRLTA. That takes in most standard residential tenancies in the state: apartments, townhomes, single-family rentals, and condominiums, whether leased by a professional management company or an individual owner.¹

The signing requirement is written to reference “parties to a written rental agreement.” Landlords who operate on an oral or handshake arrangement should still provide the statement as a practical safeguard, because the court-access penalty for nondelivery applies broadly to any landlord who has not provided it.

Lead Paint Disclosure Is a Separate Form

If the rental unit is in a building constructed before 1978, completing the Virginia statement does not satisfy the federal lead-based paint disclosure requirement. Before a tenant signs the lease, the landlord must provide a copy of the EPA pamphlet “Protect Your Family From Lead in Your Home,” disclose any known lead-based paint or hazards, share any available inspection reports, and include a lead warning statement in or attached to the lease. The signed disclosure must be kept for at least three years after the lease begins.⁶

The federal rule exempts housing built after 1977, zero-bedroom units such as studios and lofts (unless a child under six lives there), leases of 100 days or fewer with no renewal option, and senior or disability housing where no child under six resides. For every other pre-1978 unit, the lead disclosure runs on its own track alongside the Virginia statement.

1
Virginia Code Commission. Virginia Code 55.1-1204 – Terms and Conditions of Rental Agreement; Payment of Rent; Copy of Rental Agreement for Tenant
2
Virginia Code Commission. Virginia Code 36-139 – Powers and Duties of Director
3
Department of Housing and Community Development. Virginia Statement of Tenant Rights and Responsibilities
4
Department of Housing and Community Development. Virginia Statement of Tenant Rights and Responsibilities Form
5
Virginia Code Commission. Virginia Code 55.1-1204 – Terms and Conditions of Rental Agreement; Payment of Rent; Copy of Rental Agreement for Tenta
6
United States Environmental Protection Agency. Real Estate Disclosures About Potential Lead Hazards