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U.S. Department of Housing and Urban Development
Are you a Victim of Housing Discrimination?
Fair Housing is Your Right! If you have been denied your housing rights. . .you may have experienced unlawful discrimination

ARE YOU A VICTIM OF HOUSING DISCRIMINATION?
"The American Dream of having a safe and decent place to call 'home' reflects our shared belief that in this nation, opportunity and success are within everyone's reach. Under our Fair Housing laws, every citizen is assured the opportunity to build a better life in the home or apartment of their choice - regardless of their race, color, religion, sex, national origin, family status or disability."

Mel Martinez
Secretary

HOW DO YOU RECOGNIZE HOUSING DISCRIMINATION?

Under the Fair Housing Act, it is Against the Law to:

• Refuse to rent to you or sell you housing
• Tell you housing is unavailable when in fact it is available
• Show you apartments or homes only in certain neighborhoods
• Set different terms, conditions, or privileges for sale or rental of a dwelling
• Provide different housing services or facilities
• Advertise housing to preferred groups of people only
• Refuse to provide you with information regarding mortgage loans, deny you a mortgage loan, or impose different terms or conditions on a mortgage loan
• Deny you property insurance
• Conduct property appraisals in a discriminatory manner
• Refuse to make reasonable accommodations for persons with a disability if the accommodation may be necessary to afford such person a reasonable and equal opportunity to use and enjoy a dwelling.
• Fail to design and construct housing in an accessible manner
• Harass, coerce, intimidate, or interfere with anyone exercising or assisting someone else with his/her fair housing rights

It is Unlawful to Discriminate in Housing Based on These Factors...

• Race
• Color
• National origin
• Religion
• Sex
• Familial status (families with children under the age of 18, or who are expecting a child)
• Handicap (if you or someone close to you has a disability)

If You Believe Your Rights Have Been Violated...

• HUD or a State or local fair housing agency is ready to help you file a complaint.
• After your information is received, HUD or a State or local fair housing agency will contact you to discuss the concerns you raise.

Keep this information for your records.
Date you mailed your information to HUD:     __/___/___
Address to which you sent the information:   ______________
Office Telephone: __________
Street:  __________________
City __________________   State  ____  Zip Code _________

If you have not heard from HUD or a State or local fair housing agency within three weeks from the date you mailed this form, you may call to inquire about the status of your complaint. See address and telephone listings on back page.

HOUSING DISCRIMINATION INFORMATION
US. Department of Housing and Urban Development Office of Fair Housing and Equal Opportunity

Instructions: (Please type or print) Read this form carefully. Try to answer all questions. If you do not know the answer or a question does not apply to you, leave the space blank. You have one year from the date of the alleged discrimination to file a complaint. Your form should be signed and dated.

Your Name ______________________________

Your Address _______________________________________

City____________________  State _____  Zip Code __________

Best time to call: Your Daytime Phone No ___________ Evening Phone No ___________

Who else can we call if we cannot reach you?
Contact's Name ______________                   Best Time to call ____________________
Daytime Phone No ____________                  Evening Phone No ___________________

Contact's Name ______________                   Best Time to call __________
Daytime Phone No ____________                  Evening Phone No __________

1. What happened to you?
How were you discriminated against?

For example: were you refused an opportunity to rent or buy housing? Denied a loan? Told that housing was not available when in fact it was? Treated differently from others seeking housing?

State briefly what happened.

2. Why do you think you are a victim of housing discrimination?
Is it because of your:

• color religion sex national origin, familial status (families with children under 18)
• disability? For example: were you denied housing because of your race? Were you denied a mortgage loan because of your religion? Or turned down for an apartment because you have children?

Briefly explain why you think your housing rights were denied and circle the factor(s) listed above that you believe apply.

3. Who do you believe discriminated against you?
For example: was it a landlord, owner, bank, real estate agent, broker, company, or organization? Identify who you believe discriminated against you.

Name: _______________________

Address: ____________________________________________

4. Where did the alleged act of discrimination occur?
For example: Was it at a rental unit? Single family home? Public or Assisted Housing? A Mobile Home?

Did it occur at a bank or other lending institution?
Provide the address

Address _______________________

City ______________  State ____   Zip Code __________

5. When did the last act of discrimination occur?
Enter the date      ___/___/___
Is the alleged discrimination continuing or ongoing? Yes___ No ___

Signature_____________________________   Date ___/___/___

Send this form to HUD or to the fair housing agency nearest you. If you are unable to complete this form, you may call that office directly. See address and telephone listings on back page.

0MB Approval No. 2529-0011 (exp. 9/30/2004)

WHERE TO MAILYOUR FORM OR INQUIRE ABOUT YOUR CLAIM

To file electronically, visit: www.hud.gov

If after contacting the local office nearest you, you still have questions - you may contact HUD further at:

U.S. Dept. of Housing and Urban Development
Office of Fair Housing and Equal Opportunity
451 7th Street, SW., Room 5204
Washington, DC 20410-2000
Telephone (202) 708-0836 or 1-800-669-9777
Fax (202) 708-1425 o TTY 1-800-927-9275

Public Reporting Burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The Department of Housing and Urban Development is authorized to collect this information by Title VIII of the Civil Rights Act of 1968, as amended by the Fair Housing Act of 1988, (P.L. 100-430); Title of VI of the Civil Rights Act of 1964, (P.L. 88-352); Section 504 of the Rehabilitation Act of 1973, as amended (P.L. 93-112) Section 109 of Title I- Housing and Community Development Act of 1974 as amended, (P.L. 97-35); Americans with Disabilities Act of 1990, (P.L. 101-336); and by the Age Discrimination Act of 1975, as amended (42 U.S.C. 6103).

The information will be used to investigate and to process housing discrimination complaints. The information may be disclosed to the United States Department of Justice for its use in the filing of pattern and practice suits of housing discrimination or the prosecution of the person(s) who committed that discrimination where violence is involved; and to State or local fair housing agencies that administer substantially equivalent fair housing laws for complaint processing . Failure to provide some or all of the requested information will result in delay of denial of HUD assistance.

Disclosure of this information is voluntary.

U.S. Department of Housing and Urban Development
Equal Housing Opportunity
Form HUD-903.1 (1/02)

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