Form Hud-903 - Housing Discrimination Complaint Form - U.s. Department Of Housing And Urban Development

Download a blank fillable Form Hud-903 - Housing Discrimination Complaint Form - U.s. Department Of Housing And Urban Development in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Hud-903 - Housing Discrimination Complaint Form - U.s. Department Of Housing And Urban Development with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Housing Discrimination

U.S. Department of Housing

OMB Approval No. 2529-0011

and Urban Development

Complaint

Office of Fair Housing

and Equal Opportunity

Please type or print this form

Public Reporting Burden for this collection of information is estimated to average 1 hour 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.

Read this entire form and all the instructions carefully before completing. All questions should be answered. However, if you do not know the answer

or if a question is not applicable, leave the question unanswered and fill out as much of the form as you can. Your complaint should be signed and dated.

Where more than one individual or organization is filing the same complaint, and all information is the same, each additional individual or organization

should complete boxes 1 and 7 of a separate complaint form and attach it to the original form. Complaints may be presented in person or mailed to the

HUD State Office covering the State where the complaint arose (see list on back of form), or any local HUD Office, or to the Office of Fair Housing and

Equal Opportunity, U.S. Department of HUD, Washington, D.C. 20410.

This section is for HUD use only.

Number

(Check the applicable box)

Jurisdiction

Signature of HUD personnel who established Jurisdiction

Referral & Agency

Yes

(specify)

Systemic

Additional Info

Filing Date

Military Referral

1. Name of Aggrieved Person or Organization (last name, first name, middle initial) (Mr.,Mrs.,Miss,Ms.)

Home Phone

Business Phone

Street Address (city, county, State & zip code)

2. Against Whom is this complaint being filed? (last name, first name, middle initial)

Phone Number

Street Address (city, county, State & zip code)

Check the applicable box or boxes which describe(s) the party named above:

Builder

Owner

Broker

Salesperson

Supt. or Manager

Bank or Other Lender

Other

If you named an individual above who appeared to be acting for a company in this case, check this box

and write the name and address of the company in this space:

Name:

Address

Name and identify others (if any) you believe violated the law in this case:

3. What did the person you are complaining against do? Check all that apply and give the most recent date these act(s) occurred in block No. 6a below.

Refuse to rent, sell, or deal with you

Falsely deny housing was available

Engage in blockbusting

Discriminate in broker's services

Discriminate in the conditions or

Advertise in a discriminatory way

Discriminate in financing

Intimidated, interfered, or coerced you

terms of sale, rental occupancy, or

to keep you from the full benefit of the

in services or facilities

Federal Fair Housing Law

Other (explain)

4. Do you believe that you were discriminated against because of your race, color, religion, sex, handicap, the presence of children under 18, or a pregnant

female in the family or your national origin? Check all that apply.

Race or Color

Religion

Sex

Handicap

Familial Status

National Origin

Black

(specify)

Male

Physical

Presence of children