Housing Discrimination Information Form Page 6
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7It 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.
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Date you mailed your information to HUD:
Address to which you sent the information:
Offi ce
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 tele-
phone listings on back page.
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