Complaint Register Hud 958 Page 4

Privacy Act of 1974 (P.L.93-579)

Authority: Section 3 of the Housing and Urban Development Act of 1968, as amended by the Housing and

Community Development Act of 1968, as amended by the Housing and Community Development Act of 1992,

U.S.C. 1701u and implementing regulations at 24 CFR Part 135.

Purpose: The information requested on this form is to be used to investigate and process Section 3 complaints.

Use: The information requested will be used to process a complaint filed under Part 135. HUD may disclose

certain information for Federal, State, and local agencies when relevant to civil, criminal, or regulatory

investigations and prosecutions. It will not be otherwise disclosed or released outside of HUD, except as required

and permitted by law.

Penalty: Failure to provide some or all of the requested information will result in delay or denial of HUD

assistance.

Disclosure of this information is voluntary.

Page 4 of 4

form HUD-958 (11/2010)

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