HUD-903 Report Housing Discrimination

QUESTION 1

Why do you believe someone discriminated against you, someone you live with, or someone you sought to live with?

Choose at least one reason. You can choose more than one.

Because of race

Because of color

Because of religion

Because of national origin (including limited English proficiency)

Because of disability

Because of sex

Because of familial status (this includes children under 18 years old, pregnancy or seeking legal custody)

Because of retaliation, intimidation, or interference related to exercising a fair housing right (such as filing a complaint; testifying in a proceeding), or helping others to do so

Other reason (explain below)

QUESTION 2

Who discriminated against you?

Provide as much information as you have available. We won't contact them before speaking with you.

First name:

Last name:

Relationship to you: (e.g. landlord, lender, real estate agent):

Business name:

Street address:

Apt or unit:

City:

State:

Zip:

Phone number 1:

Phone number 2:

Email address:

More than one person or business discriminated against me. We'll collect their name(s) and contact information when we speak with you.

QUESTION 3

Where did the discrimination happen?

Provide the name and address of the building, apartment complex, or other location where the discrimination occurred. Provide as much information as you have available.

Location (for example, name of residential rental or sales property, business, or bank):

Street address:

Apt or unit:

City:

*State:

Zip:

QUESTION 4

*When did the discrimination happen?

If it happened multiple times or is still happening, provide the most recent date you experienced discrimination.

*Date(s) of Discrimination:

The alleged discrimination is continuing or ongoing or the alleged discrimination is still happening.

QUESTION 5

*What happened?

Summarize the events and why you believe you experienced housing discrimination because of race, color, national origin, religion, sex, disability, or familial status. 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 because of the presence of minor children? Denied a disability related reasonable accommodation? Treated differently or denied services by a state, local government, public housing agency, or other organization that may receive money from HUD? Describe the reasons you believe discrimination occurred, any evidence you might have and provide the names of witnesses (if any).

Review and submit your complaint

Review your responses, make edits(if needed), and submit your complaint.

Why do you believe someone discriminated against you, someone you live with, or someone you sought to live with?

Because of race
Because of color
Because of religion
Because of national origin (including limited English proficiency)
Because of disability
Because of sex
Because of familial status (this includes children under 18 years old, pregnancy or seeking legal custody)
Because of retaliation, intimidation, or interference related to exercising a fair housing right (such as filing a complaint; testifying in a proceeding), or helping others to do so
Other reason (explain below)

Who discriminated against you?

First name:

Last name:

Relationship to you: (e.g. landlord, lender, real estate agent):

Street address:

Apt or unit:

Business name:

City:

State:

Zip:

Phone number 1:

Phone number 2:

Email address:

More than one person or business discriminated against me. We'll collect their name(s) and contact information when we speak with you.

Where did the discrimination happen?

Location (for example, name of residential rental or sales property, business, or bank):

Street address:

Apt or unit:

City:

*State:

Zip:

*When did the discrimination happen?

*Date(s) of Discrimination:

The alleged discrimination is continuing or ongoing or the alleged discrimination is still happening.

*What happened?

How can we contact you?

Your name and contact information

*First name:

*Last name:

Phone number:

Cell phone?

Email address(s):

Preferred contact:

Best time to call:

Preferred language(s):

Your mailing address

*Street address:

Apt or unit:

*City

*State

*Zip:

Second point of contact

First name:

Last name:

Phone number:

Email address:

Relationship to you (optional)

Family member or friend
Attorney
Fair housing advocate or representative
Other (explain below)

Exit Complaint Form Without Submit

Paperwork Reduction Act Burden Statement

Privacy Act Statement

Contact Information

Your housing discrimination complaint will be reviewed by a fair housing specialist to determine if it alleges acts that might violate the Fair Housing Act. The specialist will contact you for any additional information needed to complete this review. If your complaint involves a possible violation of the Fair Housing Act, the specialist will assist you in filing an official housing discrimination complaint.

OMB Control #: 2529-0011
Expiration Date: 9/30/2025

v2.19.0

Report Housing Discrimination

U.S. Department of Housing and Urban DevelopmentOffice of Fair Housing and Equal Opportunity

U.S. Department of Housing and Urban Development
Office of Fair Housing and Equal Opportunity