HUD 904-C Bases & Issues of Reports of Discrimination

Fair Housing Initiatives Program Grant

904-C-Draft

Fair Housing Initiatives Program Grant

OMB: 2529-0033

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Bases and Issues U.S. Department of Housing OMB Approval No. 2529-0033

of Reports of and Urban Development (Exp. 10/13/2009)

D iscrimination Office of Fair Housing and Equal Opportunity

Quarter: _______________________


Organization: _______________________________________


Note: A person may report more than one basis or issue. Number of reports of discrimination this quarter1: _______



Basis

Number of Reports

Race

(total)

  • White


  • Black or African American


  • Asian


  • Native Hawaiian or Other Pacific Islander


  • American Indian or Alaska Native


  • Other




Color




Religion

(total)

  • Christian


  • Jewish


  • Muslim


  • Other




National Origin

(total)

  • Hispanic or Latino




Sex




Disability




Familial Status




Retaliation


Issue

Number of Reports

Rental




Sales




Advertising




Lending




Insurance




Reasonable Modification




Reasonable Accommodation




Design and Construction




Other










1 This is the total number of reports of discrimination received by the FHIP. A report with multiple bases or issues would be counted only once. A report from a previous quarter may be counted if a new basis or issue was added during the quarter

2. Public reporting burden for this collection of information is estimated at average 2 hours per response, including the time for searching existind data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid Office of Management and Budget (OMB) control number.

form HUD-904-C

(8/22/2006)


File Typeapplication/msword
File TitleRental-Protected Basis
AuthorH17862
Last Modified ByH09164
File Modified2007-01-11
File Created2007-01-11

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