Form HUD 958 HUD 958 Compliant Register

U.S. Department of Housing OMB Approval No. 2529-0043 (revised)

Complaint Register and Urban Development (Expires xx/xxxx)

Under Section 3 of the Housing Office of Fair Housing

And Urban Development Act of 1968 and Equal Opportunity

Instructions: This form is to be used to report allegations of noncompliance with Section 3 of the Housing and Urban Development Act of 1968, as amended and implementing regulations at 24 CFR Part 135.

Complainant Information:
Name of Complainant (Person or organization)	Home Phone
Street Address	Work Phone
City, State, Zip code
Email Address:

You are: (check all that apply)
□	Low/Very Low Income Person	□	Section 3 Business
□	Public Housing Resident	□	A Representative of a Section 3 Business
□	HUD Youthbuild Participant	□	Other: __________________________________
□	A Representative of any of the above listed Individuals (Such as: a Low-Income Person or Public Housing Resident)

Basis for alleged noncompliance with Section 3:
□ Denied Training	□ Denied Employment	□ Denied Contracting	□ Other (see below in item 6)

Complaint is against: (check one or more boxes)
□ Recipient of HUD Funds (Such: as a PHA, city/county agency, etc.)	□ Contractor	□ Subcontractor	□ Other (please specify): _______________________________

Who is this complaint being filed against?
Name of agency, organization, or company: Business Phone
Street Address
City, State, Zip code
Name and identify others (if any) who allegedly violated Section 3 in this case:

How did the HUD recipient, contractor, or subcontractor violate the requirements of Section 3? (Check all that apply – provide documentation, if available)
HUD Recipient	Contractor and/or Subcontractor
□ Failed to notify Section 3 businesses about contracting opportunities □ Failed to incorporate the Section 3 Clause into covered Section 3 bid solicitations or contracts □ Failed to provide priority consideration to Section 3 businesses for covered contracting opportunities □ Failed to select Section 3 businesses in accordance with the order of priority consideration as set forth in 24 CFR 135.36 □ Failed to award contracts to Section 3 businesses □ Failed to ensure that its contractors/ subcontractors complied with Section 3 requirements □ Knowingly entered into contracts with contractors/ subcontractors that failed to comply with Section 3 requirements □ Failed to notify Section 3 residents about training and/or employment opportunities □ Failed to provide priority consideration to Section 3 residents for employment or training opportunities □ Failed to select Section 3 residents for training or employment opportunities in accordance with the order of priority consideration set forth in 24 CFR 135.34 □ Failed to hire Section 3 residents for new employment opportunities □ Retaliated against the complainant because complainant sought to enforce Section 3 requirements or participated in an investigation or proceeding regarding Section 3 □ Other _____________________________________________	□ Failed to certify that all employment vacancies filled prior to contract execution were not filled to circumvent Section 3 □ Failed to notify potential subcontractors about Section 3 requirements □ Failed to post notices at the work site regarding Section 3 requirements in accordance with the Section 3 Clause □ Failed to send to each labor organization or representative of workers a notice of Section 3 obligations in accordance with the Section 3 Clause □ Failed to ensure that its subcontractors complied with Section 3 □ Failed to train and/or hire Section 3 residents for new employment opportunities □ Failed to provide priority consideration to Section 3 residents for employment or training opportunities in accordance with 24 CFR Part 135.34 □ Failed to ensure that contracts awarded to subcontractors included the Section 3 Clause □ Failed to award subcontracts to Section 3 businesses □ Failed to award subcontracts to Section 3 businesses in accordance with the order of priority consideration set forth in 24 CFR 135.34 □ Retaliated against the complainant because complainant sought to enforce Section 3 requirements or participated in an investigation or proceeding regarding Section 3 □ Other _______________________________________________

7. When did the act(s) checked above occur? (Include the most recent date if several dates are involved):

_______/ ________/ _________

Month Day Year

* The date of the last alleged violation or occurrence must be less than 180 days from the date of submission to HUD.

Project name or location where alleged violation occurred? (If applicable):
Project Name (if applicable): _____________________________________________ Project Number: ___________________ Project Location: ________________________________________________________________________________________ Local Contracting Agency (LCA): ___________________________________________________________________________

Identify the type of HUD funding used by the HUD funding recipient, organization, or contractor that this complaint is filed against: (Check all that apply)
□ PIH Operating Subsidy	□ Other PIH Assistance	□ Neighborhood Stabilization Program (NSP) Assistance	□ Section 811 Supportive Housing for the Disabled
□ PIH Capital Fund Subsidy	□ Community Development Block Grants (CDBG)	□ Other Community Development Assistance	□ Project Based Housing Vouchers
□ Choice Neighborhood Initiative Grant	□ HOME Investment Partnership Funding	□ Lead-Based Paint	□ Other HUD Housing Assistance
□ HOPE VI Grant	□ McKinney Homeless Assistance	□ Section 202Supportive Housing for the Elderly	□ Other Covered HUD Funding

Description of act(s) or incident(s) involving alleged violation of Section 3:
Summarize what happened? Attach additional information if necessary
Declaration Statement I declare under penalty of perjury that I have read this complaint (including any attachments) and that all information is accurate and correct.
Signature	Date

Section 3 of the Housing and Urban Development Act of 1968

Public reporting burden for this collection of information is estimated to average 2 hours 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. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB number.

The information is given voluntarily and provides the basis for HUD’s investigation of the complaint to determine if the allegations of noncompliance are valid. The Department will use the information provided as the basis for its determination of jurisdiction over a complainant’s allegations. All information collected complies with the Privacy Act of 1974 and OMB Circular A-108. The information is unique to the processing of complaints alleging noncompliance with the Section 3 statute or implementing regulations. The information collected on this form will only be used by HUD during the investigation and resolution of complaints and will not be shared with persons or parties that are not directly involved with the complaint.

What is Section 3 of the Housing and Urban Development Act of 1968?

Section 3 is a provision of the Housing and Urban Development (HUD) Act of 1968 that helps foster local economic development, neighborhood economic improvement, and individual self-sufficiency. The Section 3 requirements ensure that when new jobs or contracts are created during the usage of certain HUD funds, priority consideration is given to low- and very low-income persons residing in the community in which the funds are spent (regardless of race or gender), and to the businesses that substantially employ these persons.

Who are Section 3 residents and businesses?

Section 3 residents are:

• Public housing residents; or

• Persons who live in the area where a HUD-assisted project is located and who have a household income that falls below HUD’s income limits for low- and very low-income.

Please visit: http://www.huduser.org/portal/datasets/il.html to determine the income limits for residents of your community.

A Section 3 business is one that meets one of the following criteria:

• Is 51 percent or more owned by Section 3 residents;

• Employs Section 3 residents for at least 30 percent of its full-time, permanent staff; or

• Provides evidence of a commitment to subcontract to Section 3 business concerns, 25 percent or more of the dollar amount of the awarded contract.

What HUD funding does Section 3 cover?

Section 3 applies to any of the following:

1. Public and Indian Housing programs that receive: (1) Annual contributions for low income housing projects provided pursuant to section 5 of the U.S. Housing Act of 1937, as amended by the Quality Housing and Work Responsibility Act of 1998 (QWHRA); (2) Capital Fund Project assistance provided pursuant to Section 9 of QHWRA; (3) Operating Subsidy assistance provided pursuant to Section 9 of QHWRA.

2. Housing and community development assistance extended for: (1) housing rehabilitation (including reduction and abatement of lead based paint hazards); (2) housing construction or (3) other public construction projects; and for which the contract and subcontract exceeds $100,000; and

3. Certain competitive HUD grant funding, such as: HOPE VI, Choice Neighborhoods, etc.).

What can you do about violations of the Law?

Remember, Section 3 applies to the awarding of jobs, training programs, and contracts, generated from projects receiving HUD financial assistance. If you believe that, as a low-income person or a Section 3 business concern, the responsibilities to provide economic opportunities under Section 3 have been violated, you have a right to file a complaint within 180 days of the last alleged occurrences of noncompliance.

Complaints alleging violations of the Section 3 regulatory requirements must be submitted to the appropriate HUD Regional Office of Fair Housing and Equal Opportunity listed below. Please be certain to sign and date this form, where indicated, to ensure prompt complaint processing.

HUD will send the complaint to the appropriate HUD recipient for resolution. If resolution by the recipient fails, HUD will investigate. If HUD finds that the complaint has merit, it will try to end the violation by informal resolution. If conciliation fails, HUD may initiate other steps to enforce the law, including but not limited to suspension and debarment of the recipient or contractors as applicable.

You can obtain assistance in learning about more Section 3 by visiting www.hud.gov/section3 or by contacting one of the HUD’s Regional Offices of Fair Housing and Equal Opportunity.

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 delayed processing or rejection of this complaint for investigation.

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

All information collected is provided voluntarily and complies with the Privacy Act of 1974 and OMB Circular A-108. The information is unique to the processing of complaints alleging noncompliance with the Section 3 statute or implementing regulations. The information collected on this form will only be used by HUD during the investigation and resolution of complaints and will not be shared with persons or parties that are not directly involved with the complaint.

Instructions for completing the Section 3 Complaint Register

Box 1: Enter the requested information for the person that is filing the complaint (i.e., the complainant). This person must meet the definition of a Section 3 resident or business.

Box 2: Select the appropriate statement that describes your status as a Section 3 resident, businesses, or representative of either.

Box 3: Select the appropriate basis for the complaint which you are filing.

Box 4: Select the appropriate option that best describes the person or entity that you are filing this complaint against.

Box 5: Provide the name, address, and contact information for the person or entity that you are filing this complaint against.

Box 6: Select the statement(s) that best describe the alleged actions or omissions undertaken by the person or entity that you are filing this complaint against that are in violation of the requirements of Section 3. If you select “other”, please briefly describe the alleged violation on the appropriate line.

Box 7: Provide the date that the alleged violation or action occurred. If the alleged act or violation is continuing in nature, please provide the date of the most recent occurrence.

Box 8: If this complaint is based upon acts or omissions that occurred at a specific job site, project, or location, please provide information that will allow HUD to identify the specific project that is the subject of the complaint that you are filing.

Box 9: Select the appropriate type of covered HUD funding that the recipient, organization, contractor/ subcontractor received or administered.

NOTE: In order for the complaint to be jurisdictional, covered HUD funding must be administered by the recipient, organization, contractor/subcontractor.

Box 10: Provide a detailed description of the acts or omissions undertaken by the person or entity that you filing this complaint against. Provide enough specific information to enable HUD to clearly understand the alleged violation and whether it demonstrates noncompliance with the requirements of Section 3.

Box 11: Please sign the complaint and enter the current date.

NOTE: By signing and dating this complaint you are affirming that your statements and allegations are true and accurate by penalty of perjury. Complaints must be signed and dated prior to acceptance by HUD for investigation.

Where to file your complaint:

Please fax or mail your complaint to the appropriate HUD Regional Office of Fair Housing and Equal Opportunity that has jurisdiction over the state for which you are located or where the alleged violation occurred. Inquiries regarding the status of your complaint should be directed to the appropriate Regional office of FHEO by telephone or email.

BOSTON REGIONAL OFFICE U.S. Department of Housing and Urban Development New England Office 10 Causeway Street, Suite 308 Boston, MA 02222 (617) 994-8300 (800) 827-5005 Fax617) 565-7313 Email: [email protected] *Covers the following states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont	FORT WORTH REGIONAL OFFICE U.S. Department of Housing and Urban Development Southwest Office 801 Cherry St., Unit 45, Suite 2500 Fort Worth, TX 76102 (817) 978-5900 (888)560-8913 Fax817) 978-5876 Email: [email protected] *Covers the following states: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
NEW YORK REGIONAL OFFICE U.S. Department of Housing and Urban Development New York and New Jersey Office 26 Federal Plaza New York, NY 10278 (212) 264-1290 (800) 496-4294 Fax: (212) 264-9829 Email: [email protected] *Covers the following states: New Jersey and New York	KANSAS CITY REGIONAL OFFICE U.S. Department of Housing and Urban Development Great Plains Office 400 State Avenue Kansas City, KS 66101 (913) 551-6958 (800) 743-5323 Fax: (913) 551-6856 Email: [email protected] *Covers the following states: Iowa, Kansas, Missouri, and Nebraska
PHILADELPHIA REGIONAL OFFICE U.S. Department of Housing and Urban Development Mid-Atlantic Office 100 Penn Square East, 12th Floor Philadelphia, PA 19107 (215) 861-7646 (888) 799-2085 Fax: (215) 656-3449 Email: [email protected] *Covers the following states: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia	DENVER REGIONAL OFFICE U.S. Department of Housing and Urban Development Rocky Mountain Office 1670 Broadway Denver, CO 80202 (303) 672-5437 (800) 877-7353 Fax: (303) 672-5026 Email: [email protected] *Covers the following states: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming

ATLANTA REGIONAL OFFICE U.S. Department of Housing and Urban Development Southeast Office 40 Marietta Street Atlanta, GA 30303 (404) 331-5140 (800) 440-8091 Fax: (404) 331-1021 Email: [email protected] *Covers the following states: Alabama, Puerto Rico, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, and the Virgin Islands	SAN FRANCISCO REGIONAL OFFICE U.S. Department of Housing and Urban Development Pacific/Hawaii Office 600 Harrison Street Third Floor San Francisco, CA 94107 (415) 489-6536 (800) 347-3739 Fax: (415) 489-6560 Email: [email protected] *Covers the following states: Arizona, California, Guam, Hawaii, and Nevada
CHICAGO REGIONAL OFFICE U.S. Department of Housing and Urban Development Midwest Office 77 W. Jackson Boulevard, Suite 2101 Chicago, IL 60604 (312) 353-7776 (800) 765-9372 Fax: (312) 886-2837 Email: [email protected] *Covers the following states: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin	SEATTLE REGIONAL OFFICE U.S. Department of Housing and Urban Development Northwest/Alaska Office 909 First Avenue Seattle, WA 98104 (206) 220-5170 (800)877-0246 Fax: (206) 220-5447 Email: [email protected] *Covers the following states: Alaska, Idaho, Oregon, and Washington

Previous Editions are Obsolete Page 1 of 12 form HUD-958 (xx/xxxx)