Form HUD-903.1 Are you a Victim of Housing discrimination

Are You a
Victim of
Housing
Discrimination?
Fair Housing is Your Right!
If you have been denied your
housing rights…you may have
experienced unlawful discrimination.

U.S. Department of Housing and Urban Development

WHERE TO MAIL YOUR FORM OR
INQUIRE ABOUT YOUR CLAIM
For Connecticut, Maine, Massachusetts,
New Hampshire, Rhode Island, and Vermont:
NEW ENGLAND OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
Thomas P. O’Neill, Jr. Federal Building
10 Causeway Street, Room 321
Boston, MA 02222-1092
Telephone (617) 994-8320 or 1-800-827-5005
Fax (617) 565-7313 • TTY (617) 565-5453
E-mail: [email protected]
For New Jersey and New York:
NEW YORK/NEW JERSEY OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
26 Federal Plaza, Room 3532
New York, NY 10278-0068
Telephone (212) 264-1290 or 1-800-496-4294
Fax (212) 264-9829 • TTY (212) 264-0927
E-mail: [email protected]
For Delaware, District of Columbia, Maryland,
Pennsylvania, Virginia, and West Virginia:
MID-ATLANTIC OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
The Wanamaker Building
100 Penn Square East
Philadelphia, PA 19107
Telephone (215) 656-0663 or 1-888-799-2085
Fax (215) 656-3419 • TTY (215) 656-3450
E-mail: [email protected]
For Alabama, the Caribbean, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee:
SOUTHEAST/CARIBBEAN OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
Five Points Plaza
40 Marietta Street, 16th Floor
Atlanta, GA 30303-2808
Telephone (404) 331-5140 or 1-800-440-8091
Fax (404) 331-1021 • TTY (404) 730-2654
E-mail: [email protected]
For Illinois, Indiana, Michigan, Minnesota,
Ohio, and Wisconsin:
MIDWEST OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
Ralph H. Metcalfe Federal Building
77 West Jackson Boulevard, Room 2101
Chicago, IL 60604-3507
Telephone (312) 353-7776 or 1-800-765-9372
Fax (312) 886-2837 • TTY (312) 353-7143
E-mail: [email protected]

For Arkansas, Louisiana, New Mexico, Oklahoma, and Texas:
SOUTHWEST OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
801 North Cherry, 27th Floor
Fort Worth, TX 76102
Telephone (817) 978-5900 or 1-888-560-8913
Fax (817) 978-5876 or 5851 • TTY (817) 978-5595
E-mail: [email protected]
For Iowa, Kansas, Missouri and Nebraska:
GREAT PLAINS OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
Gateway Tower II
400 State Avenue, Room 200, 4th Floor
Kansas City, KS 66101-2406
Telephone (913) 551-6958 or 1-800-743-5323
Fax (913) 551-6856 • TTY (913) 551-6972
E-mail: [email protected]
For Colorado, Montana, North Dakota, South Dakota,
Utah, and Wyoming:
ROCKY MOUNTAINS OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
1670 Broadway
Denver, CO 80202-4801
Telephone (303) 672-5437 or 1-800-877-7353
Fax (303) 672-5026 • TTY (303) 672-5248
E-mail: [email protected]
For Arizona, California, Hawaii, and Nevada:
PACIFIC/HAWAII OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
600 Harrison Street, Third Floor
San Francisco, CA 94107-1300
Telephone (415) 489-6524 or 1-800-347-3739
Fax (415) 489-6558 • TTY (415) 436-6594
E-mail: [email protected]
For Alaska, Idaho, Oregon, and Washington:
NORTHWEST/ALASKA OFFICE
Fair Housing Hub
U.S. Dept. of Housing and Urban Development
Seattle Federal Office Building
909 First Avenue, Room 205
Seattle, WA 98104-1000
Telephone (206) 220-5170 or 1-800-877-0246
Fax (206) 220-5447 • TTY (206) 220-5185
E-mail: [email protected]
If after contacting the local office nearest you, you still have questions – you may contact HUD further at:
U.S. Dept. of Housing and Urban Development
Office of Fair Housing and Equal Opportunity
451 7th Street, S.W., Room 5204
Washington, DC 20410-2000
Telephone (202) 708-0836 or 1-800-669-9777
Fax (202) 708-1425 • TTY 1-800-927-9275

To file electronically, visit: www.hud.gov

PLACE
POSTAGE
HERE

MAIL TO:

Public Reporting Burden for this collection of information is estimated to average 20 minutes 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.
The Department of Housing and Urban Development is authorized to collect this information
by Title VIII of the Civil Rights Act of 1968, as amended by the Fair Housing Amendments Act of
1988, (P.L. 100-430); Title VI of the Civil Rights Act of 1964, (P.L. 88-352); Section 504 of the Rehabilitation Act of 1973, as amended, (P.L. 93-112); Section 109 of Title I- Housing and Community
Development Act of 1974, as amended, (P.L. 97-35); Americans with Disabilities Act of 1990, (P.L. 101-336); and by the Age
Discrimination Act of 1975, as amended, (42 U.S.C. 6103).
The information will be used to investigate and to process housing discrimination complaints. The information may be disclosed to
the United States Depar tment of Justice for its use in the filing of pattern and practice suits of housing discrimination or the prosecution of the person(s)
who committed that discrimination where violence is involved; and to State or local fair housing agencies that
administer substantially equivalent fair housing laws for complaint processing. 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.

HOUSING DISCRIMINATION INFORMATION

Departamento de Vivienda y Desarrollo Urbano Oficina de Derecho Equitativo a la Vivienda
U.S. Department of Housing and Urban Development Office of Fair Housing and Equal Opportunity

Instructions: (Please type or print) Read this form carefully. Try to answer all questions. If you do not know
the answer or a question does not apply to you, leave the space blank. You have one year from the date of the alleged
discrimination to file a complaint. Your form should be signed and dated.

Your Name

Your Address

City

Best time to call

State

Your Daytime Phone No

Zip Code

Evening Phone No

Who else can we call if we cannot reach you?
Contact’s Name

Best Time to call

Daytime Phone No

Evening Phone No

Contact’s Name

Best Time to call

Daytime Phone No

Evening Phone No

1

What happened to you?
How were you discriminated against?
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 from others seeking housing?
State briefly what happened.

Form HUD-903.1 (1/02)

OMB Approval No. 2529-0011 (exp. 11/30/2007)

HOUSING DISCRIMINATION INFORMATION

Departamento de Vivienda y Desarrollo Urbano Oficina de Derecho Equitativo a la Vivienda
U.S. Department of Housing and Urban Development Office of Fair Housing and Equal Opportunity

2

Why do you think you are a victim of housing discrimination?
Is it because of your:
• race • color • religion • sex • national origin • familial status (families with children under 18) • disability?

For example: were you denied housing because of your race? Were you denied a mortgage loan because of your
religion? Or turned down for an apartment because you have children?
Briefly explain why you think your housing rights were denied and circle the factor(s) listed above that you believe
apply.

3

Who do you believe discriminated against you?
For example: was it a landlord, owner, bank, real estate agent, broker, company, or organization?
Identify who you believe discriminated against you.

Name

Address

4

Where did the alleged act of discrimination occur?
For example: Was it at a rental unit? Single family home? Public or Assisted Housing? A Mobile Home?
Did it occur at a bank or other lending institution?
Provide the address.

Address

City

5

State

Zip Code

When did the last act of discrimination occur?
Enter the date

Is the alleged discrimination continuing or ongoing?

/

/

Y No
Yes

Signature

Date

Send this form to HUD or to the fair housing agency nearest you. If you are unable to complete this form, you may
call that office directly. See address and telephone listings on back page.

• 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.

Detach here. Fold and close with glue or tape (no staples)

It is Unlawful to Discriminate in Housing Based on These Factors...

Keep this information for your records.

/

Date you mailed your information to HUD:
Address to which you sent the information:

Office

/

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 telephone listings on back page.

ARE YOU A VICTIM OF HOUSING DISCRIMINATION?
“The American Dream of having a safe and decent place to call ‘home’
reflects our shared belief that in this nation,
opportunity and
success are within everyone’s reach.
Under our Fair Housing laws, every citizen is assured the
opportunity to build a better life in the home or apartment of their
choice — regardless of their race, color, religion, sex, national origin,
family status or disability.”
Alphonso Jackson
Secretary

HOW DO YOU RECOGNIZE HOUSING DISCRIMINATION?
UndLaw to:

Under the Fair Housing Act, it is Against the Law to:
•

Refuse to rent to you or sell you housing

•

Tell you housing is unavailable when in fact it is
available

•

Show you apartments or homes only in certain
neighborhoods

•

Set different terms, conditions, or privileges for sale or rental of a
dwelling

•

Provide different housing services or facilities

•

Advertise housing to preferred groups of people only

•

Refuse to provide you with information regarding
mortgage loans, deny you a mortgage loan, or impose different
terms or conditions on a mortgage loan

•

Deny you property insurance

•

Conduct property appraisals in a discriminatory manner

•

Refuse to make reasonable accomodations for persons with a
disability if the accommodation may be necessary to afford such
person a reasonable and equal opportunity to use and enjoy a
dwelling.

•

Fail to design and construct housing in an accessible manner

•

Harass, coerce, intimidate, or interfere with anyone
exercising or assisting someone else with his/her fair housing
rights