Fair Housing Discrimination Complaint

FAIR HOUSING DISCRIMINATION COMPLAINT — SIGNED FACTUAL STATEMENT FOR HUD

Before you use this: Send the facts in this signed narrative through HUD's current online, phone, or official mailed complaint route at HUD's Report Housing Discrimination page. HUD requires its own complaint form and an oath or affirmation; this narrative is supporting material. Under 42 U.S.C. § 3610(a)(1)(A), the administrative filing period is generally one year after the alleged practice occurred or terminated. Calculate from your actual events and preserve proof of receipt.

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

From (complainant): [FULL NAME]. Address: [MAILING ADDRESS]. Phone or safe contact method: [CONTACT]. Email, if safe: [EMAIL]. Preferred contact language and accessibility need: [DETAILS OR NONE].

Respondent(s): [PERSON / LANDLORD / MANAGER / LENDER / ORGANIZATION, ROLE, ADDRESS AND CONTACT IF KNOWN]. Identify each person's conduct separately if more than one respondent is named: [DETAILS].

Housing or program involved: [PROPERTY ADDRESS, UNIT, LISTING OR PROGRAM IDENTIFIER]. My relationship to the housing was [APPLICANT / TENANT / BUYER / OTHER], beginning [DATE].

1. Alleged conduct and dates

The earliest event I am reporting occurred [__/__/____]. The most recent event or termination of the practice occurred [__/__/____]. I first learned of [RELEVANT ACTION] on [__/__/____].

In sequence, this is what happened: [STATE THE EVENTS IN YOUR OWN WORDS, INCLUDING APPLICATION, REQUEST, RESPONSE, COMPARATORS, FOLLOW-UP, AND CURRENT STATUS. Distinguish what you personally saw from what someone else told you.]

The explanation given by the respondent was [EXACT STATEMENT OR NONE]. I believe the actual reason or effect was discriminatory because [SPECIFIC CONNECTING FACTS, COMPARATORS, POLICY, TIMING, STATEMENTS, OR DOCUMENTS]. Facts that may support a different explanation are [FACTS OR NONE KNOWN].

2. Federal basis to be evaluated

Check only a basis supported by the described facts; HUD or counsel should assess the covered housing, actor, exemption, and correct statutory route.

☐ Refusal to rent, sell, negotiate, or make a dwelling available because of [RACE / COLOR / RELIGION / SEX / FAMILIAL STATUS / NATIONAL ORIGIN], with supporting facts [FACTS] (42 U.S.C. § 3604(a)).

☐ Different terms, services, or facilities because of [ACTUAL PROTECTED BASIS], with supporting facts [FACTS] (42 U.S.C. § 3604(b) or (f)(2), as applicable).

☐ A discriminatory housing advertisement or representation, quoting the actual words and identifying the medium and date [FACTS] (42 U.S.C. § 3604(c) or (d), if applicable).

☐ Disability-related denial or terms concerning me, a person who will live in the dwelling, or an associated person, with only the facts needed to explain the restriction [FACTS] (42 U.S.C. § 3604(f)).

☐ A requested change to a rule, policy, practice, or service that may have been necessary for equal opportunity to use and enjoy the dwelling: request [WHAT / WHEN / HOW], disability-related need explained [MINIMUM NECESSARY FACTS], response [WHAT / WHEN] (42 U.S.C. § 3604(f)(3)(B)).

☐ Coercion, intimidation, threat, or interference tied to exercise of or assistance with a fair housing right: [ACT, DATE, LINK TO PROTECTED ACTIVITY] (42 U.S.C. § 3617).

☐ Another federal route, lending claim, or state/local protection: [IDENTIFY SPECIFIC LAW AND FACTS AFTER SEPARATE CURRENT-LAW REVIEW]. A housing voucher, source of income, marital status, age, or other category is not assumed to be a federal § 3604 protected class from this form alone.

3. Effect, documents, and earlier reports

The practical effect on me or the person affected was [DENIAL, DELAY, CHANGED TERMS, COST, ACCESS BARRIER, HARASSMENT, OR OTHER ACTUAL EFFECT]. Documented out-of-pocket loss, if any: [AMOUNT AND RECORD]. Other effects: [ACTUAL FACTS, NOT ESTIMATED DAMAGES]. Current housing/application status: [STATUS].

Witnesses who may know these facts: [NAMES, CONTACT IF SAFE, AND WHAT EACH PERSON OBSERVED]. Do not include a diagnosis, Social Security number, full financial account number, or another person's private data unless the intake office requests it through an appropriate channel.

Earlier HUD, state, local, or court complaint about these events: ☐ none ☐ [AGENCY / CASE NUMBER / DATE / STATUS / OUTCOME]. Any settlement or conciliation agreement addressing these events: [DETAILS OR NONE].

4. Requested action and affirmation

I ask HUD to review these facts, contact me using the safe method above, investigate any covered discriminatory housing practice, and consider relief available through the applicable process. My immediate practical request is [SPECIFIC HOUSING OPPORTUNITY / POLICY CHANGE / OTHER RESULT]. I understand that this request is not an agency finding, guaranteed award, civil penalty, or court order.

I affirm that the factual statements in this narrative are true to the best of my knowledge, and that I have identified information based on someone else's report where applicable. I will complete the oath or affirmation and any required verification in HUD's official complaint process.

HUD filing record, completed after submission: route [ONLINE / PHONE / MAIL]; date sent [__/__/____]; receipt or reference number [NUMBER]; official complaint copy and oath/affirmation completed [DATE / STATUS]; HUD contact [NAME / CHANNEL]; next notice or response date [DATE / SOURCE].