HUD Fair Housing Complaint Form (Form 903)

HUD FAIR HOUSING COMPLAINT

Housing Discrimination Complaint Form (Based on HUD Form 903.1)

SECTION 1: COMPLAINANT INFORMATION

1.1 Primary Complainant

Full Legal Name: _____________________________________________________________

Street Address: ______________________________________________________________

City: ________________________________ State: __________ ZIP Code: _____________

Mailing Address (if different): __________________________________________________

City: ________________________________ State: __________ ZIP Code: _____________

Primary Phone: (______) ______-__________ ☐ Home ☐ Mobile ☐ Work

Alternate Phone: (______) ______-__________

Email Address: ______________________________________________________________

Preferred Contact Method: ☐ Phone ☐ Email ☐ Mail

Best Time to Contact: ☐ Morning ☐ Afternoon ☐ Evening

1.2 Additional Complainants (if any)

Name: ____________________________________________________________________

Relationship to Primary Complainant: ___________________________________________

Address: __________________________________________________________________

Phone: (______) ______-__________

Email: ____________________________________________________________________

SECTION 2: RESPONDENT INFORMATION

Provide information about each person or entity you believe discriminated against you.

2.1 Primary Respondent

Name (Individual or Business): _________________________________________________

Title/Position (if applicable): __________________________________________________

Business Name (if different): __________________________________________________

Street Address: ______________________________________________________________

City: ________________________________ State: __________ ZIP Code: _____________

Phone: (______) ______-__________

Email (if known): ____________________________________________________________

Relationship to Housing:
☐ Landlord/Property Owner
☐ Property Manager
☐ Real Estate Agent/Broker
☐ Lender/Mortgage Company
☐ Insurance Company
☐ HOA/Condo Association
☐ Government Agency
☐ Other: _______________________

2.2 Additional Respondents

Name: ____________________________________________________________________

Address: __________________________________________________________________

Phone: (______) ______-__________

Role: _____________________________________________________________________

SECTION 3: PROPERTY INFORMATION

3.1 Subject Property

Property Address: ___________________________________________________________

City: ________________________________ State: __________ ZIP Code: _____________

Property Type:
☐ Single-Family Home
☐ Apartment/Multi-Family
☐ Condominium
☐ Townhouse
☐ Mobile Home
☐ Other: _______________________

Number of Units (if applicable): _____________

Is this property:
☐ For Rent
☐ For Sale
☐ Currently Occupied by Complainant
☐ Other: _______________________

SECTION 4: BASIS OF DISCRIMINATION

Check all protected classes that apply to your complaint under the Fair Housing Act.

4.1 Federal Protected Classes (42 U.S.C. § 3604)

☐ Race - Describe: ________________________________________________________

☐ Color - Describe: _______________________________________________________

☐ National Origin - Describe: _______________________________________________

☐ Religion - Describe: ____________________________________________________

☐ Sex (including sexual harassment, gender identity, sexual orientation) - Describe: ____

___________________________________________________________________________

☐ Familial Status (families with children under 18, pregnant women, persons obtaining custody)

• Number of children: ______ Ages: __________________________________________

☐ Disability/Handicap (physical or mental impairment substantially limiting major life activities)

• Nature of disability (you are NOT required to disclose specific diagnosis): ___________

________________________________________________________________________

4.2 Additional State Protected Classes (if applicable)

☐ Age
☐ Marital Status
☐ Sexual Orientation
☐ Gender Identity/Expression
☐ Source of Income
☐ Immigration/Citizenship Status
☐ Military/Veteran Status
☐ Other: _______________________

SECTION 5: TYPE OF DISCRIMINATORY CONDUCT

Check all that apply.

5.1 Rental Discrimination
☐ Refused to rent or negotiate for rental
☐ Set different terms, conditions, or privileges
☐ Provided different housing services or facilities
☐ Falsely denied housing availability
☐ Evicted or threatened eviction
☐ Refused to make reasonable accommodation (disability)
☐ Refused to permit reasonable modification (disability)
☐ Harassment or hostile housing environment

5.2 Sales Discrimination
☐ Refused to sell or negotiate for sale
☐ Set different terms, conditions, or privileges
☐ Falsely denied housing availability
☐ Steered to or away from certain neighborhoods
☐ Blockbusting (inducing sale through fear of demographic change)

5.3 Lending/Financing Discrimination
☐ Refused to make mortgage loan
☐ Set different loan terms or conditions
☐ Refused to provide information about loans
☐ Discriminatory appraisal
☐ Redlining

5.4 Insurance Discrimination
☐ Refused to provide homeowners insurance
☐ Set different insurance terms or conditions
☐ Redlining in insurance coverage

5.5 Advertising Discrimination
☐ Discriminatory advertising statements
☐ Use of discriminatory symbols or images
☐ Selective advertising placement

5.6 Other Discriminatory Conduct
☐ Retaliation for exercising fair housing rights
☐ Coercion, intimidation, threats, or interference
☐ Other: _______________________

SECTION 6: NARRATIVE STATEMENT OF FACTS

Provide a detailed description of what happened. Include dates, times, locations, persons involved, and what was said or done.

6.1 Date(s) of Discrimination

First incident date: ____________________

Most recent incident date: ____________________

Is the discrimination ongoing? ☐ Yes ☐ No

6.2 Detailed Description of Events

Describe the discriminatory act(s) in chronological order. Be specific about what happened, who was involved, what was said, and how you were treated differently.

___________________________________________________________________________

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(Attach additional pages if necessary)

6.3 Why do you believe the conduct was discriminatory?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

6.4 How were you harmed by this discrimination?

☐ Denied housing
☐ Paid higher rent/prices
☐ Forced to move
☐ Emotional distress
☐ Financial harm
☐ Other: _______________________

Describe specific harm: _______________________________________________________

___________________________________________________________________________

SECTION 7: WITNESSES AND EVIDENCE

7.1 Witnesses

List anyone who witnessed the discrimination or has relevant information.

7.2 Documentary Evidence

Check all documents you have that support your complaint.

☐ Rental/Purchase Application
☐ Lease Agreement
☐ Written Correspondence (letters, emails, texts)
☐ Photographs
☐ Video/Audio Recordings
☐ Advertisements
☐ Credit Reports
☐ Financial Documents
☐ Medical Documentation (for disability cases)
☐ Other: _______________________

SECTION 8: COMPARABLE TREATMENT

If known, describe how others were treated differently than you.

Did you observe or learn that persons not in your protected class were treated more favorably?

☐ Yes ☐ No ☐ Unknown

If yes, describe: ____________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

SECTION 9: PRIOR FILINGS

9.1 Have you filed a complaint with any other agency regarding this matter?

☐ No
☐ Yes - Provide details:

Agency Name: ______________________________________________________________

Date Filed: ____________________

Case/Docket Number: ________________________________________________________

Status: ☐ Pending ☐ Closed ☐ Unknown

9.2 Have you filed a lawsuit regarding this matter?

☐ No
☐ Yes - Provide details:

Court: ____________________________________________________________________

Case Number: ______________________________________________________________

Status: ___________________________________________________________________

SECTION 10: RELIEF REQUESTED

Check all remedies you are seeking.

☐ Stop the discriminatory practice
☐ Be allowed to rent/purchase the housing
☐ Compensatory damages (actual monetary losses)
☐ Damages for emotional distress
☐ Civil penalties against respondent
☐ Changes to discriminatory policies
☐ Reasonable accommodation/modification
☐ Training for respondent on fair housing laws
☐ Other: _______________________

Estimated actual monetary damages: $________________

Describe: __________________________________________________________________

___________________________________________________________________________

SECTION 11: CERTIFICATION AND SIGNATURE

I certify under penalty of perjury that the information provided in this complaint is true and correct to the best of my knowledge and belief.

I understand that:

• HUD will investigate this complaint at no cost to me
• I must file within ONE YEAR of the alleged discriminatory act
• I may also file a private lawsuit within TWO YEARS
• It is illegal for anyone to retaliate against me for filing this complaint

☐ I authorize HUD to release my identity to the respondent(s) for investigation purposes.

Complainant Signature: _________________________________ Date: ________________

Print Name: ______________________________________________________________

SECTION 12: REPRESENTATIVE INFORMATION (IF APPLICABLE)

Is someone assisting you with this complaint?

☐ No
☐ Yes - Complete below:

Representative Name: ________________________________________________________

Organization (if applicable): __________________________________________________

Address: __________________________________________________________________

Phone: (______) ______-__________

Email: ____________________________________________________________________

Relationship: ☐ Attorney ☐ Fair Housing Organization ☐ Family Member ☐ Other: ________

FILING INSTRUCTIONS

How to File This Complaint

Online: https://portalapps.hud.gov/FHEO903/Form903/Form903Start.action

Phone: 1-800-669-9777 (Voice) or 1-800-927-9275 (TTY)

Mail: Send to your regional HUD Office of Fair Housing and Equal Opportunity (FHEO)

Email: Check HUD website for regional email addresses

Important Deadlines

• HUD Complaint: Must be filed within ONE (1) YEAR of the discriminatory act
• Federal Court Lawsuit: Must be filed within TWO (2) YEARS of the discriminatory act

STATE-SPECIFIC NOTES

California

• Additional Agency: California Civil Rights Department (CRD)
• Phone: (800) 884-1684
• Website: calcivilrights.ca.gov
• Additional Protected Classes: Sexual orientation, gender identity, source of income, citizenship status, primary language, age, marital status, genetic information, military/veteran status
• Filing Deadline: One year for HUD/CRD; Two years for court
• Note: Complaints filed with HUD are automatically dual-filed with CRD

Texas

• Additional Agency: Texas Workforce Commission Civil Rights Division
• Phone: (512) 463-2642
• Website: twc.texas.gov
• Filing Deadline: One year from date of discrimination
• Requirement: Property owner must generally have more than three properties (excluding multi-family dwellings)
• Submission: Email, fax, hand delivery, online, or mail

Florida

• Additional Agency: Florida Commission on Human Relations (FCHR)
• Phone: (850) 488-7082
• Email: [email protected]
• Website: fchr.myflorida.com
• Protected Classes: Race, color, religion, national origin, sex, pregnancy, disability, familial status
• Filing Deadline: One year from alleged discriminatory act
• Note: Do NOT file with FCHR if you have already filed with HUD

New York

• Additional Agency: New York State Division of Human Rights (DHR)
• Phone: (844) 697-3471 or Fair Housing Hotline: (844) 862-8703
• Website: dhr.ny.gov
• Additional Protected Classes: Age, sexual orientation, gender identity/expression, immigration/citizenship status, lawful source of income, domestic violence victim status, military status, marital status, sealed conviction/arrest record
• Filing Deadline: Three years for incidents occurring after February 15, 2024
• Note: DHR automatically dual-files qualifying cases with HUD

ATTACHMENTS CHECKLIST

☐ Copy of lease agreement or rental application
☐ Copies of all written communications
☐ Photographs of property or relevant evidence
☐ Timeline of events
☐ List of witnesses with contact information
☐ Supporting documentation (financial records, medical verification if applicable)
☐ Prior complaint filings (if any)

Form based on HUD Form 903.1 - Housing Discrimination Complaint Form
This template is provided for informational purposes only.