District of Columbia Residential Rental Application and Screening Packet

District of Columbia Residential Rental Application and Screening Packet

Use one packet per adult applicant. Deliver the screening criteria and District disclosures before requesting information or money.

Privacy rule: Do not place a Social Security number, taxpayer-identification number, bank-account number, payment-card number, or full government-ID number in this packet. Collect identity credentials only through a separately approved secure channel with access controls and a retention schedule.

District Tenant-Screening Disclosure

Complete and give this section before screening.

• Each fee or deposit, purpose, mandatory/voluntary status, refundability: [________________________________]
• Information sources to be accessed: [________________________________]
• Criteria causing automatic denial: [________________________________]
• Other criteria that may cause denial: [________________________________]
• Consumer-reporting agency and contact information: [________________________________]
• Approximate available units by bedroom size/rent, or prior-fiscal-year monthly availability: [________________________________]
• Decision will issue within [____] days after receipt.
• Applicant may dispute inaccurately attributed information or prohibited criteria and receive a response.
• Applicant may receive a refund of any unused application fee.
• Applicant may complain to the D.C. Office of Human Rights or pursue a civil action in D.C. Superior Court.

Application fee: $[________]. Confirm the current CPI-adjusted ceiling before use; the statutory base ceiling is $50. Charge no other pre-lease fee. Charge only one application fee for applications made within 30 calendar days to units owned or operated by the same provider unless more than one screening is required. Refund within no more than 14 days if no screening occurs. D.C. Code § 42-3505.10(a)-(c).

Do not inquire about or base adverse action on possession actions or alleged lease breaches barred by § 42-3505.10(d). Do not base adverse action solely on a credit score or the absence of a score. A District adverse-action notice must identify the specific grounds, include the third-party information relied on, and explain dispute and complaint rights. Respond in writing to a timely dispute within 10 days. D.C. Code § 42-3505.10(d)-(g).

1. Property and Housing Provider

• Property address/unit: [________________________________]
• Monthly rent: $[________]
• Proposed move-in date: [__/__/____]
• Lease term: [________________________________]
• Housing provider/agent: [________________________________]
• Notice address and contact: [________________________________]
• Completed application received: [__/__/____] at [____] ☐ a.m. ☐ p.m.

2. Written Screening Criteria

Apply criteria consistently. Do not discriminate because of race, color, religion, sex, disability, familial status, or national origin. 42 U.S.C. § 3604. Check all additional District and local protected classes before use.

3. Applicant Information

• Full legal name: [________________________________]
• Name used for reference matching: [________________________________]
• Email/telephone: [________________________________]
• Current address and time there: [________________________________]
• Requested move-in date: [__/__/____]
• Other proposed occupants and relationship: [________________________________]
• Animals: [________________________________]
• Assistance-animal accommodation requested through confidential process: ☐ Yes ☐ No

Do not ask for diagnosis or disability details here.

4. Residence and Income History

Applicant authorizes verification of tenancy dates, payment history, lease compliance, property condition, and stated rent-payment resources, subject to applicable law.

5. Applicant Statements and Consumer-Report Authorization

• ☐ Information supplied is complete and accurate to the best of the applicant's knowledge.
• ☐ Applicant received the criteria and District disclosures before screening or payment.
• ☐ Applicant received the privacy/retention notice.
• ☐ Applicant understands this is not a lease or promise of approval.

I give written instructions authorizing [HOUSING PROVIDER/AGENT] and [CONSUMER REPORTING AGENCY] to obtain and use the report types checked below solely to evaluate this rental application and, if a tenancy begins, for lawful account review. This authorization relies on 15 U.S.C. § 1681b(a)(2).

• Agency/address/telephone: [________________________________]
• Report types: ☐ Credit ☐ Rental history ☐ Eviction records ☐ Criminal records ☐ Other: [________]
• Authorization expires if no report is requested by: [__/__/____]

Applicant signature: [________________________________] Date: [__/__/____]

6. Fee Receipt and Internal Decision Record

• Amount received: $[________] on [__/__/____]
• Character: ☐ No fee ☐ Application fee ☐ Refundable deposit
• Payment reference, without full account number: [________________________________]
• Refund due/date: $[________] by [__/__/____]
• Criteria applied exactly as disclosed: ☐ Yes
• Decision: ☐ Approved ☐ Approved with lawful conditions ☐ Denied ☐ Withdrawn
• Specific criterion and verified fact: [________________________________]
• Consumer report affected decision: ☐ Yes ☐ No
• District notice/dispute response completed: [________________________________]
• Decision maker/date: [________________________________]

7. Federal Adverse-Action Notice

Applicant/property/date: [________________________________]

Action: ☐ Denied ☐ Increased deposit ☐ Guarantor required ☐ Other: [________________________________]

Specific disclosed criterion and reason: [________________________________]

Consumer-report information affected the action: ☐ Yes ☐ No

If yes, identify the reporting agency, address, telephone, credit score and required score factors if used. The agency did not make the decision. The applicant may request a free report within 60 days and dispute inaccurate or incomplete information. 15 U.S.C. § 1681m(a). Attach the separate District notice required by D.C. Code § 42-3505.10(f).

Housing provider/agent signature: [________________________________]

Sources and References

• 15 U.S.C. § 1681b — https://uscode.house.gov/view.xhtml?req=(title:15%20section:1681b%20edition:prelim)
• 15 U.S.C. § 1681m — https://uscode.house.gov/view.xhtml?req=(title:15%20section:1681m%20edition:prelim)
• 42 U.S.C. § 3604 — https://uscode.house.gov/view.xhtml?req=(title:42%20section:3604%20edition:prelim)
• D.C. Code § 42-3505.10 — https://code.dccouncil.gov/us/dc/council/code/sections/42-3505.10