Nevada Residential Rental Application and Screening Packet

Nevada Residential Rental Application and Screening Packet

Use one packet per adult applicant. Do not charge application, credit-report, or background-check fees for minor household members.

Privacy rule: Do not place sensitive identifiers or financial-account numbers in this packet. Collect identity credentials only through a separately approved secure channel with access controls and a retention schedule.

Nevada Prospective-Tenant Module

• Prospective tenant requested a copy of the proposed written rental agreement: ☐ No ☐ Yes
• Copy delivered on: [__/__/____]
• Fee collected for application processing: $[________]
• Fee collected for credit report: $[________]
• Fee collected for background check: $[________]
• Fee charged for any minor household member: ☐ No

If the unit is rented to a different prospective tenant and the activity for which a fee was collected was not performed, refund that fee. A landlord may not collect an application, credit-report, or background-check fee for a household member under 18. NRS 118A.306. On request, provide the prospective tenant a copy of the written rental agreement that would govern the tenancy. NRS 118A.235.

1. Property and Housing Provider

• Property address/unit: [________________________________]
• Monthly rent/proposed move-in/term: [________________________________]
• Housing provider/agent and notice address: [________________________________]
• 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 additional Nevada and local protected classes.

3. Applicant Information

• Full legal name/name used for references: [________________________________]
• Email/telephone: [________________________________]
• Current address and time there: [________________________________]
• Requested move-in date: [__/__/____]
• Other proposed occupants/relationship/age category only: [________________________________]
• Animals: [________________________________]
• Confidential assistance-animal process requested: ☐ Yes ☐ No

4. Residence and Income History

5. Applicant Statements and Consumer-Report Authorization

• ☐ Information is complete and accurate to the best of the applicant's knowledge.
• ☐ Applicant received the criteria and Nevada fee/refund disclosure before 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 checked reports solely for this rental application and lawful account review. 15 U.S.C. § 1681b(a)(2).

• Agency/address/telephone: [________________________________]
• Reports: ☐ Credit ☐ Rental history ☐ Eviction records ☐ Criminal records ☐ Other: [________]
• Authorization expires: [__/__/____]

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

6. Fee Receipt and Decision Record

• Amount/character: $[________] ☐ No fee ☐ Application fee ☐ Report fee ☐ Refundable deposit
• Activity performed/date: [________________________________]
• Refund due because activity was not performed: $[________]
• Criteria applied exactly as disclosed: ☐ Yes
• Decision: ☐ Approved ☐ Conditional approval ☐ Denied ☐ Withdrawn
• Criterion and verified fact: [________________________________]
• Consumer report affected decision: ☐ Yes ☐ No
• Decision maker/date: [________________________________]

7. Adverse-Action Notice

Applicant/property/date: [________________________________]

Action and specific reason: [________________________________]

If a consumer report affected the action, identify the agency, address, telephone, 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).

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)
• NRS Chapter 118A (including §§ 118A.235 and 118A.306) — https://www.leg.state.nv.us/nrs/nrs-118a.html
• Nevada A.B. 121 (2025 enrolled text) — https://www.leg.state.nv.us/Session/83rd2025/Bills/AB/AB121_EN.pdf