form HUD-903 (7/2001)
ref Handbook 8024.1
Previous editions are obsolete
Page 1 of 3
Housing Discrimination
Complaint
This section is for HUD use only.
Number (Check the applicable box) Jurisdiction Signature of HUD personnel who established Jurisdiction
Referral & Agency (specify) Yes No
Filing Date Systemic Additional Info
Military Referral
1. Name of Aggrieved Person or Organization (last name, first name, middle initial) (Mr.,Mrs.,Miss,Ms.) Home Phone Business Phone
Street Address (city, county, State & zip code)
2. Against Whom is this complaint being filed? (last name, first name, middle initial) Phone Number
Street Address (city, county, State & zip code)
Check the applicable box or boxes which describe(s) the party named above:
Builder Owner Broker Salesperson Supt. or Manager Bank or Other Lender Other
If you named an individual above who appeared to be acting for a company in this case, check this box and write the name and address of the company in this space:
Name: Address
Name and identify others (if any) you believe violated the law in this case:
3. What did the person you are complaining against do? Check all that apply and give the most recent date these act(s) occurred in block No. 6a below.
Refuse to rent, sell, or deal with you Falsely deny housing was available Engage in blockbusting Discriminate in broker's services
Discriminate in the conditions or Advertise in a discriminatory way Discriminate in financing Intimidated, interfered, or coerced you
terms of sale, rental occupancy, or to keep you from the full benefit of the
in services or facilities Federal Fair Housing Law
Other (explain)
4. Do you believe that you were discriminated against because of your race, color, religion, sex, handicap, the presence of children under 18, or a pregnant
female in the family or your national origin? Check all that apply.
Race or Color Religion Sex Handicap Familial Status National Origin
Black (specify) Male Physical Presence of children Hispanic American Other
White Female Mental Asian or Indian or (specify)
Other Pregnant female Pacific Alaskan
Islander Native
5. What kind of house or property was involved? Did the owner live there? Is the house or property What is the address of the house or property?
Single-family house Yes Being sold? (street, city, county, State & zip code)
A house or building for 2, 3, or 4 families No Being rented?
A building for 5 families or more Unknown
Other, including vacant land held for
residential use (explain)
7. I declare under penalty of perjury that I have read this complaint
(including any attachments) and that it is true and correct.
Signature & Date
6a.When did the act(s) checked in Item
3 occur? (Include the most recent
date if several dates are involved)
U.S. Department of Housing
and Urban Development
Office of Fair Housing
and Equal Opportunity
OMB Approval No. 2529-0011
Please type or print this form
Public Reporting Burden for this collection of information is estimated to average 1 hour 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.
Read this entire form and all the instructions carefully before completing. All questions should be answered. However, if you do not know the answer
or if a question is not applicable, leave the question unanswered and fill out as much of the form as you can. Your complaint should be signed and dated.
Where more than one individual or organization is filing the same complaint, and all information is the same, each additional individual or organization
should complete boxes 1 and 7 of a separate complaint form and attach it to the original form. Complaints may be presented in person or mailed to the
HUD State Office covering the State where the complaint arose (see list on back of form), or any local HUD Office, or to the Office of Fair Housing and
Equal Opportunity, U.S. Department of HUD, Washington, D.C. 20410.
under 18 in the family
6. Summarize in your own words what happened. Use this space for a brief and concise statement of the facts.
Additional details may be submitted on an attachment.
Note: HUD will furnish a copy of the complaint to the person or organization against whom the complaint is made.
form HUD-903 (7/2001)
ref Handbook 8024.1
Previous editions are obsolete
Page 2 of 3
What Does the Fair Housing Amendments Act of 1988 Provide?
The Fair Housing Act declares that it is national policy to provide fair
housing throughout the United States and prohibits eight specific
kinds of discriminatory acts regarding housing if the discrimination is
based on race, color, religion, sex, handicap, familial status or
national origin.
1. Refusal to sell or rent or otherwise deal with a person.
2. Discriminating in the conditions or terms of sale, rental, or occu-
pancy.
3. Falsely denying housing is available.
4. “Blockbusting”—causing person(s) to sell or rent by telling them
that members of a minority group are moving into the area.
6. Discrimination in financing housing by a bank, savings and loan
association, or other business.
7. Denial of membership or participation in brokerage, multiple
listing, or other real estate services.
8. Interference, coercion, threats or intimidation to keep a person
from obtaining the full benefits of the Federal Fair Housing Law
and/or filing a complaint.
What Does the Law Exempt?
The first three acts listed above do not apply (1) to any single family
house where the owner in certain circumstances does not seek to
rent or sell it through the use of a broker or through discriminatory
advertising, nor (2) to units in houses for two-to-four families if the
owner lives in one of the units.
What Can You Do About Violations of the Law?
Remember, the Fair Housing Act applies to discrimination based on
race, color, religion, sex, handicap, familial status, or national origin.
If you believe you have been or are about to be, discriminated against
or otherwise harmed by the kinds of discriminatory acts which are
prohibited by law, you have a right, within 1 year after the discrimi-
nation occurred to:
1. Complain to the Secretary of HUD by filing this form by mail or
in person. HUD will investigate. If it finds the complaint is covered
by the law and is justified, it will try to end the discrimination by
conciliation. If conciliation fails, other steps will be taken to
enforce the law. In cases where State or local laws give the same
rights as the Federal Fair Housing Law, HUD must first ask the
State or local agency to try to resolve the problem.
2. Go directly to Court even if you have not filed a complaint with
the Secretary. The Court may sometimes be able to give quicker,
more effective, relief than conciliation can provide and may also,
in certain cases, appoint an attorney for you (without cost).
You Should Also Report All Information about violations of the
Fair Housing Act to HUD even though you don't intend to complain
or go to court yourself.
Additional Details. If you wish to explain in detail in an attach-
ment what happened, you should consider the following:
1. If you fee that others were treated differently from you, please
explain the facts and circumstances.
2. If there were witnesses or others who know what happened,
give their names, addresses, and telephone numbers.
3. If you have made this complaint to other government agencies
or to the courts, state when and where and explain what
happened.
Racial/Ethnic Categories
1. White (Non Hispanic)—A person having origins in any of the
original peoples of Europe, North Africa, or the Middle East.
2. Black (Non Hispanic)—A person having origins in any of the
black racial groups of Africa.
3. Hispanic—A person of Mexican, Puerto Rican, Cuban, Central or
South American or other Spanish Culture or origin, regardless of
race.
4. American Indian or Alaskan Native—A person having origins in
any of the original peoples of North America, and who maintains,
cultural identification through tribal affiliation or community recog-
nition.
5. Asian or Pacific Islander—A person having origins in any of the
original peoples of the Far East, Southeast Asia, the Indian
Subcontinent, or the Pacific Islands. This area includes, for
example, China, Japan, Korea, the Philippine Islands, and Sa-
moa.
You can obtain assistance (a) in learning about the Fair Housing Act,
or (b) in filing a complaint at the HUD Regional Offices listed below:
For Connecticut, Maine, Massachusetts, New Hampshire,
Rhode Island, and Vermont:
NEW ENGLAND OFFICE
Fair Housing Enforcement Center
U.S. Department of Housing and Urban Development
Thomas P. O’Neill, Jr. Federal Building
10 Causeway Street, Room 321
Boston, MA 02222-1092
Telephone (617) 994-8300 or 1-800-827-5005
Fax (617) 565-7313 • TTY (617) 565-5453
For New Jersey and New York
New York/New Jersey Office ([email protected])
Fair Housing Enforcement Center
U.S. Department 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
For Delaware, District of Columbia, Maryland, Pennsylvania,
Virginia, and West Virginia
MID-ATLANTIC OFFICE
Fair Housing Enforcement Center
U.S. Department of Housing and Urban Development
The Wanamaker Building
100 Penn Square East
Philadelphia, PA 19107-9344
Telephone (215) 656-0662 or 1-888-799-2085
Fax (215) 656-3419 • TTY (215) 656-3450
form HUD-903 (7/2001)
ref Handbook 8024.1
Previous editions are obsolete
Page 3 of 3
For Alabama, the Caribbean, Florida, Georgia, Kentucky,
Mississippi, North Carolina, South Carolina, and Tennessee:
SOUTHEAST/CARIBBEAN OFFICE
Fair Housing Enforcement Center
U.S. Department of Housing and Urban Development
Five Points Plaza
40 Marietta Street, 16th Floor
Atlanta, GA 30303-2806
Telephone (404) 331-5140 or 1-800-440-8091
Fax (404) 331-1021 • TTY (404) 730-2654
For Illinois, Indiana, Michigan, Minnesota, Ohio, and Wiscon-
sin:
MIDWEST OFFICE ([email protected])
Fair Housing Enforcement Center
U.S. Department 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
For Arkansas, Louisiana, New Mexico, Oklahoma, and Texas:
SOUTHWEST OFFICE
(Thurman G. [email protected] or
Fair Housing Enforcement Center
U.S. Department 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
For Iowa, Kansas, Missouri and Nebraska:
GREAT PLAINS OFFICE
Fair Housing Enforcement Center
U.S. Department 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
For Colorado, Montana, North Dakota, South Dakota, Utah, and
Wyoming:
ROCKY MOUNTAINS OFFICE
(Sharon_L. [email protected])
Fair Housing Enforcement Center
U.S. Department of Housing and Urban Development
633 17th Street
Denver, CO 80202-3690
Telephone (303) 672-5437 or 1-800-877-7353
Fax (303) 672-5026 • TTY (303) 672-5248
For Arizona, California, Hawaii, and Nevada:
PACIFIC/HAWAII OFFICE
Fair Housing Enforcement Center
U.S. Department of Housing and Urban Development
Phillip Burton Federal Building and U.S. Courthouse
450 Golden Gate Avenue
San Francisco, CA 94102-3448
Telephone (415) 436-8400 or 1-800-347-3739
Fax (415) 436-8537 • TTY (415) 436-6594
For Alaska, Idaho, Oregon, and Washington:
NORTHWEST/ALASKA OFFICE
Fair Housing Enforcement Center
U.S. Department 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
If after contacting the local office nearest you, you still have
questions – you may contact HUD further at
:
U.S. Department 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
Privacy Act of 1974 (P.L. 93-579)
Authority: Title VIII of the Civil Rights Act of 1968, as amended by
the Fair Housing Amendments Act of 1988, (P.L. 100-430).
Purpose: The information requested on this form is to be used to
investigate and to process housing discrimination complaints.
Use: The information may be disclosed to the United States Depart-
ment of Justice for its use in the filing of pattern or practice suits of
housing discrimination or the prosecution of the person who commit-
ted the discrimination where violence is involved; and to state or local
fair housing agencies which administer substantially equivalent fair
housing laws for complaint processing.
Penalty: 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.
For further information call the Toll-free Fair Housing Complaint Hotline 1-800-669-9777.
Hearing Impaired persons may call (TDD) 1-800-927-9275.
