Submit Resident Inquiries or Complaints

The purpose of this form is for residents, advocates, or other interested parties to submit inquiries or complaints regarding resident rights or impacts during a RAD conversion. Please complete as much information as possible below so that the Resident Engagement and Protections team can look into your question/concern and respond as quickly and thoroughly as possible.

Name (First*/Last):

First Name *

Last Name

How can we contact you:*

Telephone

I do not have a number

Telephone choice *

Email

I do not have an email

Email Choice *

Best Time to Contact *

AM

PM

Time Zone *

Eastern

Central

Mountain

Pacific

Contact Information:*

Phone number *

Email address *

Tell us about you:*

About you other

Property Name & Address:*

Property name *

Property Address *

Public Housing Agency (PHA) Information (if known):

PHA Name

PHA Address

Topics/Issues in complaint/Inquiry:*

Topics Issues

Please describe your concern or issue:*

Description of complaint *

Other Information

Has the property manager or other HUD offices been contacted about your concern?

Yes

No

I don’t know

Not applicable

Is there a pending lawsuit regarding this matter?

Yes

No

I don’t know

Not applicable

If answered, “yes” above, provide a brief explanation

Explanation

What code is in the image? *