MAIL TO:

PLACE

POSTAGE

HERE

Send this form to USDA or to the U.S. Department 

of Housing and Urban Development at one of the 

following addresses. If you are unable to complete this 

form, you may call the USDA Rural Development Office 

of Civil Rights, in Washington, DC, at (202) 692-0252.

1. U.S. Secretary of Agriculture

1400 Independence Ave.

Washington, DC 20250

2. USDA Director

Office of Operations

Room 1575-S

1400 Independence Ave.

Washington, DC 20250

3. Office of Civil Rights Director

USDA Rural Development

Stop 0703

14th St. & Independence Ave., SW

Washington, DC 20250-0703

4. Office of Fair Housing and 

Equal Opportunity

U.S. Department of Housing and 

Urban Development (HUD)

Washington, DC 20410

5. Any U.S. Department 

of Housing and Urban 

Development Regional Office

USDA is an equal opportunity provider, employer, and lender.

PA-2265 | September 2020

Your Partner for 

Fair Housing

If you have been denied your housing rights...

you may have experienced unlawful discrimination. 

Fair Housing Is Your Right!

Together, America Prospers

rd.usda.gov/about-rd/offices/civil-rights

1 (800) 787-8821 (Toll Free) 

1 (800) 877-8339 (Federal Relay) 

RA.RD.MOSTL.CivilRights@usda.gov

According to the Paperwork Reduction Act of 1995 an agency may not 

conduct or sponsor, and a person is not required to respond to a collection 

of information unless it displays a valid OMB control number. The valid 

OMB control number for this information collection is 0575-0018. The time 

required to complete this information collection is estimated to average 

30 minutes 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.

OMB No. 0575-0018

Exp. 05/31/2021
Are You a Victim of Housing Discrimination?

The American Dream of having a safe and decent place to call 

“home” reflects our shared belief that in this Nation, opportunity 

and success are within everyone’s reach. Under our Fair Housing 

laws, every citizen is assured the opportunity to build a better life in 

the home or apartment of their choice — regardless of their race, 

color, religion, sex, national origin, family status or disability.

The U.S. Department of Agriculture (USDA) is committed to 

fair housing for all Americans. This form can help you address 

housing discrimination.

How Do You Recognize Housing Discrimination?

Under the Fair Housing Act, It Is Against the Law to:

• Refuse to rent to you or sell you housing

• Tell you housing is unavailable when in fact it is available

• Show you apartments or homes only in certain neighborhoods

• Set different terms, conditions, or privileges for sale or rental 

of a dwelling

• Provide different housing services or facilities

• Advertise housing to preferred groups of people only

• Refuse to provide you with information regarding mortgage 

loans, deny you a mortgage loan, or impose different terms or 

conditions on a mortgage loan

• Deny you property insurance

• Conduct property appraisals in a discriminatory manner

• Refuse to let you make reasonable modifications to your dwelling 

or common use areas, at your expense, if it may be necessary for 

you to fully use the housing. (Where reasonable, a landlord may 

permit changes only if you agree to restore the property to its 

original condition when you move.)

• Refuse to make reasonable accommodations in rules, policies, 

practices, or services if it may be necessary for you to use the 

housing on an equal basis with nondisabled persons

• Fail to design and construct housing in an accessible manner

• Harass, coerce, intimidate, or interfere with anyone exercising or 

assisting someone else with his/her fair housing rights

It Is Unlawful to Discriminate in 

Housing Based on These Factors:

• Race

• Color

• National origin

• Religion

• Sex

• Disability

• Familial status 

(families with children under 

the age of 18, or who are 

expecting a child)

If You Believe Your Rights Have Been Violated...

• USDA or a State or local fair housing agency is ready to help 

you file a complaint.

• After your information is received, USDA or a State or local 

fair housing agency will contact you to discuss the concerns 

you raise.

Detach here. Fold and close with glue or tape (no staples).

Instructions: (Please type or print) Read this form carefully. Try to 

answer all questions. If you do not know the answer or a question 

does not apply to you, leave the space blank. You have 1 year from 

the date of the alleged discrimination to file a complaint. Sign and 

date your form.

1 What happened to you? 

How were you discriminated against? For example: were you refused 

an opportunity to rent or buy housing? Denied a loan? Told that 

housing was not available when in fact it was? Treated differently 

from others seeking housing? State briefly what happened.

2 Why do you think you are a victim 

of housing discrimination?

Is it because of your:

race

color

religion

sex

national origin

disability 

familial status 

(families with children 

under age 18) 

For example: Were you denied housing because of your race? Were 

you denied a mortgage loan because of your religion? Or turned 

down for an apartment because you have children? Briefly explain 

why you think your housing rights were denied and circle the 

factor(s) listed above that you believe apply.

3 Who do you believe discriminated against you?

For example: Was it a landlord, owner, bank, real estate agent, broker, 

company, or organization? Identify who you believe discriminated 

against you.

Name:________________________________________________________

Address: _____________________________________________________

City:__________________________ State: ______ Zip Code: _________

4 Where did the alleged act of 

discrimination occur?

For example: Was it at a rental unit? Single family home? 

Public or Assisted Housing? A mobile home? 

Did it occur at a bank or other lending institution? Provide the address.

Name:________________________________________________________

Address: _____________________________________________________

City:__________________________ State: ______ Zip Code: _________

5 When did the last act of discrimination occur?

Enter the date: ________________________________________________

Is the alleged discrimination continuing? Yes No

Signature: _____________________Date: _______________

Housing Discrimination Information

Your Name: _________________________________________________________

Your Address: ______________________________________________________

City:_____________________________ State: _______ Zip Code: __________

Best time to call:________________________

Your Daytime Phone No: ______________ Evening Phone No:______________

Email: ______________________________________________________________

Who else can we call if we cannot reach you? __________________________

Contact’s Name: ____________________ Best Time to call: _______________

Daytime Phone No: __________________ Evening Phone No: _____________