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Fair Criminal Record Screening for Housing Intake Form

Fair Criminal Record Screening
Housing Intake Questionnaire

The Fair Criminal Record Screening for Housing Act of 2016 prohibits District housing providers from asking about arrests, pending criminal accusations, or criminal convictions on an rental housing application or during the application review process (exceptions apply)*. If criminal background information is inquired or asked about during the application review process or if you believe your conditional offer of rental housing was improperly revoked because of your criminal background, please complete this form. More information about the law is available by visiting or calling the Office of Human Rights, or by visiting Fields with asterisks (*) are required.


To file a complaint, the alleged violation must meet the following criteria (please check the required boxes):

Complainant Information

Complainant Address

Do you need a reasonable accommodation?

Housing Provider Information

Does the property owner live in the building?

Number of Rental Units at Property

Incident Information

The following steps help us to ensure we have the proper information about your housing application experience and assists us in preparing for our intake interview with you. Please complete each step below to the best of your ability before submitting this complaint to us (required boxes are marked with

  • Step 1: Application Submission

Date of Application Submission

Date Picker

Did you submit an application fee?

If yes, what date did you submit the application fee?

Date Picker

Did you receive a copy of the rental eligibity criteria from the housing provider before or at the time you applied for housing?

  • Step 2: Conditional Housing Offer

Did you receive a conditional housing offer?

If yes, what date was the conditional offer made?

Date Picker

Did the housing provider inquire or ask about your criminal background before making a conditional offer?

If yes, what did the housing provider ask about?

  • Step 3: Offer Withdrawn

Was your conditional housing offer withdrawn?

Did you receive written notification from the housing provider that included the reason(s) for withdrawing the conditional offer?

Did you receive a written notice of your right to file a complaint with OHR from the housing provider when they withdrew the offer?

  • Step 4: Requesting Records

Did you request a copy of all information that the housing provider used during the application process?

Did you receive the requested infromation from the housing provider?

  • Step 5: Criminal Backgroup

Do you have any criminal conviction(s)?

Do you have any pending criminal accusations?

Attorney or Counsel Information (optional)

Counsel Address

Additional Information

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