Privacy & Reporting Responsibilities

The PHA, if presented with a claim for continued or initial tenancy or assistance based on status as a victim of domestic violence, dating violence or stalking, has the option to request that the victim document or provide written evidence to demonstrate that the violence occurred. 

The PHA may require the use of HUD form 50066. If this form is used by the victim, they must complete and submit it within fifteen (15) calendar days of receiving it. If the victim does not complete and return this form (or provide third-party verification) by the fifteenth calendar day or by an extension of the date provided by the PHA, the victim cannot be assured s/he will receive VAWA protections. 

Victim Documentation 

An applicant or participant claiming that the cause of an unfavorable history is that a member of the applicant family is or has been a victim of domestic violence, sexual violence, dating violence, or stalking must provide documentation demonstrating the connection between the abuse and the unfavorable history and naming the perpetrator of the abuse. The documentation may consist of any of the following: 

  1. A statement signed by the victim certifying that the information provided is true and correct and that it describes bona fide incident(s) of actual or threatened domestic violence, sexual violence, dating violence, or stalking 
  2. A police or court record documenting the domestic violence, sexual violence, dating violence, or stalking. 
  3. Documentation signed by a person who has assisted the victim in addressing domestic violence, sexual violence, dating violence, or stalking, or the effects of such abuse. This person may be an employee, agent, or volunteer of a victim service provider; an attorney; or a medical or other knowledgeable professional. The person signing the documentation must attest under penalty of perjury to the person’s belief that the incidents in question are bona fide incidents of abuse. The victim must also sign the documentation. 

Perpetrator Documentation 

If the perpetrator of the abuse is a member of the applicant family, the applicant must provide additional documentation consisting of one of the following: 

  1. Documentation that the perpetrator has successfully completed, or is successfully undergoing, rehabilitation or treatment. The documentation must be signed by an employee or agent of a domestic violence service provider or by a medical or other knowl
  2. A signed statement requesting that the perpetrator be removed from the application and certifying that the perpetrator will not be permitted to visit or to stay as a guest in the assisted unit 
  3. edgeable professional from whom the perpetrator has sought or is receiving assistance in addressing the abuse. The signer must attest under penalty of perjury that it is their belief the rehabilitation was successfully completed or is progressing successfully. The victim and perpetrator must also sign or attest to the documentation related to rehabilitation or treatment received by the perpetrator. 

Confidentiality Requirements 

All information provided to the PHA regarding domestic violence, sexual violence, dating violence, or stalking, including the fact that an individual is a victim of such violence or stalking, must be retained in confidence and maintain confidentiality of information received and shared, and keep all information provided confidential.  

The PHA will not enter information into any shared database nor provide information to any related entity, except to the extent that it is requested or consented to by the individual in writing, is required for use in an eviction proceeding, or is otherwise required by applicable law. 

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