Reasonable Accommodation Request Tracking Form (HUD)

Intake and track a tenant reasonable accommodation request, supporting verification, review, and final determination under HUD fair housing processes.

Submission Notice

• Who is submitting this request?
• Consent and disclosure acknowledgment
• What happens after I submit?

Requester Information

• Requester full name
• Email address
• Phone number
• Preferred contact method
• Relationship to tenant

Tenant and Unit Details

• Tenant name
• Unit number
• Property or community name
• Lease or case reference number
• Move-in date

Accommodation Request

• Date requested
• Type of request
• Requested accommodation
  Describe the accommodation or change being requested.
• Barrier or housing need addressed
  Briefly describe the barrier the accommodation is intended to address.
• Urgency level

Verification and Supporting Information

• Is verification needed to evaluate the request?
• Verification requested
• Supporting documents
  Upload only documents necessary to support the request. Avoid sending unnecessary medical records.
• Additional notes

Review and Determination

• Assigned reviewer
• Review status
• Decision date
• Determination
• Determination reason
• Follow-up actions