Source of Income Discrimination Form

It is illegal in New York State for any owner, managing agent, broker or any other representative to refuse to rent, sell, or lease housing to any person based on their source of income with certain, limited exceptions. The law prohibits denying any application for housing based on source of income or setting different terms or conditions because of your source of income. It also prohibits advertising that certain forms of income, such as Section 8 vouchers, are not accepted.  

Click here for a more detailed explanation and examples of source of income discrimination.

Regional office
Contact information
(ex:999-999-9999 or 999-999-9999 x9999)
Are you the person that experienced discrimination?
Discrimination information
Contact information for person who experienced discrimination
Have you made a complaint regarding this discrimination to any government agency or fair housing organization?
If yes
What is the address of the property that you were seeking to rent or buy?
How many units/apartments does this property have?
Does the owner live in the building where you tried to rent?
What is the type of income that you have that was the source of discrimination?
How was the discriminatory act communicated to you?
Communication method details
Were you told directly that your source of income was not accepted, or was another reason given for refusing housing to you?
Maximum 5 files.
25 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, txt, rtf, pdf, doc, docx, ppt, pptx, xls, xlsx, .