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 type of income was the source of discrimination?
How was the discriminatory act communicated to you?
Did you interact with a broker?
Broker information
Do you know who the landlord or management company of the property is?
Landlord or management company
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, .
In filing this complaint, I understand that:
The Attorney General is not my private lawyer. The Attorney General is a public servant who protects the public from illegal or misleading practices. This complaint does not mean that the Attorney General will start a lawsuit for me.
The Attorney General cannot give me legal advice or represent me in court. If I have any questions about my legal rights or responsibilities, I should contact a private lawyer.
The Attorney General may send a copy of my complaint, and any documents I provide, to the person or organization I mention in my complaint. I give that person or organization permission to provide information about my complaint to the Attorney General.
The Attorney General may use information from my complaint to show that the law has been broken.
The Attorney General works with other government agencies at the state, local, and federal levels to investigate complaints and work with the police. The Attorney General may share my complaint with these agencies.
‎‏‏‎My complaint is true and accurate, as far as I know. Any false statements I have made in this complaint can be punished as a Class A misdemeanor (under Penal law Section 175.30 or Section 210.45, or both).
By signing or typing my full name below, I certify that the above complaint is true and accurate to the best of my knowledge and that any documents attached are true and accurate copies of the originals.