AHA Interactive Complaint Form

Please describe your complaint. Please keep this as brief as possible and include names, dates and witnesses as applicable.

Please attach any documentation relating to your complaint. Please do not attach personal medical information.

By checking this box and typing my name below, I am electronically signing this form.

Date: Print Name:

If a physical address was provided we intend to respond to your complaint within 10 business days. Please do not call during this time. We will respond in writing. Please understand that if you have not spoken with the site staff/senior property manager the Housing Authority will most likely pass your complaint to them for initial response and follow up.

If you have a disability and need to file a reasonable accommodation request, please contact your worker or property manager. If you are making a 504 discrimination complaint, please contact the 504 Coordinator at 504coordinator@alamedahsg.org.

For office use only:

Date Received	By whom
Date Responded	By whom

My Name:
Address:
Telephone:	Email:

Rent increase	Maintenance	Parking
Lease Violation	Smoking	Other

Alameda Housing Authority

Fair Housing

Departments

Housing Authority

Yes Date and person you spoke with:
No You are advised to speak with the property manager.