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Administrative Plan 7/1/2025 Page 16-58 <br />The PHA will keep confidential requests for emergency transfers by victims of domestic <br />violence, dating violence, sexual assault, or stalking, and the location of any move by such <br />victims and their families. <br />The PHA’s emergency transfer plan provides further information on emergency transfers, and <br />the PHA must make a copy of its emergency transfer plan available to you if you ask to see it. <br />Documenting You Are or Have Been a Victim of Domestic Violence, Dating Violence, <br />Sexual Assault or Stalking <br />The PHA can, but is not required to, ask you to provide documentation to “certify” that you are <br />or have been a victim of domestic violence, dating violence, sexual assault, or stalking. Such <br />request from the PHA must be in writing, and the PHA must give you at least 14 business days <br />(Saturdays, Sundays, and federal holidays do not count) from the day you receive the request to <br />provide the documentation. The PHA may, but does not have to, extend the deadline for the <br />submission of documentation upon your request. <br />You can provide one of the following to the PHA as documentation. It is your choice which of <br />the following to submit if the PHA asks you to provide documentation that you are or have been <br />a victim of domestic violence, dating violence, sexual assault, or stalking. <br />A complete HUD-approved certification form given to you by the PHA with this notice, <br />that documents an incident of domestic violence, dating violence, sexual assault, or <br />stalking. The form will ask for your name, the date, time, and location of the incident of <br />domestic violence, dating violence, sexual assault, or stalking, and a description of the <br />incident. The certification form provides for including the name of the abuser or <br />perpetrator if the name of the abuser or perpetrator is known and is safe to provide. <br />A record of a Federal, State, tribal, territorial, or local law enforcement agency, court, or <br />administrative agency that documents the incident of domestic violence, dating violence, <br />sexual assault, or stalking. Examples of such records include police reports, protective <br />orders, and restraining orders, among others. <br /> A statement, which you must sign, along with the signature of an employee, agent, or <br />vounteer of a victim service provider, an attorney, a medical professional or a mental <br />helth professional (collectively, “professional”) from whom you sought assistance in <br />addressing domestic violence, dating violence, sexual assault, or stalking, or the effects of <br />abuse, and with the professional selected by you attesting under penalty of perjury that <br />they believe that the incident or incidents of domestic violence, dating violence, sexual <br />assault, or stalking are grounds for protection. <br />Any other statement or evidence that the PHA has agreed to accept. <br />If you fail or refuse to provide one of these documents within the 14 business days, the PHA <br />does not have to provide you with the protections contained in this notice. <br />If the PHA receives conflicting evidence that an incident of domestic violence, dating violence, <br />sexual assault, or stalking has been committed (such as certification forms from two or more <br />members of a household each claiming to be a victim and naming one or more of the other <br />petitioning household members as the abuser or perpetrator), the PHA has the right to request <br />that you provide third-party documentation within thirty 30 calendar days in order to resolve the <br />conflict. If you fail or refuse to provide third-party documentation where there is conflicting <br />evidence, the PHA does not have to provide you with the protections contained in this notice. <br />EXHIBIT 1