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Administrative Plan 7/1/2025 Page 16-61
<br />EXHIBIT 16-2: CERTIFICATION OF DOMESTIC VIOLENCE, DATING VIOLENCE,
<br />SEXUAL ASSAULT, OR STALKING AND ALTERNATE DOCUMENTATION,
<br />FORM HUD-5382
<br />CERTIFICATION OF U.S. Department of Housing OMB Approval No. 2577-0286
<br />DOMESTIC VIOLENCE, and Urban Development Exp. 06/30/2017
<br />DATING VIOLENCE,
<br />SEXUAL ASSAULT, OR STALKING,
<br />AND ALTERNATE DOCUMENTATION
<br />Purpose of Form: The Violence Against Women Act (“VAWA”) protects applicants, tenants, and
<br />program participants in certain HUD programs from being evicted, denied housing assistance, or
<br />terminated from housing assistance based on acts of domestic violence, dating violence, sexual assault, or
<br />stalking against them. Despite the name of this law, VAWA protection is available to victims of domestic
<br />violence, dating violence, sexual assault, and stalking, regardless of sex, gender identity, or sexual
<br />orientation.
<br />Use of This Optional Form: If you are seeking VAWA protections from your housing provider, your
<br />housing provider may give you a written request that asks you to submit documentation about the incident
<br />or incidents of domestic violence, dating violence, sexual assault, or stalking.
<br />In response to this request, you or someone on your behalf may complete this optional form and submit it
<br />to your housing provider, or you may submit one of the following types of third-party documentation:
<br />(1) A document signed by you and an employee, agent, or volunteer of a victim service provider, an
<br />attorney, or medical professional, or a mental health professional (collectively, “professional”) from
<br />whom you have sought assistance relating to domestic violence, dating violence, sexual assault, or
<br />stalking, or the effects of abuse. The document must specify, under penalty of perjury, that the
<br />professional believes the incident or incidents of domestic violence, dating violence, sexual assault, or
<br />stalking occurred and meet the definition of “domestic violence,” “dating violence,” “sexual assault,” or
<br />“stalking” in HUD’s regulations at 24 CFR 5.2003.
<br />(2) A record of a Federal, State, tribal, territorial or local law enforcement agency, court, or
<br />administrative agency; or
<br />(3) At the discretion of the housing provider, a statement or other evidence provided by the applicant or
<br />tenant.
<br />Submission of Documentation: The time period to submit documentation is 14 business days from the
<br />date that you receive a written request from your housing provider asking that you provide documentation
<br />of the occurrence of domestic violence, dating violence, sexual assault, or stalking. Your housing
<br />provider may, but is not required to, extend the time period to submit the documentation, if you request an
<br />extension of the time period. If the requested information is not received within 14 business days of when
<br />you received the request for the documentation, or any extension of the date provided by your housing
<br />provider, your housing provider does not need to grant you any of the VAWA protections. Distribution or
<br />issuance of this form does not serve as a written request for certification.
<br />Confidentiality: All information provided to your housing provider concerning the incident(s) of
<br />domestic violence, dating violence, sexual assault, or stalking shall be kept confidential and such details
<br />shall not be entered into any shared database. Employees of your housing provider are not to have access
<br />to these details unless to grant or deny VAWA protections to you, and such employees may not disclose
<br />this information to any other entity or individual, except to the extent that disclosure is: (i) consented to
<br />EXHIBIT 1
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