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Housing Intake

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Section A: Basic Information Please provide the following basic information, which will be used to perform a conflicts check. If we are unable to assist you based on this information, we will not review and will not enter into our system any information from the following sections.

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Section B: Income Information Please provide the following information about your household income, which will be used to determine if you are eligible for our services. Please include all income that any member of your household receives. If you do not know exact figures, please provide your best estimate. For example, if your paycheck changes based on the hours you work each week, try to estimate your average weekly or monthly income. If we are not able to help you further based on your household income, the information in this section will not be entered into our system.
Type of Income*
Amount
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Type of Income
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Type of Income
Amount
Frequency
Type of Income
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Type of Income
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Tip: If no one in your household receives any form of income, please select the option that says “My household has zero income” in the first drop-down box.

If you are unsure about what kind of income you receive, or you want to give us additional information, please use the box below.
Section C: Information about your Legal Matter Please provide the additional information below describing your legal matter. If you have multiple issues, please check all boxes that apply.
If you need to return to an earlier part of the form, please use the “Back” button below instead of your browser’s “Back” button.

Landlord says that I owe rentLandlord says I violated my leaseLandlord not making necessary repairs to my homeProblems with D.C. Housing Authority
NOTE: If you do not see your housing problem listed here, then please call Legal Aid’s Intake Unit at 202.628.1161 for more information.

Landlord says that I owe rent
1. Do you live in subsidized housing? Subsidized housing is:

  • Where the government pays for part or all of your rent
  • Where your rent is based on your income
  • YesNoI don't know
    a. Where do you go to fill out your recertification paperwork? (Ex: your leasing office, 1133 North Capitol St NE)

    2. Has your landlord sued you for not paying rent? YesNo

    a. When is the next court date?
    b. Please enter your Landlord-Tenant court case number if you have it (e.g., 2019 LTB XXXXXXX). This is optional.
    c. Is this your first court date? YesNo

    CLICK HERE for information on what to do on your first court date.

    3. Is there a written lease? YesNoNot Sure
    If you have a copy of the lease, please make sure to provide it to us in Section D: Documents.

    4. Do you believe you owe your landlord rent? YesNoNot Sure

    a. How much rent do you believe you owe? b. Did you withhold the rent on purpose? If so, why? c. Why did you get behind on rent?


    5. Are there any problems in your home (examples: repairs that need to be made, rodent problems)? YesNo

    a. List all the problems in your unit. Please include approximately when each problem began, if you remember. b. Do you have any proof of these problems (in the form of pictures or video)? YesNo

    If you have any pictures or videos, please make sure to provide them to us in Section D: Documents.
    c. Did you tell your landlord about the problems? YesNo

    i. When did you tell your landlord about the problems? (Try to estimate even if you don't know the exact date.) ii. How did you tell them? (Ex: in person, over the phone, through email, etc.)

    d. Have any repairs been made? YesNo

    i. Were the repairs made by you or the landlord, and around when did the repairs happen?

    e. Did you ever call a housing inspector about the problems? YesNo

    i. Around when and what was the result? Do you have a copy of the inspection report?
    **If you have a copy of the inspection report, please make sure to provide it to us in Section D: Documents.

    f. Does the landlord have a key to your home? YesNoI don't know g. Has there ever been a time when the landlord came to make repairs and you would not let him/her in? If so, why?


    6. Do you think your landlord is retaliating against you? For example, do you think your landlord is trying to evict you because you complain about problems in your apartment? YesNoI don't know
    a. Why?

    7. Do you have receipts or canceled checks proving payment of rent? YesNo
    If you have proof of paying rent, please make sure to provide it to us in Section D: Documents.

    8. Do you currently have the money to pay the unpaid rent? YesNo

    a. Can you get the money from somewhere? YesNo


    9. Can you afford to pay your rent going forward? YesNoI'm not sure
    10. Is there anything else we should know about your case?
    Landlord says I violated my lease
    1. Do you live in subsidized housing (housing where the government pays for part or all of your rent, or where your rent is based on your income)? YesNoI don't know
    a. Where do you go to fill out your recertification paperwork? (Ex: your leasing office, 1133 North Capitol St NE)

    2. Has your landlord sued you for violating your lease? YesNo

    a. When is the next court date? b. Is this your first court date? YesNo

    CLICK HERE for information on what to do on your first court date.

    3. Please list all lease violations that your landlord has mentioned.

    4. Are drugs or criminal activity involved in the landlord’s allegations against you? YesNo

    a. What happened, from your point of view? b. Do you have a criminal case too? YesNo

    i. May we contact your criminal defense attorney about your case? If so, please include their name and phone # in case we decide to do this.


    5. Do you agree or disagree with what your landlord is saying? Please explain.

    6. If you agree with all or part of what the landlord is saying, have you made an effort to fix the problems? YesNo
    Please explain.

    7. Do you think your landlord is retaliating against you? For example, do you think your landlord is trying to evict you because you complain about problems in your apartment? YesNoI don't know
    a. Why?

    8. Has your landlord also sued you for not paying rent? YesNo
    9. Is there anything else we should know about your case?
    Landlord not making necessary repairs to my home
    Note: if you already gave us the following information in another section of the application, you don't need to enter the same information again.

    1. List all the problems in your unit. Please include approximately when each problem began, if you remember.

    2. Do you have any proof of these problems (in the form of pictures or video)? YesNo
    If you have any pictures or videos, please make sure to provide them to us in Section D: Documents.

    3. Did you tell your landlord about the problems? YesNo

    i. When did you tell your landlord about the problems? (Try to estimate even if you don't know the exact date.) ii. How did you tell them? (Ex: in person, over the phone, through email, etc.)


    4. Have any repairs been made? YesNo

    i. Were the repairs made by you or the landlord, and around when did the repairs happen?


    5. Did you ever call a housing inspector about the problems? YesNo

    i. Around when did the inspector come out and what was the result? Do you have a copy of the inspection report?


    6. Does the landlord have a key to your home? YesNoI don't know
    7. Has there ever been a time when the landlord came to make repairs and you would not let him/her in? If so, why?

    8. Have you sued your landlord in Housing Conditions Court for these problems? YesNo
    Has the housing inspector come out yet? YesNo
    If you have a copy of the inspection report, please be sure to provide us with a copy in Section D.
    When is the next court date?

    9. Are you behind on rent? YesNoI don't know
    10. Can you afford to pay your rent going forward? YesNoNot Sure
    11. Is there anything else we should know about your case?
    Problems with D.C. Housing Authority
    1. What problems are you having with the D.C. Housing Authority?

    2. Have you attempted to try to resolve the problem on your own? YesNo
    Please describe what steps you have taken, including details on any conversations or meetings with the DC Housing Authority.

    3. Did you request a hearing on this issue? YesNoNot Sure
    a. When is/was the hearing? b. If you already had the hearing, please describe what happened.
    If D.C. Housing Authority sent you any documents after your hearing, please be sure to provide them to us in Section D.
    c. Do you have an upcoming hearing date scheduled? YesNo
    When?

    4. Has the D.C. Housing Authority sued you for eviction? YesNoI don't know

    a. Are they trying to evict you for not paying rent? YesNo

    Please scroll to the top of the page and fill out the new questions that have appeared regarding your landlord saying you owe rent.
    b. Are they trying to evict you for violating your lease? YesNo

    Please scroll to the top of the page and fill out the new questions that have appeared regarding your landlord saying you violated your lease.

    5. Is there anything else we should know about your case?
    Section D: Documents
    If you have documents related to your issue, it can be helpful to us to see them to better understand your legal problem. Here are the kinds of documents that could be helpful in your case:

  • A. Lease
  • B. Notice to Quit
  • C. Complaint and Summons
  • D. Other court papers
  • E. Correspondence with landlord, DC Housing Authority, Office of Administrative Hearings
  • F. Rent receipts
  • G. Photographs of housing code violations
  • H. Inspection Reports (DCRA or DCHA)
  • I. Criminal case paperwork

  • Please let us know if you have any relevant documents, and, if so, how you would like to provide them to us.
    I have no documents.I can upload some of my documents now.I have documents and will drop them off in person at Legal Aid (1331 H Street NW, Suite 350, Washington, DC 20005; M 9am-6pm, T-F 9am-5pm).I have documents and will email them to onlineintake@legalaiddc.org. Please include your full name in the subject.I have documents and will fax them to Legal Aid at 202-727-2132. Please put to the attention of Online Intake on the cover sheet.I have documents and will mail them to Legal Aid. Please include your full name on the envelope and on the cover sheet (if any).

    Please send the documents to the following address:
    Legal Aid Society of the District of Columbia
    Attn: Online Intake
    1331 H St NW, Suite 350
    Washington, DC 20005



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