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Housing Intake

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 delete from our systems the information in the following sections. * indicates a required field.
WhiteBlackHisp./LatinoAsianPacific Island.Native Amer.Biracial/MultiracialPrefer Not to AnswerOther
FemaleMaleGender NonconformingPrefer Not to AnswerOther:
By applying for legal assistance online you are agreeing to be contacted by all methods. If you prefer not to be contacted by these methods please call the intake line at 202-628-1161 option 2.




Section B: Household Income Legal Aid generally serves individuals whose household income is at or below 200% of the Federal Poverty Guidelines. For some types of cases, we may serve individuals whose household income is between 200% and 300% of the Federal Poverty Guidelines. Please provide the following basic information about your household income so that we can determine whether you are eligible for our services. If we are unable to assist you for any reason, this information in this section will be deleted from our system.
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Type of Income
Amount
Frequency
Section C: Information about Your Legal Matter Please provide the additional information below describing your legal matter. If we are unable to provide you with legal representation on this matter for any reason, the information in this section will be deleted from our system.
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 (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

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.
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 intentionally? If so, why?

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 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?

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 any reason? YesNoI don't know 7. Do you have receipts or canceled checks proving payment of rent? YesNo 8. Do currently have the money to pay the unpaid rent? YesNo

a. Can you get the money from somewhere? YesNo

9. 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
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? a. 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 any reason? YesNoI don't know 8. Has your landlord also sued you for not paying rent? YesNo 8. 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 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. 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. Have you had a hearing on this issue already or have you requested one? YesNoNot Sure
a. If you have already had the hearing, please describe when and 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.
b. Do you have an upcoming hearing date? 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?
IMPORTANT DOCUMENTS IN HOUSING CASES If you have any of the following documents, please upload, e-mail (to onlineintake@legalaiddc.org) or fax them to 202.727.2132 (Attn: Online Intake) 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