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HousingOfficial formconditional

VAWA self-certification and alternate documentation

Official owner U.S. Department of Housing and Urban Development

HUD's optional self-certification is one permitted response when a covered housing provider makes a written request for documentation of domestic violence, dating violence, sexual assault, or stalking.

What problem this helps solve

HUD's optional self-certification is one permitted response when a covered housing provider makes a written request for documentation of domestic violence, dating violence, sexual assault, or stalking.

Who completes it: The applicant or tenant seeking VAWA protections in a covered housing program; a helper may assist.

What this does not prove

The form describes at least 14 business days to respond to a provider's written request, subject to the request and any extension. Keep victim information private and use a safe submission route.

Dated source check

Official destination checked

The official three-page HUD PDF was retrieved September 30, 2026. The displayed OMB expiration January 31, 2028 is not a revision date.

Last checked Sep 30, 2026. A working link does not establish the current edition, suitability, agency acceptance, or service availability.

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Direct document

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Use the official pathway

NOLO's preparation notes summarize the dated sources in this record. Follow the agency's official instructions and current edition when they differ.

1. Check that this route fits

Stage and purpose
Respond to a written VAWA documentation request.
Who completes it
The applicant or tenant seeking VAWA protections in a covered housing program; a helper may assist.
Jurisdiction
Covered housing programs; confirm the provider and program
Application mode
Paper self-certification or permitted alternate documentation to the covered provider

2. Prepare before starting

  • Confirm the housing program is covered.
  • Read the provider's written request and deadline.
  • Choose safe contact and submission arrangements.

Documents named by the source

  • The form describes self-certification and permitted alternate documentation; a police report is not universally required.
  • Read the provider's written request for the applicable response deadline and any extension.
Fees and fee waivers
UNKNOWN; ask the receiving agency.
Account
No universal online-account requirement is stated.
Appointment
UNKNOWN; ask the covered provider for a safe route.
Signature
The applicant or tenant certifies, signs, and dates the official form.
Third-party certification or assessment
The applicant or tenant signs and dates the certification on the official form.

3. Follow official submission instructions

Read official instructions
  • Respond to the covered provider's written documentation request using its safe submission instructions.

4. Get help or an accommodation

Languages: English source observed; other versions UNKNOWN.

Accessibility: The form explains language assistance and reasonable accommodations, including additional time and help completing the form. Ask the covered provider.

5. Know the supported next step

  • Keep a safe copy and confirmation of receipt.
  • Read the provider's decision and any next housing step.

Restrictions and unresolved details

  • The form is optional and alternate documentation is permitted.
  • The provider controls the case-specific written request; NOLO does not determine eligibility or deadlines.

The form describes at least 14 business days to respond to a provider's written request, subject to the request and any extension. Keep victim information private and use a safe submission route.

PDF filling support

PDF with fillable fields. Checked 2026-10-05. Signature support and agency acceptance still need confirmation.

Continue with your journey

Return to the connected step to decide what to do next. Opening this record does not complete that step or submit an application. If the official route is unavailable, use the assistance options above or browse help in the journey.

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Form record

Adds to a private plan in this browser tab. Nothing is sent to the provider, and nothing is applied for.

Official title
VAWA self-certification and alternate documentation
Form number
HUD-5382
Program
VAWA protections in covered housing
Jurisdiction
Covered housing programs; confirm the provider and program
Revision / edition
Unknown
Who completes it
The applicant or tenant seeking VAWA protections in a covered housing program; a helper may assist.
Signature
The applicant or tenant certifies, signs, and dates the official form.
Submission methods
Respond to the covered provider's written documentation request using its safe submission instructions.
Supporting documents
  • • The form describes self-certification and permitted alternate documentation; a police report is not universally required.
  • • Read the provider's written request for the applicable response deadline and any extension.
Languages
English source observed; other versions UNKNOWN.
Accessibility
The form explains language assistance and reasonable accommodations, including additional time and help completing the form. Ask the covered provider.

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  • • If a page asks for payment unexpectedly, stop and confirm the fee with the agency.

Source note: The form describes at least 14 business days to respond to a provider's written request, subject to the request and any extension. Keep victim information private and use a safe submission route.

NOLO does not process this form, receive your answers, decide eligibility, or represent the agency. A destination check does not confirm current funding, acceptance, or an outcome.

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