[City of Stamford] Fair Rent Complaint Form

Fair Rent Complaint Form

Welcome to the Stamford Department of Health & Human Services, Division of Housing Services.

Please complete the below pre-screening form to help us prepare for how to best assist you!

Note: By filing this complaint, you are authorizing the City of Stamford to contact and request information from interested parties to assist in resolving your complaint or to answer your question(s). This form may be shared with others.

It is important to understand that part or all of your concerns documented in this form may not be something that can be resolved through the Stamford Department of Health & Human Services.

Complainant Information

Provide a phone number where we can contact you

Provide your E-mail

Landlord Information

Provide the Landlord's contact number:

Do you have a written lease?

Upload your lease agreement.

Click Here to Upload

Please provide the date when you lease is set to end.

How much is the monthly rent?

Is your rent paid up-to-date?

How many months are you currently behind?

What is the amount of the proposed rent increase?

Are there any new or proposed fee increase? (Example: Utilities, Parking, Amenities, Storage, etc.)

Prior to this increase, have the rent been increased before?

Prior to this increase, what was the total amount of the previous increase?

Have you discussed the changes in rental payments with the Landlord?

What reasons (if any) has the Landlord provided for the changes in rental payment?

How long have you lived at the current address?

Does the property have 5 or more apartment units?

What is the total amount of rooms in your apartment?

Number of Bedrooms

Number of Bathrooms

Do you have a basement or storage unit?

What is the total number of people currently living in the apartment?

How many children (ages 0 - 17) are currently living in the apartment?

How many adults (ages 18 - 61) are currently living in the apartment?

How many seniors (ages 62 & older) are currently living in the apartment?

How many people are currently employed that live in the apartment?

What is the total household income?

Please indicate how you described the household income?

Does the Landlord provide any of the following items?

Heat

Hot Water

Gas

Electricity

Stove

Refrigerator

Dishwasher

Air Conditioning

Washer/Dryer (In-Unit or Shared Laundry Room)

Parking/Garage

Garbage Removal

Just a few more questions

Has any City Department(s) inspected your apartment?

Provide City Department(s) who conducted an inspection of your apartment and when?

Are there any repairs that need to be addressed in your apartment?

Please be advised, complaints related to unaddressed repairs must be submitted separately.

Please visit Fix It Stamford to submit your Housing Complaint.

Provide the description of the repairs that need to be addressed in your apartment.

Have you informed the Landlord of the repairs needed in your apartment?

After informing your Landlord of the repairs needed, briefly describe the communication you received.

Please include any additional information you would like us to know.

Please upload any additional documentation that you would like us to review.

Click Here to Upload

By signing this form, you are acknowledging that the information provided in this form is truthful and up-to-date.

Please Note: During this process, you must continue to pay on-time and in the full amount of the monthly-rent due, prior to filing this complaint. Failure to pay your rent may result in the dismissal of your complaint, in addition to being subjected to eviction.

Complainant Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.