Fair Housing Monitoring Form

Grantee:  	

Grant Number:  	

Prepared by:  	

Date Prepared:  	

		Comments	

1.	
When was Fair Housing Plan approved by Compliance?		

2.	
List proposed activities and scheduled date of completion per the approved plan:	
	
Activity	
Date Implemented	
Cost of Activity	

3.	
Have all activities scheduled as of the monitoring visit been completed as proposed in the plan?	
Yes	
No	
If not, list incomplete activities:	

4.	
Does the plan specify the name or position and TDD number of the local official responsible for fair housing complaints and conducting follow- up action?	
Yes	
No	

Name: Position:	
Record Keeping	

5.	
Has the grantee completed their Analysis of
Impediments?	Yes	No		
		N/A		

6.	
Does the grantee have records in their files documenting their Analysis of Impediments to fair housing choice in their community?
		
Yes	
No		

7.	
What were the actions proposed in their Analysis of Impediments and what has been accomplished to date?		
Complaint Procedures	

8.	
Has the grantee publicized within its corporate limits the name, location, and TDD number of the local official responsible for fair housing complaints?	
Yes	
No		
	
Newspaper Name: Date Publicized:		

9.	
Have any fair housing complaints been received by the grantee?	Yes	No		
	
If yes, was the complaint responded to within ten (10) days?	
Yes	
No		
	
Describe efforts to resolve the complaint:	

_________________________________________	        _______________________
Grantee Representative				                    Date

____________________________________	         ___________________
Grant Management Representative			          Date