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Optional Contact Person (HUD-92006)

You have the right by law to name a family member, friend, or social, health, advocacy or other organization that we may contact to help resolve issues during your tenancy, or to help provide any special care or services you need. This is HUD form 92006.

Naming a contact is your choice. You do not have to, and it does not affect your application or your housing.
You can update, remove or change your contact at any time by sending this form again.
The information is confidential. It is kept in your file and not shared except as you allow or the law permits.

About you

Your full name

Your mailing address

Telephone

Cell phone

Do you want to name a contact? Yes, I want to name a contact person or organization. No, I choose not to provide contact information.

I am signing this form. The information above is true, and my typed name above is my signature.

This goes only to the SHA staff who handle it. See our Privacy Notice.

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Visit hud.gov for additional information.