4.1.5 Required Documentation

Under VAWA, a survivor of domestic violence may provide as documentation within 14 days of a request any one of the following:

• A completed HUD Certification of Domestic Violence form, currently HUD Form 5382
• A document signed by the survivor and an employee, agent, or volunteer of a victim service provider, an attorney, or medical professional, or a mental health professional that specifies under penalty of perjury that the professional believes the incident or incidents of domestic violence, dating violence, sexual assault, or stalking occurred and meet the definition of “domestic violence,” “dating violence,” “sexual assault,” or “stalking” in HUD’s regulations at 24 C.F.R. § 5.2003
• A record of a federal, state, tribal, territorial or local law enforcement agency, court, or administrative agency
• At the discretion of the housing provider, a statement or other evidence provided by the applicant or tenant1

HUD Form 5383 can be used for an emergency transfer request under VAWA.

• 134 U.S.C. § 12491(c); 24 C.F.R. § 5.2007(b).