You must have JavaScript enabled to use this form. Landlord / Property Owner Name Landlord Email Address Claim Type Damages Rental Assistance Property Management Company or Owner Name Property Address Address Address 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Property County Tenant Name Tenant Phone Number Tenant HMIS ID Amount of Claim Documentation Attach the following documentation as files: Signed Move-In Condition Checklist Signed Lease Agreement Tenant Ledger Showing Unpaid Balance Repair Invoices or Receipts Before/After Photos of Damages (if applicable) Completed Risk Mitigation Claim Invoice Unlimited number of files can be uploaded to this field.256 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Leave this field blank