X-VAWA Emergency Transfer

City of Chandler — Regular Meeting (2025-03-24)

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Revised 7/1/2025 
 
 
 
 
City of Chandler Housing and Redevelopment Division 
 
EMERGENCY TRANSFER PLAN  
FOR VICTIM OF DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, OR 
STALKING 
 
Public Housing Program 
 
Emergency Transfers 
The City of Chandler Housing and Redevelopment Division (COCHRD) is concerned about the safety of its 
tenants, and such concern extends to tenants who are victims of domestic violence, dating violence, sexual 
assault, or stalking. In accordance with the Violence Against Women Act (VAWA), COCHRD allows tenants 
who are victims of domestic violence, dating violence, sexual assault, or stalking to request an emergency 
transfer from the tenant’s current unit to another unit. The ability to request a transfer is available regardless 
of sex, gender identity, or sexual orientation.  The ability of COCHRD to honor such request for tenants 
currently receiving assistance, however, may depend upon a preliminary determination that the tenant is or 
has been a victim of domestic violence, dating violence, sexual assault, or stalking, and on whether COCHRD 
has another dwelling unit that is available and is safe to offer the tenant for temporary or more permanent 
occupancy.  
 
This plan identifies tenants who are eligible for an emergency transfer, the documentation needed to 
request an emergency transfer, confidentiality protections, how an emergency transfer may occur, and 
guidance to tenants on safety and security. This plan is based on a model emergency transfer plan published 
by the U.S. Department of Housing and Urban Development (HUD), the federal agency that oversees that the 
public housing and housing choice voucher (HCV) programs are in compliance with VAWA. 
 
Eligibility for Emergency Transfers 
A tenant who is a victim of domestic violence, dating violence, sexual assault, or stalking, as provided in HUD’s 
regulations at 24 CFR part 5, subpart L, is eligible for an emergency transfer if the tenant reasonably believes 
that there is a threat of imminent harm from further violence if the tenant remains within the same unit. If 
the tenant is a victim of sexual assault, the tenant may also be eligible to transfer if the sexual assault 
occurred on the premises within the 90-calendar- day period preceding a request for an emergency transfer. 
 
A tenant requesting an emergency transfer must expressly request the transfer in accordance with the 
procedures described in this plan. 
 
Tenants who are not in good standing may still request an emergency transfer if they meet the eligibility 
requirements in this section.

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Revised 7/1/2025 
 
Emergency Transfer Request Documentation 
To request an emergency transfer, the tenant shall notify the PHA’s management office and submit a written 
request for a transfer to any PHA office. The PHA will provide reasonable accommodations to this policy for 
individuals with disabilities. The tenant’s written request for an emergency transfer should include either: 
 
1.   A statement expressing that the tenant reasonably believes that there is a threat of imminent 
harm from further violence if the tenant were to remain in the same dwelling unit assisted under 
the PHA’s program; OR 
2.   A statement that the tenant was a sexual assault victim and that the sexual assault occurred 
on the premises during the 90-calendar-day period preceding the tenant’s request for an 
emergency transfer. 
 
Confidentiality 
The PHA will keep confidential any information that the tenant submits in requesting an emergency transfer, 
and information about the emergency transfer, unless the tenant gives the PHA written permission to release 
the information on a time-limited basis, or disclosure of the information is required by law or required for use 
in an eviction proceeding or hearing regarding termination of assistance from the covered program. This 
includes keeping confidential the new location of the dwelling unit of the tenant, if one is provided, from the 
person or persons that committed an act of domestic violence, dating violence, sexual assault, or stalking 
against the tenant. See the Notice of Occupancy Rights under the Violence against Women Act for All Tenants 
for more information about the PHA’s responsibility to maintain the confidentiality of information related to 
incidents of domestic violence, dating violence, sexual assault, or stalking. 
 
Emergency Transfer Timing and Availability 
The PHA cannot guarantee that a transfer request will be approved or how long it will take to process a 
transfer request. The PHA will, however, act as quickly as possible to move a tenant who is a victim of 
domestic violence, dating violence, sexual assault, or stalking to another unit, subject to availability and safety 
of a unit. If a tenant reasonably believes a proposed transfer would not be safe, the tenant may request a 
transfer to a different unit. If a unit is available, the transferred tenant must agree to abide by the terms and 
conditions that govern occupancy in the unit to which the tenant has been transferred. The PHA may be 
unable to transfer a tenant to a particular unit if the tenant has not or cannot establish eligibility for that unit. 
 
If the PHA has no safe and available units for which a tenant who needs an emergency transfer is eligible, the 
PHA will assist the tenant in identifying other housing providers who may have safe and available units to 
which the tenant could move. At the tenant’s request, the PHA will also assist tenants in contacting the local 
organizations offering assistance to victims of domestic violence, dating violence, sexual assault, or stalking 
that are attached to this plan. 
 
Emergency Transfers: Public Housing (PH) Program  
If you are a public housing resident and request an emergency transfer as described in this plan, the PHA will 
attempt to assist you in moving to a safe unit quickly. The PHA will make exceptions as required to policies 
restricting moves. 
Emergency transfers for which you are not required to apply for assistance include the following: 
• 
Public housing unit in a different development 
• 
Public housing unit in the same development, if you determine that the unit is safe 
At your request, the PHA will refer you to organizations that may be able to further assist you.

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Revised 7/1/2025 
 
You may also request an emergency transfer to the following programs for which you are required to apply 
for assistance: 
• 
HCV tenant-based program 
• 
HCV project-based assistance 
• 
Other programs administered by the PHA (such as state housing programs) 
Emergency transfers will not take priority over waiting list admissions for these types of assistance. At your 
request, the PHA will refer you to organizations that may be able to further assist you. 
Safety and Security of Tenants 
Pending processing of the transfer and the actual transfer, if it is approved and occurs, the tenant is urged to 
take all reasonable precautions to be safe. 
Tenants who are or have been victims of domestic violence are encouraged to contact the National Domestic 
Violence Hotline at 1-800-799-7233, or a local domestic violence shelter, for assistance in creating a safety 
plan. For persons with hearing impairments, that hotline can be accessed by calling 1-800-787-3224 (TTY). 
Tenants who have been victims of sexual assault may call the Rape, Abuse, and Incest National Network’s 
National Sexual Assault Hotline at 1-800-656-HOPE, or visit the online hotline at https://ohl.rainn.org/online/. 
Tenants who are or have been victims of stalking seeking help may visit the National Center for Victims of 
Crime’s Stalking Resource Center at https://www.victimsofcrime.org/our-programs/stalking-resource-center.

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Form HUD-5383 
 
U.S. Department of Housing and Urban Development 
OMB Approval No. 2577-0286 
Exp. 1/31/2028 
EMERGENCY TRANSFER REQUEST FOR VICTIMS OF 
DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING 
Confidentiality Note: Any personal information you share in this form will be maintained by your covered housing 
provider according to the confidentiality provisions below. 
Purpose of Form: If you are a tenant of housing assisted under a covered housing program, or if you are receiving 
transitional housing or rental assistance under a covered housing program, you may use this form to request an 
emergency transfer and certify that you qualify for an emergency transfer under the Violence Against Women Act 
(“VAWA”). This form refers to domestic violence, dating violence, sexual assault, or stalking as “VAWA 
violence/abuse.” 
VAWA PROTECTS INDIVIDUALS AND FAMILIES REGARDLESS OF A VICTIM’S AGE OR ACTUAL 
OR PERCEIVED SEXUAL ORIENTATION, GENDER IDENTITY, SEX, OR MARITAL STATUS. 
You may request an emergency transfer when: 
1. You (or a household member) are a victim of VAWA violence/abuse; 
2. You expressly request the emergency transfer; AND 
3. EITHER 
a. you reasonably believe that there is a threat of imminent harm from further violence, including 
trauma, if you (or a household member) stay in the same dwelling unit; or 
b. if you (or a household member) are a victim of sexual assault, either you reasonably believe 
there is a threat of imminent harm from further violence, including trauma, if you (or a 
household member) stay in the unit, or the sexual assault occurred on the premises and you 
request an emergency transfer within 90 days (including holidays and weekend days) of when 
that assault occurred. 
A covered housing provider, in response to an emergency transfer request, should not evaluate whether you 
are in good standing as part of the assessment or provision of an emergency transfer.  Whether or not you are 
in good standing does not impact your ability to request an emergency transfer under VAWA. 
However, submitting this form does not necessarily mean that you will receive an emergency transfer. See 
your covered housing provider’s VAWA Emergency Transfer Plan for more information about VAWA 
emergency transfers and see “Notice of Occupancy Rights Under the Violence Against Women Act,” Form 
HUD-5380, for additional housing rights you may be entitled to. 
Am I required to submit any documentation to my covered housing provider? Your covered housing 
provider may request documentation proving that you, or a household member, are a victim of VAWA 
violence/abuse, in addition to completing this emergency transfer request form. The request can be met by 
completing and submitting the VAWA Self-certification Form (Form HUD-5382), unless the covered 
housing provider receives conflicting information about the VAWA violence/abuse. If you have third-party 
documentation that demonstrates why you are eligible for an emergency transfer, you may, instead, choose 
to submit that documentation to your covered housing provider. See “Notice of Occupancy Rights Under the 
Violence Against Women Act,” Form HUD-5380, for more information. 
Will my information be kept confidential? Whenever you ask for or about VAWA protections, your 
covered housing provider must keep any information you provide about the VAWA violence/abuse or the 
fact you (or a household member) are a victim, including the information on this form, strictly confidential. 
This information should be securely and separately kept from your other tenant files. This information can

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Form HUD-5383 
 
only be accessed by an employee/agent of your covered housing provider if (1) access is required for a 
specific reason, (2) your covered housing provider explicitly authorizes that person’s access for that reason, 
and (3) the authorization complies with applicable law. This information will not be given to anyone else or 
put in a database shared with anyone else, unless your covered housing provider (1) gets your written 
permission to do so for a limited time, (2) is required to do so as part of an eviction or termination hearing, 
or (3) is required to do so by law. 
In  addition, your covered housing provider must keep your address strictly confidential to ensure that it is 
not disclosed to a person who committed or threatened to commit VAWA violence/abuse against you (or a 
household member).  
 
What if I need this information in a language other than English?  To read this in Spanish or another language, 
please contact the City of Chandler Housing 480-782-3200. You can read translated VAWA forms at  
https://www.hud.gov/program_offices/administration/hudclips/forms/hud5a#4. If you speak or read in a language other 
than English, your covered housing provider must give you language assistance regarding your VAWA protections (for 
example, oral interpretation and/or written translation). 
 
Can I request a reasonable accommodation? If you have a disability, your covered housing provider must provide 
reasonable accommodations to rules, policies, practices, or services that may be necessary to allow you to equally 
benefit from VAWA protections (for example, giving you more time to submit documents or assistance with filling out 
forms). You may request a reasonable accommodation at any time, even for the first time during an eviction. If a 
provider is denying a specific reasonable accommodation because it is not reasonable, your covered housing provider 
must first engage in the interactive process with you to identify possible alternative accommodations. Your covered 
housing provider must also ensure effective communication with individuals with disabilities. 
 
Need further help? For additional information on VAWA and to find help in your area, visit    
https://www.hud.gove/vawa . To speak with a housing advocate, contact 
 
TO BE COMPLETED BY OR ON BEHALF OF THE TENANT REQUESTING AN EMERGENCY TRANSFER 
 
1. Name(s) of victim(s): __________________________________________________ 
 
2. Your name (if different from victim’s): ______________________________________ 
 
3.  Name (s)  of other household members(s): 
_______________________________________________________________________________________
_______________________________________________________________________________________ 
 
4.  Name(s) of other household members (s) who would transfer with the victim: 
_______________________________________________________________________________________
_______________________________________________________________________________________ 
 
5. Name of the perpetrator (if know and can be safely disclosed): __________________________________ 
 
6. Address of location from which the victim seeks to transfer: 
_____________________________________________________________________________________ 
 
7. Current Unit Size (# of bedrooms): ________________

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Form HUD-5383 
 
 
8. What is the safest and most secure way to contact you? (You may choose more than one).  
If any contact information changes or is no longer a safe contact method, notify your covered housing provider. 
Phone Phone Number:   
 
 
 
Safe to receive a voicemail: 
Yes 
No 
 
E-mail 
E-mail Address:  
 
 
 
Safe to receive an email: 
Yes 
No 
 
Mail 
Mailing Address:  
 
 
 
Safe to receive mail from your housing provider: 
Yes 
No 
 
Other 
Please List:  
 
 
 
9. Anything else your housing provider should know to safely communicate with you? 
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________ 
10.  What features are requested for a safe unit? You may list here any information that would facilitate a suitable 
transfer, such as accessibility needs, and a description of where it is safe or unsafe for you to live. 
(Please note that the ability to provide an emergency transfer is based on unit availability.) 
New Neighborhood 
First Floor unit 
Near an Exit 
24-hour Security 
 Other: 
_______________ 
New Building 
Second Floor unit (and above) 
Well-lit hallways/walkways 
Accessible unit

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Form HUD-5383 
 
 
11. To approve your request for an emergency transfer, your covered housing provider may require that you provide 
written documentation that you (or a household member) are a victim of VAWA violence/abuse. Your covered 
housing provider must make this request for documentation in writing. You can choose to submit any one of the 
following types of documentation: 
• 
 Form HUD-5382 Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking, and 
Alternate Documentation, which asks your name and the perpetrator’s name (if known and safe to 
provide); 
• 
A document signed by a victim service provider, attorney, mental health professional, or medical 
professional who has helped you address the VAWA violence/abuse. The professional must state “under 
penalty of perjury” that he/she/they believe in the occurrence of the incident of VAWA violence/abuse and 
that it is covered by VAWA. Both you and the professional must sign the statement; 
• 
A police, administrative, or court record (such as a protective order) that shows you (or a household 
member) are a victim of VAWA violence/abuse; OR 
• 
If permitted by your covered housing provider, a statement or other evidence provided by you. 
 
Certification of Tenant: By signing below, I am certifying that the information provided on this form 
is true and correct to the best of my knowledge and recollection, and that I meet the conditions 
described on this form to qualify for an emergency transfer. 
Signature ___________________________ 
 
Date ________________ 
 
Public reporting burden for this collection of information is estimated to average 20 minutes per response. This includes the time for collecting, reviewing, and 
reporting. Comments concerning the accuracy of this burden estimate and any suggestions for reducing this burden can be sent to the Reports Management 
Officer, QDAM, Department of Housing and Urban Development, 451 7th Street, SW, Washington, DC 20410. Covered housing providers in programs covered by 
VAWA may ask for a written request for an emergency transfer for a tenant who is a victim of domestic violence, dating violence, sexual assault, or stalking. 
Housing providers may distribute this form to tenants and tenants may use it to request an emergency transfer. The information is subject to the confidentiality 
requirements of VAWA. A Federal agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid 
Office of Management and Budget control number.