How to Fill Out and Submit Form HUD-5383: Emergency Transfer Request

Form HUD-5383 is a short request you fill out and hand to your own housing provider to ask for an emergency move when you or a household member is a victim of domestic violence, dating violence, sexual assault, or stalking. To fill out Form HUD-5383, you enter names and household details, indicate how the provider can contact you safely, describe what a safe unit looks like for you, and sign the certification at the bottom. You do not need a police report, a court order, or anyone else’s signature to submit it.

Before You Start: Do You Qualify

You can use this form if you receive assistance under a covered HUD program and either reasonably believe you face a threat of imminent harm from further violence if you stay in your unit, or you are a victim of sexual assault that occurred on the premises within the 90 calendar days before your request.¹ The belief standard is your own assessment; you are not asked to prove the threat to a legal standard on the form itself. Either path also covers a household member who is the victim, so a parent can fill the form out for a child in the household.

Where to Get the Form

The HUD-5383 is a free fillable PDF on HUD’s website at hud.gov/sites/dfiles/OCHCO/documents/5383.pdf.² Your housing provider or Public Housing Agency is also required under VAWA to make it available on request, along with the companion Notice of VAWA Housing Rights (Form HUD-5380).³

Filling Out Each Field

The form runs three pages. Page one explains your rights and the eligibility standards; pages two and three hold the fields and the certification.

Fields 1 Through 7: Who You Are and Where You Live

Fields 1 through 4 collect names: the victim’s name, your own name if you are filling out the form for someone else, all other members of the household, and which of those household members will move with the victim. Field 5 asks for the perpetrator’s name. Provide it only if you know it and it is safe to share; leaving it blank does not disqualify your request. Fields 6 and 7 ask for the address you want to leave and the number of bedrooms in your current unit.²

Fields 8 and 9: Safe Contact Methods

Field 8 is where you tell the provider how to reach you safely. You can check phone, email, or mail, and for each you indicate whether it is safe to leave a voicemail, send an email, or send letters to the address on file. Take this field seriously. A perpetrator who monitors your phone or mailbox can intercept a call or letter about your transfer. Field 9 is an open space for anything else the provider should know about contacting you, such as safe hours, an alternate number, or a trusted person to route messages through.

Field 10: What a Safe Unit Looks Like for You

Field 10 lets you describe the housing features you need. The form gives checkboxes for a new neighborhood, a new building, a first-floor unit, a unit on the second floor or above, proximity to an exit, well-lit hallways, 24-hour security, and an accessible unit. There is also a free-text area to describe where it would be safe or unsafe for you to live and to list any accessibility needs. Checking these boxes gives your provider a starting point; it does not guarantee every feature, because the provider can only offer what is available.² You, not the provider, decide whether a unit offered to you is safe.

Signing the Certification

At the bottom, you sign a statement certifying that the information you provided is true and correct to the best of your knowledge and recollection, and that you meet the conditions to qualify for an emergency transfer. That is the only signature the form requires.

One point that trips people up: the HUD-5383 is a request with a built-in certification that you believe you qualify. It is not, by itself, proof that you are a victim. If your provider wants that proof, it will ask for it separately, in writing.²

Documentation Your Provider May Request Next

Not every provider asks for additional documentation, and some will act on the HUD-5383 alone. If yours does ask, the request must come in writing, and you get to choose which of the following you supply:

Form HUD-5382, a self-certification where you attest to the violence under penalty of perjury and name the perpetrator if safe. This is the simplest option and needs no one else’s involvement.
A signed statement from a victim service provider, attorney, medical professional, or mental health professional who has helped you. Both of you sign, and the professional declares under penalty of perjury that they believe the incident occurred and is covered by VAWA.
An official record such as a police report, court record, administrative agency record, or protective order.
Your own written statement or other evidence, if the provider chooses to accept it.

If the provider receives conflicting information about the incident, it can require third-party documentation instead of accepting the HUD-5382 self-certification on its own.² Whether documentation is requested at all depends on the agency’s own policies.⁴

How to Submit the Form

You submit the completed HUD-5383 to your housing provider or Public Housing Agency’s management office. Not to HUD.

Delivering it in person is the fastest option. Ask the staff member who takes it to give you a date-stamped copy so you have proof of the submission date if a dispute later comes up over timing. If going to the office is unsafe or impractical, send the form by certified mail with return receipt requested; the receipt records the exact date the provider took possession. Some agencies also accept documents through a secure online tenant portal, but availability varies.

Keep a copy of the completed form for yourself no matter which method you use. If you later need to escalate or contact HUD, having your own dated copy saves time.

What Happens After You Submit

Everything you disclosed on the form is confidential. Your provider must store the HUD-5383 separately from your regular tenant file and limit access to employees or agents specifically authorized to see it for a documented reason.⁵ Your new address, once you have one, must be kept strictly confidential and cannot be shared with anyone who committed or threatened violence against you. The provider cannot enter your information in a shared database or disclose it to outside parties unless you give written, time-limited consent, the disclosure is needed for an eviction hearing, or the law otherwise compels it.²

Federal regulations do not set a specific number of days by which the provider must approve or deny your request. They do require providers to treat these as emergencies and to prioritize VAWA transfer requests over other transfer requests.⁶ Actual speed depends on unit availability and each provider’s internal policies, which are laid out in a written Emergency Transfer Plan every covered provider must adopt.¹ If you feel your request is stalling, ask for a copy of that plan; it should describe the agency’s own timelines and how it prioritizes VAWA transfers. You can stay in your current unit while the request is being processed.

If a safe unit is immediately available at the same property or under the same housing authority, the provider must offer an internal transfer, and you keep your tenant status without a new application. If no internal unit is available, the plan describes how the provider will help you pursue an external transfer to a different housing provider, where you go through a new application at the receiving agency.

Which Housing Programs the Form Covers

The HUD-5383 works if your assistance comes through a VAWA-covered HUD program. That includes Public Housing, Housing Choice Vouchers (tenant-based and project-based Section 8), Section 8 Moderate Rehabilitation, Continuum of Care, Emergency Solutions Grants, HOME, HOPWA, the Housing Trust Fund, Section 202, Section 811, and Section 236 multifamily assistance.⁷ Tenants in housing that does not receive federal HUD assistance are not covered by these specific protections, though state or local laws may provide separate remedies.

1
eCFR. 24 CFR 5.2005 – VAWA Protections
2
U.S. Department of Housing and Urban Development. Emergency Transfer Request for Victims of Domestic Violence, Dating Violence, Sexual Assault, or Stalking
3
U.S. Department of Housing and Urban Development. Violence Against Women Act
4
HUD Exchange. What Are Some Forms of Documentation Used to Verify Eligibility for Protection Under VAWA
5
eCFR. 24 CFR 5.2007 – Documenting the Occurrence of Domestic Violence, Dating Violence, Sexual Assault, or Stalking
6
HUD Exchange. Do Violence Against Women Act Transfers Take Priority Over All Other Transfers
7
HUD Exchange. Violence Against Women Act Covered Housing