Form CIS-H. "Housing/Real Estate Transaction Complainant Information Sheet" - Illinois

What Is Form CIS-H.?

This is a legal form that was released by the Illinois Department of Human Rights - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 6, 2017;
  • The latest edition provided by the Illinois Department of Human Rights;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CIS-H. by clicking the link below or browse more documents and templates provided by the Illinois Department of Human Rights.

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Download Form CIS-H. "Housing/Real Estate Transaction Complainant Information Sheet" - Illinois

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HOUSING/REAL ESTATE TRANSACTION COMPLAINANT INFORMATION SHEET
State of Illinois
Department of Human Rights
(For IDHR Use Only) CONTROL NUMBER:
Instructions: Read this entire form and all the instructions carefully before completing. All questions should be answered. However, if you do not
know the answer or if a question is not applicable, leave the question unanswered and fill out as much of the form as you can. Return the form in person, by
mail or fax to IDHR's Chicago Office. You have one year from the date of the alleged discrimination to file a charge, but it's best to file as soon as possible.
The form should be signed and dated below. Use additional sheets if necessary. THIS IS NOT A CHARGE. If IDHR accepts your claim, we will send you a
charge form for signature.
Complainant Information:
Name of Aggrieved Person(s) or Organization:
Telephone No.
Address:
Apt. No.
City, State, ZIP
County:
Cell Phone No.:
E-mail Address:
Who else can we call if we cannot reach you?
First Contact's Name:
Daytime Phone:
Address, City, State, ZIP:
Second Contact's Name:
Daytime Phone:
Address, City, State, ZIP:
1a. What happened to you? Check all that apply.
Refused an opportunity to rent or buy housing or told housing was not available when it was.
Discriminated against in broker's services.
Refused a request to accommodate policies or practices or modify housing because of a disability.
Treated differently than others seeking housing.
Discriminated against in the terms or conditions of sale, rental occupancy, or in services or facilities.
Denied a loan.
Discriminated against in financing of a home or commercial property.
Intimidated/interfered/coerced in the exercise of my housing rights.
Other (explain)
1b. State briefly what happened.
(Attach an additional page if necessary.)
2a. On what date did the last act of discrimination occur?
2b. Is the action on going?
Yes
No
Protected classes: It is a violation of the Illinois Human Rights Act to deny a person housing rights because of any of the following protected classes: race;
color; religion; sex (including sexual harassment); pregnancy, national origin; familial status (families with children under 18); disability; aiding/abetting; willful
interference and coercion; military status; unfavorable military discharge; retaliation; marital status; ancestry; age (40 and over); sexual orientation (including
gender identity); and order of protection status.
3. Why do you believe you are being discriminated against?
For example: were you denied housing because of your race? Were you denied a mortgage loan
because of your religion? Or turned down for an apartment because you have children? Were you harassed because you assisted someone in obtaining their fair housing rights? Briefly explain
why you think your housing rights were denied because of any of the protected classes listed above.
CONTINUED ON PAGE 2
CIS-H. 1/6/2017
100 W Randolph St, 10th Floor, Attn: Housing Intake, Chicago, IL 60601; 312-814-6229; 866-740-3953 (TTY); INTERVIEWS MON.-THURS.
In Springfield: 222 South College, Room 101-A, Attn: Housing Intake, Springfield, IL 62704; 217-785-5100; 866-740-3953 (TTY)
www.illinois.gov/dhr TOLL FREE: 800-662-3942 CHICAGO FAX NO. 312-814-6251
SPRINGFIELD FAX NO. 217-785-5106
HOUSING/REAL ESTATE TRANSACTION COMPLAINANT INFORMATION SHEET
State of Illinois
Department of Human Rights
(For IDHR Use Only) CONTROL NUMBER:
Instructions: Read this entire form and all the instructions carefully before completing. All questions should be answered. However, if you do not
know the answer or if a question is not applicable, leave the question unanswered and fill out as much of the form as you can. Return the form in person, by
mail or fax to IDHR's Chicago Office. You have one year from the date of the alleged discrimination to file a charge, but it's best to file as soon as possible.
The form should be signed and dated below. Use additional sheets if necessary. THIS IS NOT A CHARGE. If IDHR accepts your claim, we will send you a
charge form for signature.
Complainant Information:
Name of Aggrieved Person(s) or Organization:
Telephone No.
Address:
Apt. No.
City, State, ZIP
County:
Cell Phone No.:
E-mail Address:
Who else can we call if we cannot reach you?
First Contact's Name:
Daytime Phone:
Address, City, State, ZIP:
Second Contact's Name:
Daytime Phone:
Address, City, State, ZIP:
1a. What happened to you? Check all that apply.
Refused an opportunity to rent or buy housing or told housing was not available when it was.
Discriminated against in broker's services.
Refused a request to accommodate policies or practices or modify housing because of a disability.
Treated differently than others seeking housing.
Discriminated against in the terms or conditions of sale, rental occupancy, or in services or facilities.
Denied a loan.
Discriminated against in financing of a home or commercial property.
Intimidated/interfered/coerced in the exercise of my housing rights.
Other (explain)
1b. State briefly what happened.
(Attach an additional page if necessary.)
2a. On what date did the last act of discrimination occur?
2b. Is the action on going?
Yes
No
Protected classes: It is a violation of the Illinois Human Rights Act to deny a person housing rights because of any of the following protected classes: race;
color; religion; sex (including sexual harassment); pregnancy, national origin; familial status (families with children under 18); disability; aiding/abetting; willful
interference and coercion; military status; unfavorable military discharge; retaliation; marital status; ancestry; age (40 and over); sexual orientation (including
gender identity); and order of protection status.
3. Why do you believe you are being discriminated against?
For example: were you denied housing because of your race? Were you denied a mortgage loan
because of your religion? Or turned down for an apartment because you have children? Were you harassed because you assisted someone in obtaining their fair housing rights? Briefly explain
why you think your housing rights were denied because of any of the protected classes listed above.
CONTINUED ON PAGE 2
CIS-H. 1/6/2017
100 W Randolph St, 10th Floor, Attn: Housing Intake, Chicago, IL 60601; 312-814-6229; 866-740-3953 (TTY); INTERVIEWS MON.-THURS.
In Springfield: 222 South College, Room 101-A, Attn: Housing Intake, Springfield, IL 62704; 217-785-5100; 866-740-3953 (TTY)
www.illinois.gov/dhr TOLL FREE: 800-662-3942 CHICAGO FAX NO. 312-814-6251
SPRINGFIELD FAX NO. 217-785-5106
HOUSING COMPLAINANT INFORMATION SHEET
Illinois Department of Human Rights
4a. Who do you believe discriminated against you?
Name:
Phone No.:
Address, City, State, ZIP:
4b. Mark the applicable box that describes the person named above:
Landlord
Owner
Bank or Other Lender
Real Estate Agent
Broker Other:
5a. What kind of house, rental unit or property was involved?
Check the appropriate box(es):
Single family home
Apartment building of more than 4 units
Owner lives on the property
Public or assisted housing
Vacant land
Mobile home park
Commercial space
Other
(specify):
Number of units on the property:
5b. What is the address of the house, rental unit, or property?
Address:
Apt. No.:
City, State, ZIP:
County:
Is the property still available?
Yes
No
Unknown
6. We need some information for statistical purposes:
Sex:
Date of birth (age cases only):
National Origin (specify):
How did you learn of our office?
7. Have you filed a charge with any other agency?
If so, which agency?
CONSENT AGREEMENT AND RELEASE
I have read the provided “Notice to Complainant” and I understand that: 1) In the course of investigating my charge, IDHR will reveal my identity (including my
name) and my personal information to named Respondent(s) in my charge to obtain facts and evidence regarding my charge; 2) I do not have to reveal my
personal information to IDHR, but IDHR may close my charge if I refuse to reveal information needed to fully investigate my charge; 3) IDHR may be required
by law, subpoena, court order, and/or FOIA request to disclose my charge and information in the Department's investigation file concerning my charge to
persons outside of IDHR.
If IDHR takes a charge based on the information provided, I consent for IDHR to disclose my identity and personal information as necessary to process and
investigate my charge, and I release IDHR from any liability whatsoever concerning disclosure of my identity and any personal information I provided to IDHR
or IDHR obtained in processing my charge.
My signature below verifies the accuracy of the information provided herein and my consent and release as indicated above.
Print Name
Signature
Date
NOTE: If there is certain personal information you would like withheld, please discuss your concern with an Intake supervisor.
CIS-H 1/6/2017
HOUSING COMPLAINANT INFORMATION SHEET
Illinois Department of Human Rights
IDHR Notice of Accessibility
IDHR's programs are accessible to persons with disabilities in compliance with the ADA and Sec. 504 of the Rehabilitation Act of 1973. IDHR provides sign
language interpreters upon request. A person with a disability needing an accommodation to participate in IDHR programs should contact the ADA
Coordinator at 312-814-6262, 312-814-1436 (fax), 866-740-3953 (TTY) or e-mail IDHR.ADA@illinois.gov.
Notice to complainant on release of identity and personal information
The Illinois Human Rights Act (“Act”), 775 ILCS 5/1-101 et seq., and Section 2520.330 of IDHR's Rules and Regulations, 56 Ill. Admin. Code, Ch. II, Section
2520.330, require a charge to contain certain information in such detail as to substantially apprise the parties of the time, place, and facts with respect to the
alleged civil rights violation. Pursuant to the Department's Rules and Regulations (2 Ill. Admin Code, Ch. X, Section 926.210), anyone who submits
information to IDHR in connection with a discrimination charge should take notice and be aware of the following:
(a) All contents and files maintained by IDHR pertaining to charges shall be confidential and not subject to public disclosure. Relevant exceptions are: 1) the
parties to a charge may inspect the file at any time subsequent to the written notice of substantial evidence, default, or dismissal, administrative closure,
or approval of terms of settlement by the Human Rights Commission (“Commission”); 2) after the filing of a Complaint with the Commission or the
institution of judicial proceedings involving a charge, the Director may release information pertaining to the charge if such information is requested of
IDHR or if the Director finds such information newsworthy, useful in education or training, relevant to an issue before the General Assembly, or similarly
appropriate for disclosure.
(b) Authorized personnel within IDHR analyze information that IDHR collects. This information may include personal information. IDHR staff may need to
reveal some of the personal information to individuals outside the office in order to verify facts related to the charge, or to discover new facts which will
help IDHR to determine whether the law has been violated. IDHR may need to disclose to Respondent correspondence that IDHR receives from
Complainant or other sources.
(c) IDHR may release the identity and personal information of the parties pursuant to a Freedom of Information Act (“FOIA”) request, a subpoena or a court
order, and information submitted to or obtained by IDHR may also be revealed to persons outside of IDHR to enforce a Commission Order or a
settlement agreement.
(d) No person is required to file a charge with IDHR and reveal personal information to IDHR; however, if a person files a charge and IDHR cannot obtain
the information needed to fully investigate the allegations in the charge, IDHR may close the case.
The Cooper v. Salazar injunction
IDHR is under a federal-court injunction that, among other things, orders IDHR:
“to cease permanently from relying on credibility determinations made without affording the rights of confrontation and cross-examination”.
See, Cooper v. Salazar, #98 C 2930, U.S. District Court for the Northern District of Illinois, Order dated November 1, 2001, at p. 26, ¶1.
Meaning of the Cooper Injunction
The Department cannot assess the credibility of Complainant's testimony, the testimony of Complainant's witnesses or the testimony of Respondent's
representatives or the witnesses of Respondent where there is conflicting testimony. In other words, if the determination of substantial evidence turns on
issues of credibility, the Department should make a finding of substantial evidence so that a trier of fact may resolve those issues of credibility. This means
that if a determination of lack of substantial evidence requires the Department to make a finding of fact as to conflicting evidence, the Department will make a
finding of substantial evidence so that credibility may be resolved by the Human Rights Commission at a Public Hearing or in circuit court.
The Illinois Human Rights Act defines “substantial evidence” as:
“evidence which a reasonable mind accepts as sufficient to support a particular conclusion and which consists of more than a mere scintilla but may
be somewhat less than a preponderance”. Illinois Human Rights Act §7A-102(D)(2), codified at 775 ILCS 5/7A-102(D)(2).
The Meaning of Credibility
IDHR is an investigatory agency. IDHR's purpose is to gather all of the evidence from each of the parties as to whether Respondent may or may not have
discriminated against the Complainant within the meaning of the Illinois Human Rights Act. IDHR's purpose is to review all of the evidence and make a
determination based upon the law as to whether there is sufficient evidence of discrimination to file a complaint against the Respondent with the Illinois
Human Rights Commission. IDHR will not make a finding that evidence submitted by a party is either believable or not believable. Thus, IDHR will not base
its findings on the fact that one of the parties is not telling the truth or that one party's evidence is not believable. If the resolution of the charge of
discrimination requires believing the evidence of one party over another party, IDHR will make a finding of Substantial Evidence and refer the matter to the
Illinois Human Rights Commission so that a trier of fact may resolve the case.
Conflicting evidence exists when there are
1.
Statements of a person with material first hand knowledge contradicted by statements of a different person with material first hand knowledge.
2.
Business records contradicted by oral statements of a person with material first hand knowledge.
3.
Business records of one person contradicted by business records of another person.
CIS-H 1/6/2017
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