Housing Authority Accessibility Needs Survey

HAPGC requests that you complete this survey. This survey is voluntary and will not affect your tenancy, eligibility, or participation in any of HAPGC’s programs. HAPGC may contact you to see if housing improvements or modifications are needed.

If you have questions about this survey or need help understanding or filling out this form because of a disability, contact:

504 Coordinator
The Housing Authority of Prince George's County
9200 Basil Court, Suite #500
Largo, MD 20774
Phone: 301-883-5576
For deaf or hard of hearing contact 301-883-5576 through Relay Service at 7-1-1
Email: DHCD-504@co.pg.md.us

You can submit this survey online or select print at the end. Printed surveys should be returned to your property manager or to the Housing Authority's office at: 9200 Basil Ct., Suite #500, Largo MD 20774.

Name

Email Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

How many bedrooms are in the current unit?

Are you currently a resident of public housing?

Yes

Are you currently a participant in the Housing Choice Voucher Program?

Yes

Are you currently a resident of either Central Gardens II, Regency Lane or other assisted housing?

Yes

Do you or a member of your household have a disability?

Yes

Thank you for helping us to plan for your needs.

Please note that you can ask for a reasonable accommodation to use HAPGC’s housing or services. This can include auxiliary aids or services, materials in an alternative format, or help in completing paperwork or changes to your housing based on your disability. Contact the 504 Coordinator at (301)883-5576 or email dhcd-504@co.pg.md.us for assistance.

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