BRHP | Non-Payment of Rent Report Form

Please use this form to inform BRHP staff if one of your BRHP-assisted tenants is late or past-due on their rental portion.

Use this form to report if your BRHP tenant is late or has not paid their portion of rent.

This form should only be used for reporting non-payment of rent for BRHP-assisted households.
Your Information

Please provide your name and contact information below so that a member of our team can follow up with any questions.
Your Name*
First Last
Your Email*
Your Phone Number*
Tenant and Unit Information

Please provide the information below.
Tenant Name*
First Last
Assisted Unit Address*
Street Address Address Line 2 City State ZIP Code
Monthly Tenant Share of Rent*
The amount the tenant (not BRHP) is supposed to pay to you monthly.
Number of Months Tenant is Past Due or Late*
Amount of Past Due or Late Tenant Rent Owed*
Have you filed a Failure to Pay Rent or Eviction case with the courts for this tenant?*
Please share any additional information you feel is relevant below:
Rental Ledger Upload
Drop files here or

Max. file size: 50 MB.
You may use this feature if you wish to share the rental ledger for this tenant with BRHP.