File a Complaint Using the Civil Rights Discrimination Complaint Form Package

Open and fill out the Civil Rights Discrimination Complaint Form Package  [PDF, 468 KB] in PDF format. You will need Adobe Reader software to fill out the complaint and consent forms. You may either:
 

• Print and mail the completed complaint and consent forms to:
  Centralized Case Management Operations
  U.S. Department of Health and Human Services
  200 Independence Avenue, S.W.
  Room 509F HHH Bldg.
  Washington, D.C. 20201

• 800-458-9858
   

 

https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html