Page 2

A complaint must be filed no later than 180 days from the date of the alleged discrimination. All complaints shall contain the following information: 1. The name, address, telephone number, and email or other means of contacting the person filing the complaint. 2. The name and location of the organization or office accused of the discriminatory practice. 3. A description of the alleged discrimination incident. 4. The reason for the alleged discrimination (race, color, national origin, sex, religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity). 5. The names, titles (if appropriate) and addresses of individuals who may have knowledge of the alleged discriminatory acts. 6. The date(s) the alleged discriminatory action(s) happened.

Language assistance services for OCR matters are available and provided free of charge. OCR services are accessible to persons with disabilities.

If a complainant makes allegations verbally and is unable or is reluctant to put the allegations in writing, the State employee to whom the allegations are made shall document the complaint in writing. Every effort shall be made by the individual accepting the complaint to have the complainant provide the information specified in 1- 6 above.

FIELD STAFF RESPONSIBILITIES 1. Inform individuals of their right to file a civil rights complaint with DPHHS. 2. Describe the process to everyone expressing an interest in filing a complaint. 3. Advise individuals of their right to file a complaint and that any complaint filed with the State Office is forwarded to the appropriate Federal Office for investigation. 4. If the individual indicates they will submit a complaint directly to the OCR (Office for Civil Rights) or State Agency, field staff will send an email to their direct supervisor within 1 business day alerting him/her that there is a potential civil rights complaint being submitted by the client – email must include the case number and brief description of the potential complaint. 5. If the individual makes verbal allegations and is reluctant to put their complaint into writing, field staff should attempt to obtain all required information from the client, document the complaint in writing and send this documentation to their direct supervisor within 1 business day. 6. Assure all complaints meet the requirements stated above. 7. Respond promptly to any requests from management regarding the complaint and include your direct supervisor in any responses. 8. Do not engage in any further discussion with the client about the complaint. If the client initiates additional conversation, assure them that they will hear from the