USDA Program Discrimination Complaint Form

PURPOSE: The purpose of this form is to assist you in filing a USDA program discrimination complaint. For help filling out the form, you may call any of the telephone numbers listed at the bottom of the complaint form. You are not required to use the complaint form. You may write a letter instead. If you write a letter it must contain all of the information requested in the form and be signed by you or your authorized representative. Incomplete information will delay the processing of your complaint. You may also send a complaint by FAX or e-mail. We must have a signed copy of your complaint, so if you send your complaint by e-mail, be sure to attach the signed copy to your email. Incomplete information or an unsigned form will delay the processing of your complaint.
Apollo-Ridge School District Food Service 
Procedure For Receiving and Processing Complaints
1) District receives a Civil Rights complaint from the complainant (i.e. parent).
a) District must inform complainant of Federal Civil Rights rules and regulations that have been established for protected classes. (A protected class is any person or group of people who are protected from discrimination based on):
1. Race
2. Color
3. National Origin
4. Age
5. Sex
6. Disability

b) District must provide complainant the necessary information to file a complaint, which is:
1. Mailing address of the USDA:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410;

2. USDA’s Telephone/Fax numbers and Email address:
(866) 632-9992 / (202) 690-7442 F/ [email protected]
3. Electronic link to file a civil rights complaint:

Note: If the district is unsure if the complaint falls under a protected class, the district should
provide complainant the federal complaint information.

c) After providing the complainant with the information on how to file a Civil Rights complaint directly at the Federal level, the district may attempt to resolve the complaint if it is a matter that can be resolved quickly. Resolving complaints in real-time at the lowest possible level is encouraged.
(*Note: This is not an investigation as neither the district nor the State agency has the authority to conduct complaint investigations. This is simply trying to resolve the situation if it was potentially caused by a miscommunication.)

If the complainant refuses to discuss the matter any further with the district or if the matter cannot be resolved quickly, then the district should:
1. reiterate the complaint filing procedures in 1)b),
2. document the complaint and actions taken (i.e. referral to Federal complaint procedures) in a Civil Rights complaint log that is separate from any other complaint log, (*Note: A separate Civil Rights complaint log is necessary due to confidentiality and privacy laws. See complaint log requirements in d) below.), and
3. notify the State agency of the discussion. (*Note: it is important for the district to notify the State agency because regular communication between the district and State agency is key to operating the program successfully.)
If the complainant is willing to try to resolve the issue with the district and a satisfactory resolution is achieved, then the district should still remind the complainant of his/her right to file at the Federal level if necessary. (*Note: Complainants retain the right to file at the Federal level even if a resolution seems to have been reached at the district level.) The district needs to document the complaint and actions taken (i.e., how resolution was achieved) in a log that is separate from any other complaint log and notify the State agency of the resolution.

d) Regardless if the complainant wishes to file at the Federal level, the district should document as much information as possible in their Civil Rights complaint log including, but not limited to, the following:
* Date Complaint Received
*Complainant’s Name
*Complainant’s Address
*Complainant’s Telephone Number
*Complainant’s Email Address
*Allegation of Discrimination/Issue (i.e. FNS program involved, protected class(es) involved, etc.)
*Date of Alleged Discriminatory Action

The district must forward the information, within 5 days of receipt of complaint from
complainant, to the State agency:
*State Agency Civil Rights Coordinator
* State Agency Director
* FNS Regional Office Civil Rights Contact, FNS Headquarters Civil Rights Office Complainant