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OMB CONTROL NUMBER:XXXX-XXXX EXPIRATION DATE: XX XX XXXX

OMB CONTROL NUMBER:XXXX-XXXX EXPIRATION DATE: XX XX XXXX 2026

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The document outlines the procedures and requirements for filing an Individual Complaint of Employment Discrimination with the U.S. Department of Transportation. It includes information on eligibility, filing timelines, representation, and privacy considerations under the Privacy Act. The form is intended for individuals who believe they have experienced discrimination based on various factors such as race, sex, age, or disability.

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Click ‘Get Form’ to open the Individual Complaint of Employment Discrimination form in the editor.
Begin by filling out Part I, which includes your identification information. Provide your name, contact details, and employment status.
In Part II, designate a representative if you choose to have one. Fill in their details accurately to ensure proper communication.
Move to Part III and describe the alleged discriminatory actions. Be clear and concise about the events that occurred and how they affected you.
Complete any additional sections as required, ensuring all fields are filled out completely before submitting.

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Versions	Form popularity	Fillable & printable
2019	4.6 Satisfied (27 Votes)
2009	4.7 Satisfied (50 Votes)

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