Dhhs complaint form 2026

1. Click ‘Get Form’ to open the dhhs complaint form in the editor.
2. Begin by entering your name and address in the 'Complainant Name' and 'Address' fields. Ensure all information is accurate.
3. Provide your telephone numbers, both home and business, to ensure you can be contacted regarding your complaint.
4. If someone else is completing the form on your behalf, fill out their details in the 'Person Completing This Form' section.
5. Identify the county or program that you believe has discriminated against you by filling in the relevant fields.
6. Specify when the event occurred by entering the date in the designated field.
7. Describe the event thoroughly, including names of individuals involved if possible. Use additional space on page 2 if necessary.
8. Indicate whether you have filed this complaint with any other agency or court by selecting 'Yes' or 'No'. If yes, provide details of that agency or court.
9. Complete any additional questions regarding future filings with other agencies or courts as needed.
10. Finally, sign and date the form before submitting it to ensure it is valid.

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