complaint procedure.

Providers should handle a civil rights complaint as follows:

Providers must give beneficiaries a copy of nondiscrimination statement at the time of the complaint.
Providers should inform beneficiaries of their option to file the complaint with USDA directly.
USDA civil rights complaint forms should be available for beneficiaries at distribution sites. If necessary, providers should assist the beneficiaries in completing the complaint form.
Providers must document the complaint in a log with information relevant to investigate and resolve the complaint. This log must be separate from other program-related complaints and maintained for three fiscal years plus current year.
If beneficiaries submit the complaint form directly to the provider, the provider must mail it to USDA within 180 days if the alleged action
If a beneficiary submits a verbal complaint the provider must forward the complaint to USDA within 180 days from the alleged action
Provider must notify their CDSS Program Consultant of any civil rights complaint within two days of learning about the complaint

COMPLAINT FORM