Form 148 - Program Discrimination Complaint Form - Usda
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6Form 148
September 2015
AD-3027
OMB Control Number 0508-0002
(1/19/12)
UNITED STATES DEPARTMENT OF AGRICULTURE (USDA)
Office of the Assistant Secretary for Civil Rights
USDA Program Discrimination Complaint Form Instructions
(The complaint form is below the instructions)
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.
FILING DEADLINE: A program discrimination complaint must be filed not later than
180 days of the date you knew or should have known of the alleged discrimination,
unless the time for filing is extended by USDA. Complaints sent by mail are considered
filed on the date the complaint was signed, unless the date on the complaint letter
differs by seven days or more from the postmark date, in which case the postmark date
will be used as the filing date. Complaints sent by fax or email will be considered filed on
the day the complaint is faxed or emailed. Complaints filed after the 180-day deadline
must include a ‘good cause’ explanation for the delay. For example, you may have “good
cause” if:
1. You could not reasonably have been expected to know of the discriminatory act
within the 180-day period;
2. You were seriously ill or incapacitated;
3. The same complaint was filed with another Federal, state, or local agency and that
agency failed to act on your complaint.
USDA POLICY: Federal law and policy prohibits discrimination against you based on the
following: race, color, national origin, religion, sex, disability, age, marital status, sexual
orientation, family/parental status, income derived from a public assistance program,
and political beliefs. (Not all bases apply to all programs).
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