Get Wi Dhhs Form F 80983

The Wi Dhhs Form F 80983 is a civil rights complaint form that allows individuals to report discrimination when utilizing services from the Department of Health Services. This guide provides step-by-step instructions on how to effectively complete this form online, ensuring that your concerns are formally documented and addressed.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to retrieve the Wi Dhhs Form F 80983 and open it in your online document editor.
2. In Section I, provide your personal information as the complainant, including your last name, first name, middle initial, address, telephone numbers, email address, and filing date.
3. In Section II, fill out the respondent or provider information. Include the name of the organization or agency, the representative's name and title, and their contact details.
4. Proceed to Section III and indicate the reasons for your discrimination complaint by checking the relevant boxes. If applicable, fill in your protected status or preferred language.
5. In Section IV, carefully describe the events leading to your complaint. Use additional pages if needed to detail the actions and the individuals involved.
6. In Section V, certify your complaint with your signature, confirming that the information provided is accurate to the best of your knowledge. Record the date you signed the form.
7. Finally, save the completed form, and you may choose to download, print, or share it as required.

Complete your Wi Dhhs Form F 80983 online today to ensure your voice is heard.