Get Va Form 10 0381

Filling out the VA Form 10-0381 online is an essential step for users who wish to submit a formal complaint regarding civil rights discrimination. This guide will provide you with clear, step-by-step instructions to help you navigate the process effectively.

Follow the steps to complete the form online:

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Begin by filling in your name in the first field. Ensure you provide your last name, followed by your first name and middle initial.
3. In the second section, enter your mailing address, ensuring that you provide a complete and accurate location.
4. Next, in section 3A, include your work telephone number, making sure to include the area code.
5. In section 3B, provide your home telephone number, again remembering to include the area code.
6. For section 4, identify the VA facility or other agency where you believe the discrimination occurred, including the full address.
7. In section 5, provide the name of the service or product line where the alleged discrimination took place.
8. In section 6, if known, enter the name of the individual who discriminated against you, including their phone number. If not known, describe the discriminatory practice.
9. Section 7 requires you to enter the date of discrimination. Include the most recent date or dates applicable.
10. In section 8, list the basis for your discrimination complaint. You can specify multiple bases under the provided categories.
11. In section 9, briefly describe the issues you encountered related to the discrimination.
12. For section 10, indicate your preferred time and place for being contacted regarding this complaint.
13. If applicable, provide the name, address, and telephone number of your attorney or representative in section 11.
14. In section 12, if the discriminatory act happened more than 180 days ago, offer an explanation for the delay in filing.
15. In section 13, list any persons who can support your allegations, including their name, address, and phone number.
16. Answer section 14 by indicating whether you have filed this complaint with another agency, providing the agency's name and address if yes.
17. In section 15, state the remedy you are seeking regarding the discrimination reported.
18. Sign the form in section 16, ensuring that your signature is clear.
19. Finally, enter the date of your signature in section 17 in the specified date format.
20. After completing the form, you can save your changes, download the document, print it, or share it as needed.

Take the next step and complete your VA Form 10-0381 online today.