Get Ssa Online Complaint Form

This guide provides clear and supportive instructions to help you complete the Social Security Administration (SSA) Online Complaint Form. If you believe you have experienced program discrimination, following these steps will ensure that your complaint is filed correctly.

Follow the steps to fill out the SSA Online Complaint Form

1. Click ‘Get Form’ button to obtain the SSA Online Complaint Form, which you will need to fill out.
2. Provide your name, address, and Social Security number in the designated fields to identify yourself as the complainant.
3. If the complaint involves another person, enter their information, including their name, address, and contact number.
4. Specify your relationship to the individual mentioned, if applicable, to clarify the context of the complaint.
5. Indicate the reason(s) for the discrimination, selecting from the options provided, including race, color, and disability.
6. Document the date(s) when the alleged discrimination occurred to establish a timeline for your complaint.
7. If the incident took place over 180 days ago, explain the reason for the delay in filing your complaint.
8. Describe the action taken by the SSA that you believe was discriminatory, providing details regarding the individuals involved.
9. If applicable, describe any retaliation you experienced as a result of filing a previous complaint.
10. List any witnesses to the actions you are complaining about, including their contact information.
11. Note if you've discussed the discrimination with any SSA officials, including names and dates of communication.
12. Clearly state what you would like SSA to do in response to your complaint, outlining any remedies you seek.
13. Indicate whether you have filed a complaint with any other agency or organization related to this matter.
14. Finally, sign and date the form to validate your complaint, ensuring all necessary signatures are included.
15. You can now save the changes, download, print, or share the completed form as required for submission.

Complete your SSA Online Complaint Form today to ensure your concerns are addressed.