Get Hhs Hhs-699 2009-2025

Filling out the HHS HHS-699 form is a crucial step in addressing civil rights discrimination. This guide provides clear instructions to help users navigate the online form effectively and ensure that their complaint is accurately represented.

Follow the steps to fill out the HHS HHS-699 form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your first name and last name in the designated fields to identify yourself as the complainant.
3. Provide your contact information by entering your home and work phone numbers, including the area code, and your email address if available.
4. Complete your full street address, city, state, and ZIP code to ensure accurate identification.
5. Indicate if you are filing the complaint on behalf of someone else by selecting 'Yes' or 'No.' If 'Yes,' provide the first and last name of the individual whose civil rights you believe have been violated.
6. Select the basis for discrimination from the options provided, which include race, color, national origin, age, disability, religion, or sex. If applicable, specify other reasons.
7. Identify the person, agency, or organization you believe discriminated against you or someone else by providing their name and address.
8. Enter the approximate date(s) when you believe the discrimination occurred in the provided box.
9. Describe the incident in detail, including how and why you believe discrimination occurred. You can attach additional pages if necessary.
10. Sign and date the complaint where indicated. If submitting online via email, your email submission represents your signature.
11. Review all entered information for accuracy and completeness before finalizing your submission.
12. Once completed, you can choose to save changes, download, print, or share your form as needed.

Complete your complaint form online today to take the first step in addressing civil rights violations.