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Get DOE Form 1600 1 1996-2021

On, or Physical and/or Mental Disability) (See Reverse for Instructions) 2. COMPLETE HOME ADDRESS: Street Address, RD, or P.O. Box: 1. COMPLAINANT’S FULL NAME 3. BUSINESS TELEPHONE: (Include Area Code) City, State, Zip Code: 4. HOME TELEPHONE: (Include Area Code) 5A. OFFICE YOU BELIEVE DISCRIMINATED AGAINST YOU: 6A. ARE YOU PRESENTLY WORKING FOR THE FEDERAL GOVERNMENT? YES (Answer B, C, and D Below) NO (Continue with Question 7) B. ADDRESS: (Include Street, City, State, Zip Code) B. A.

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