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COMPLAINANT CONSENT FORM

This is form to be completed by a complainant because to investigate your complaint, OCR may need to reveal your identity or identifying information about you to persons at the entity or agency under investigation or to other persons, agencies, or entities

Download the Guidance Document

Final

Issued by: Office for Civil Rights (OCR)

Issue Date: June 30, 1905

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.