Forms Catalog Document - SSA437 :-: SSA :-: Discrimination Complaint Form

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Discrimination Complaint Form

The information collected on Form SSA-437 will be used by SSA to investigate and informally resolve complaints of discrimination based on race, color, national origin, sex, age, religion, and retaliation in any program or activity conducted by SSA. A person who believes that he or she has been discriminated against on any of the above bases may file a written complaint of discrimination. The information will be used to identify the complainant; identify the alleged discriminatory act; ascertain the date of such alleged act; obtain the identity of the individual(s)/facility/component that allegedly discriminated; and ascertain other relevant information that would assist in the investigation and resolution of the complaints.

Form #: SSA 437 BK
Agency: Social Security Administration

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Both Form and Instructions	7	100	[2] Printable Only	Adobe Reader Download

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