HOW TO PARTICIPATE-You have the right to obtain a copy of the complaint of discrimination (including a copy of any investigative report filed). To obtain a copy of the investigative report filed on your behalf, contact the appropriate OCR Regional office. To obtain a copy of the complaint of discrimination on behalf of a member of the military or civilian employee of any branch of the federal government, contact the appropriate OCR regional office. 4. COPYRIGHT NOTICE- This information may be used for the following purposes only: (1) in response to a complaint of discrimination on the basis of protected classifications under Title VI or Title IX; and (2) by the OCR and the appropriate Regional Office to investigate the allegation of discrimination. OCR will provide access to this information only upon written request by the complainant or the protected class member. 5. DISCLOSURE OF INFORMATION- In addition, under some conditions, an OCR Regional Office may make this information available for public inspection under various conditions. You may contact the OCR Regional Office nearest you for more information and to obtain information about other available forms of complaint-based access to the information covered by the complaint of discrimination (see instructions on reverse). 6. CONFRONTED DISCLOSURES- The information collected via this form is used solely to document the issues or allegations and will not be shared. In addition, OCR does not confirm the accuracy or credibility of the information. OCR urges you to retain copies of any complaints filed with the government concerning the alleged discrimination. 7. SECURITY FEES- The OCR does not charge application fees or make a financial contribution to OCR or to a Regional Office for this program. 8. DISCLOSURES- The information collected via this form may be viewed in the regional offices for which the complainant/investigator is responsible. The information collected may also be transferred to and entered into another database. Any such disclosure will not create any right or benefit (financial or nonfinancial) for any United States person. 9. REIMBURSEMENT- The OCR does not have a program of reimbursement for the costs associated with this program, and OCR does not receive direct reimbursement for the costs of this program. 10. PRIVACY PROTECTION- Privacy Act Statement. A copy of the Privacy Act Statement may be obtained from the Director of the Office for Civil Rights or from the Office for Civil Rights at. 10.
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U.S. Department of Justice Complaint of Discrimination (See instructions on reverse) PRIVACY ACT STATEMENT: 1. AUTHORITY- The authority to collect this information is derived from 42 U.S.C. Section
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