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DEPARTMENT OF HEALTH AND HUMAN SERVICES Form Approved: OMB No. 09900269. See OMB Statement on Reverse. OFFICE FOR CIVIL RIGHTS (OCR) CIVIL RIGHTS DISCRIMINATION COMPLAINT YOUR FIRST NAME YOUR LAST
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Form approved OMB no. is a form that has been approved by the Office of Management and Budget (OMB) for use by federal agencies. It usually includes a control number assigned by OMB.
The specific individuals or entities required to file form approved OMB no. can vary depending on the form itself and the regulations governing it.
Form approved OMB no. should be filled out following the instructions provided on the form itself or in accompanying guidance documents.
The purpose of form approved OMB no. is to collect specific information from individuals or entities for regulatory or reporting purposes.
The specific information that must be reported on form approved OMB no. will be outlined on the form itself or in accompanying instructions.
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