Discrimination Complaint Form

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Please complete this form to notify the Colorado Dept. of Human Services Food Distribution Programs about a discrimination complaint. Provide as much information as you have at the moment. This information will be sent to the United States Department of Agriculture (USDA) within 72 hours of receipt and the USDA may contact you to gather additional information.

For questions regarding a complaint or how to complete this form, please call 303.866.5106 or 1.888.467.0418. You may also email CDHS_FDP@state.co.us.

This process should never deny a complainants right to file a complaint directly with the USDA. for more information about the USDA Discrimination Complaint process, visit the website: https://www.usda.gov/oascr/how-to-file-a-program-discrimination-complaint.

Email *

Name of the person who experienced the possible discrimination (the complainant)

Mailing Address for complainant

City for complainant

State for complainant

Zip code for complainant

Email address for complainant

Telephone number (including area code) for complainant

Optional alternate telephone number (Including area code) for complainant

What is the best way to reach the above person?

Phone

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