Nature of Complaint
Location of Complaint
Non-Discrimination StatementThe following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
Ethnicity (optional) ---Hispanic or Latino DescentNot of Hispanic or Latino Descent
Race (optional) ---WhiteAsianBlack or African-AmericanAmerican Indian/Alaska NativeNative Hawaiian or Other Pacific Islander
Please leave this field empty.
Please click Submit button one time only. Transmission may take up to ten seconds.
Instead of completing the online form, you may print, complete, and return the printable Citizen Complaint Form.
Printable Form PDF »
For immediate assistance, please call us at (830) 393-3965.