Why do you believe this occurred? If this complaint is resolved to your satisfaction, what remedy do you seek? Name, Address and Telephone Number of Person Lodging Complaint: Signature Date NONDISCRIMINATION COVERED PROGRAMS COMPLIANCE AGENCIES U. S. Department of Justice VOCA Victim Assistance Formula Grant Office of Justice Programs Office For Civil Rights 810 Seventh Street, NW Washington, DC 20531 202) 514-4609 (voice) (202) 514-0716 (TTY) HHS Director Family Violence Prevention & Services State Office for Civil Rights Grant (FVPSA) Room 515-F 200 Independence Avenue, S.W. Washington, D.C. 20201 (202) 619-0403 (voice) (800) 537-7697 (TTY) Submit complaint to: Idaho Council on Domestic Violence and Victim Assistance Attn: Executive Director PO Box Boise, ID 83720-0036
Why do you believe this occurred? If this complaint is resolved to your satisfaction, what remedy do you seek? Name, Address and Telephone Number of Person Lodging Complaint: Signature Date NONDISCRIMINATION COVERED PROGRAMS COMPLIANCE AGENCIES U. S. Department of Justice VOCA Victim Assistance Formula Grant Office of Justice Programs Office For Civil Rights 810 Seventh Street, NW Washington, DC 20531 202) 514-4609 (voice) (202) 514-0716 (TTY) HHS Director Family Violence Prevention & Services State Office for Civil Rights Grant (FVPSA) Room 515-F 200 Independence Avenue, S.W. Washington, D.C. 20201 (202) 619-0403 (voice) (800) 537-7697 (TTY) Submit complaint to: Idaho Council on Domestic Violence and Victim Assistance Attn: Executive Director PO Box Boise, ID 83720-0036
CR_Complaint_Form_2016.docx