U.S. Department of Health and Human Services
Office for Civil Rights
Complaint Portal:

Person sitting at a laptop

Complaint Form Confirmation


Receipt Number:

Thank you for contacting the U.S. Department of Health and Human Services, Office for Civil Rights (OCR). OCR enforces federal civil rights laws which prohibit discrimination in the delivery of health and human services based on race, color, national origin, disability, age, sex, religion, and the exercise of conscience, and also enforces the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Breach Notification Rules.

We are in the process of reviewing your correspondence. We will complete our initial review as quickly as possible.

If you have questions about the novel coronavirus, COVID-19, please go to the Centers for Disease Control website at https://www.cdc.gov.

For additional information about OCR, including the complaint review process, and our HIPAA, civil rights, and conscience regulations, please see the following links:

https://www.hhs.gov/ocr/complaints/index.html
https://www.hhs.gov/hipaa/index.html
https://www.hhs.gov/civil-rights/index.html

If you have any additional questions or need a reasonable accommodation, please contact OCR’s Customer Response Center at 1-800-368-1019, Monday through Friday, 8:00 am to 6:00 pm, ET.

Sincerely,
Director, CCMO

English If you speak a non-English language, call 1-800–368–1019 (TTY: 1-800-537-7697), and you will be connected to an interpreter who will assist you with this document at no cost.
Español - Spanish Si usted habla español marque 1-800-368-1019 (o a la línea de teléfono por texto TTY 1-800-537-7697) y su llamada será conectada con un intérprete que le asistirá con este documento sin costo alguno.
中文 - Chinese 如果你讲中文，请拨打1-800-368-1019（打字电话：1-800-537-7697), 你将被连接到一位讲同语种的翻译员为你提供免费服务。
Tiếng Việt - Vietnamese Nếu bạn nói tiếng Việt, xin gọi 1-800-368-1019 (TTY: 1-800-537-7697), và bạn sẽ được kết nối với một thông dịch viên, người này sẽ hỗ trợ bạn với tài liệu này miễn phí.
한국어 - Korean 한국어를 하시면 1-800-368-1019 (청각 장애용: 1-800-537-7697) 로 연락 주세요. 통역관과 연결해서 당신의 서류를 무료로 도와 드리겠습니다.
Tagalog (Filipino) Kung ikaw ay nagsasalita nang Tagalog, tumawag sa 1-800-368-1019 (TTY: 1-800-537-7697) para makonek sa tagapagsalin na tutulong sa iyo sa dokumentong ito na walang bayad.
Pусский - Russian Если вы говорите по- русски, наберите 1-800-368-1019. Для клиентов с ограниченными слуховыми и речевыми возможностями: 1-800-537-7697), и вас соединят с русскоговорящим переводчиком, который вам поможет с этим документом безвозмездно.


Complaint Detail
 
Receipt Number:

Thank you for contacting the U.S. Department of Health and Human Services, Office for Civil Rights (OCR). OCR enforces federal civil rights laws which prohibit discrimination in the delivery of health and human services based on race, color, national origin, disability, age, sex, religion, and the exercise of conscience, and also enforces the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Breach Notification Rules.

We are in the process of reviewing your correspondence. We will complete our initial review as quickly as possible.

If you have questions about the novel coronavirus, COVID-19, please go to the Centers for Disease Control website at https://www.cdc.gov.

For additional information about OCR, including the complaint review process, and our HIPAA, civil rights, and conscience regulations, please see the following links:

https://www.hhs.gov/ocr/complaints/index.html
https://www.hhs.gov/hipaa/index.html
https://www.hhs.gov/civil-rights/index.html

If you have any additional questions or need a reasonable accommodation, please contact OCR’s Customer Response Center at 1-800-368-1019, Monday through Friday, 8:00 am to 6:00 pm, ET.

Sincerely,
Director, CCMO

English If you speak a non-English language, call 1-800–368–1019 (TTY: 1-800-537-7697), and you will be connected to an interpreter who will assist you with this document at no cost.
Español - Spanish Si usted habla español marque 1-800-368-1019 (o a la línea de teléfono por texto TTY 1-800-537-7697) y su llamada será conectada con un intérprete que le asistirá con este documento sin costo alguno.
中文 - Chinese 如果你讲中文，请拨打1-800-368-1019（打字电话：1-800-537-7697), 你将被连接到一位讲同语种的翻译员为你提供免费服务。
Tiếng Việt - Vietnamese Nếu bạn nói tiếng Việt, xin gọi 1-800-368-1019 (TTY: 1-800-537-7697), và bạn sẽ được kết nối với một thông dịch viên, người này sẽ hỗ trợ bạn với tài liệu này miễn phí.
한국어 - Korean 한국어를 하시면 1-800-368-1019 (청각 장애용: 1-800-537-7697) 로 연락 주세요. 통역관과 연결해서 당신의 서류를 무료로 도와 드리겠습니다.
Tagalog (Filipino) Kung ikaw ay nagsasalita nang Tagalog, tumawag sa 1-800-368-1019 (TTY: 1-800-537-7697) para makonek sa tagapagsalin na tutulong sa iyo sa dokumentong ito na walang bayad.
Pусский - Russian Если вы говорите по- русски, наберите 1-800-368-1019. Для клиентов с ограниченными слуховыми и речевыми возможностями: 1-800-537-7697), и вас соединят с русскоговорящим переводчиком, который вам поможет с этим документом безвозмездно.
* First Name:   * Preferred Pronoun:   * Last Name:
* Preferred days/times to receive phone calls:
Phone:
Street Address Line 1:*
Street Address Line 2:
* City:
* State:  Country:  * ZIP:   Email Address

No
Are you filing this complaint for someone else? No
* Street Address Line 1:
Street Address Line 2:
* City:
* State:  Country:  ZIP:   
Phone:

Have you, or the person on whose behalf you are filing, been a client or patient of the agency or organization? No
Have you, or the person on whose behalf you are filing, been an employee of the agency or organization? No

Date(s) Alleged Violation Occurred:
Violation Date
Violation Date
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(Attach additional pages as needed)

Witnesses
Witness name(s)Email AddressPhone Number
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* Signature:
Do you need special accommodations for OCR to communicate with you about this complaint?
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If we cannot reach you directly, is there someone we can contact to help us reach you?
No entries

Have you filed your complaint anywhere else? If so, please provide the following . (Attach additional pages as needed )
Filed Elsewhere
Name(s) of agency/organization/courtDate FiledCase Number (If known)
No records found
Has your complaint been accepted by the other agency/organization/court?No
Has there been a decision or a determination?No

Ethnicity:
Race: No entries
Primary Language Spoken (if other than English):

CONSENT FORM


The Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) has the authority to collect and receive material and information about an individual, including personnel and medical records, when they are relevant to its investigation.

To investigate a complaint, OCR may need to disclose the individual’s name and other identifying information about the individual to persons at the entity or agency under investigation or to other persons, agencies, or entities. In some circumstances, OCR may refer a complaint to another government agency, as warranted.

The Privacy Act of 1974 protects certain federal records that contain personally identifiable information and, with your consent, allows OCR to use an individual’s name or other personal information, if necessary, to investigate a complaint.

Consent is voluntary, and it is not always needed in order to investigate a complaint; however, failure to give consent is likely to impede the investigation of your complaint and may result in the closure of the case.

Additionally, OCR may disclose information, including medical records and other personal information, which it has gathered during the course of its investigation in order to comply with a request under the Freedom of Information Act (FOIA) and may refer a complaint to another appropriate agency.

Under FOIA, OCR may be required to release information regarding the investigation of a complaint; however, we will make every effort, as permitted by law, to protect information that identifies individuals or that, if released, could constitute a clearly unwarranted invasion of personal privacy.

OCR will use any applicable protections in that law to safeguard information which could identify an individual, or that, if released, could constitute a clearly unwarranted invasion of personal privacy. OCR may be required to release some information regarding the investigation of a complaint under the Freedom of Information Act (FOIA).

Please read and review the documents entitled Notice to Complainants and Other Individuals Asked to Supply Information to the Office for Civil Rights and Protecting Personal Information in Complaint Investigations for further information regarding how OCR may obtain, use, and disclose your information while investigating your complaint.

In order to expedite the investigation of this complaint if it is accepted by OCR, please read, sign, and return one copy of this consent form to OCR with your complaint. Please make one copy for your records.
  • I understand that in the course of the investigation of this complaint it may become necessary for OCR to reveal my identity or identifying information about me to persons at the entity or agency under investigation or to other persons, agencies, or entities.
  • I am also aware of the obligations of OCR to honor requests under the Freedom of Information Act (FOIA). I understand that it may be necessary for OCR to disclose information which it has gathered as part of its investigation of this complaint.
  • In addition, I understand that I may be covered by the Department of Health and Human Services’ (HHS) regulations which protect any individual from being intimidated, threatened, coerced, retaliated against, or discriminated against because the individual has made a complaint, testified, assisted, in any manner in any mediation, investigation, hearing, proceeding, or other part of HHS’s investigation, conciliation, or enforcement process.
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U.S. Department of Health & Human Services - 200 Independence Avenue, S.W. - Washington, D.C. 20201 HHS Vulnerability Disclosure